Meyr Andrew J, Sebag Joshua A
Clinical Associate Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
Podiatric Student, Temple University School of Podiatric Medicine, Philadelphia, PA.
J Foot Ankle Surg. 2017 Jul-Aug;56(4):748-755. doi: 10.1053/j.jfas.2017.02.007.
The objective of the present investigation was to examine the effect of cuboid height on the presence of plantar midfoot ulceration and the relationship of cuboid height to other commonly performed radiographic parameters during evaluation of midfoot Charcot neuroarthropathy. A retrospective analysis was performed of 68 feet in 60 subjects who met the inclusion criteria. We did not observe statistically significant differences in the presence of a plantar midfoot ulceration when considering a cuboid height threshold of 0.0 mm, 2.0 mm, -2.0 mm, or -5.0 mm nor was the cuboid height a robust predictor for the presence of plantar midfoot ulceration when considering the positive predictive value, negative predictive value, sensitivity, or specificity. We observed a significant negative association between a negative cuboid height and the presence of Sanders Type 2 deformities (76.2% of those with negative height versus 50.0% of those with positive height had type 2 deformities; p = .0036), the absence of radiographic visualization of the lateral tarsometatarsal joint (71.4% of those with negative height versus 26.9% of those with positive height had an absence of radiographic visualization; p = .005), and lower calcaneal inclination angles (6.06° versus 15.08°; p < .001). We further observed significant positive correlations between the cuboid height and the calcaneal-fifth metatarsal angle (0.655; p < .000), calcaneal inclination angle (0.591; p < .001), calcaneal-cuboid angle (0.254; p = .038), medial column height (0.264; p = .029), and first metatarsal inclination angle (0.245; p = .047). We also observed negative correlations with Meary's angle (-0.475; p < .001) and the talar declination angle (-0.387; p < .001). These findings showed a general trend toward a decreasing cuboid height and increasing sagittal plane deformity involving both the medial and the lateral columns. The results of the present investigation provide evidence against a single radiographic parameter being associated with the presence of plantar midfoot ulceration.
本研究的目的是在评估中足夏科特神经关节病期间，研究骰骨高度对足底中足溃疡存在的影响，以及骰骨高度与其他常用影像学参数之间的关系。对符合纳入标准的60名受试者的68只脚进行了回顾性分析。当考虑骰骨高度阈值为0.0毫米、2.0毫米、-2.0毫米或-5.0毫米时，我们未观察到足底中足溃疡存在的统计学显著差异，并且在考虑阳性预测值、阴性预测值、敏感性或特异性时，骰骨高度也不是足底中足溃疡存在的可靠预测指标。我们观察到骰骨高度为负与桑德斯2型畸形的存在之间存在显著负相关（高度为负的患者中有76.2%有2型畸形，而高度为正的患者中有50.0%有2型畸形；p = 0.0036），外侧跗跖关节无影像学显示（高度为负的患者中有71.4%无影像学显示，而高度为正的患者中有26.9%无影像学显示；p = 0.005），以及跟骨倾斜角度较低（6.06°对15.08°；p < 0.001）。我们还观察到骰骨高度与跟骨-第五跖骨角（0.655；p < 0.000）、跟骨倾斜角度（0.591；p < 0.001）、跟骨-骰骨角（0.254；p = 0.038）、内侧柱高度（0.264；p = 0.029）和第一跖骨倾斜角度（0.245；p = 0.047）之间存在显著正相关。我们还观察到与梅里角（-0.475；p < 0.001）和距骨偏斜角度（-0.387；p < 0.001）呈负相关。这些发现显示出骰骨高度降低以及涉及内侧和外侧柱的矢状面畸形增加的总体趋势。本研究结果提供了证据，反对单一影像学参数与足底中足溃疡的存在相关。
