Cheung Zoe B, Myerson Mark S, Tracey Joseph, Vulcano Ettore
1 Department of Orthopaedic Surgery, Mount Sinai West, New York, NY, USA.
2 The Institute for Foot & Ankle Reconstruction at Mercy, Baltimore, MD, USA.
Foot Ankle Int. 2018 Jan;39(1):67-74. doi: 10.1177/1071100717732549. Epub 2017 Oct 3.
An association between hallux rigidus and metatarsus primus elevatus (MPE) has been suggested, although there remains no general consensus about the nature of this relationship. Past studies were limited due to inaccuracies of assessing MPE on 2-dimensional radiographs. The aims of this study were to (1) assess and compare foot alignment in patients with and without hallux rigidus using 3-dimensional (3D) reconstructions from weightbearing computed tomography (CT) and (2) assess intraobserver and interobserver reliability of these measurements.
A prospective study was performed in 50 consecutive patients with symptomatic hallux rigidus and 50 control patients who underwent a weightbearing CT. Two investigators measured first and second metatarsal declination angles, first and second metatarsal lengths, first to second intermetatarsal angle (IMA), hallux valgus angle (HVA), and foot width on 3D CT reconstructions. Measurements were repeated after 1 month. Student t tests were performed to compare hallux rigidus and control groups. Intraclass and interclass correlation coefficients were calculated to evaluate reliability.
The first to second metatarsal declination ratio was less in patients with hallux rigidus (mean, 0.81) than controls (mean, 0.92; P < .001). Patients with Coughlin and Shurnas grade 3 and 4 hallux rigidus had greater first metatarsal declination than patients with grade 1 and 2 hallux rigidus. Last, IMA was higher (mean, 13 degrees) but HVA was lower (mean, 11 degrees) in patients with hallux rigidus than controls (IMA mean, 12 degrees; HVA mean, 15 degrees; P = .04). Intraobserver (ICC1,1 ≥ 0.93) and interobserver (ICC3,1 ≥ 0.85) reliability were good to excellent for all measured parameters.
Patients with hallux rigidus had MPE. Patients with grade 3 and 4 hallux rigidus had more MPE than patients with grade 1 and 2 hallux rigidus. There was no clear correlation between hallux rigidus and bunions. Finally, weightbearing CT proved to be a reliable method of assessing all measured parameters.
II, prospective comparative series.
虽然拇僵硬症与第一跖骨抬高（MPE）之间的关联已被提出，但关于这种关系的本质仍未达成普遍共识。过去的研究由于在二维X线片上评估MPE存在不准确之处而受到限制。本研究的目的是：（1）使用负重计算机断层扫描（CT）的三维（3D）重建来评估和比较有和没有拇僵硬症患者的足部对线情况；（2）评估这些测量的观察者内和观察者间的可靠性。
对50例有症状的拇僵硬症患者和50例接受负重CT的对照患者进行了一项前瞻性研究。两名研究者在3D CT重建上测量第一和第二跖骨倾斜角、第一和第二跖骨长度、第一至第二跖间角（IMA）、拇外翻角（HVA）和足宽。1个月后重复测量。采用学生t检验比较拇僵硬症组和对照组。计算组内和组间相关系数以评估可靠性。
拇僵硬症患者的第一至第二跖骨倾斜比（均值为0.81）低于对照组（均值为0.92；P <.001）。Coughlin和Shurnas 3级和4级拇僵硬症患者的第一跖骨倾斜度大于1级和2级拇僵硬症患者。最后，拇僵硬症患者的IMA较高（均值为13度），但HVA较低（均值为11度），而对照组的IMA均值为12度，HVA均值为15度（P = 0.04）。所有测量参数的观察者内（ICC1,1≥0.93）和观察者间（ICC3,1≥0.85）可靠性均为良好至优秀。
拇僵硬症患者存在MPE。3级和4级拇僵硬症患者的MPE比1级和2级拇僵硬症患者更多。拇僵硬症与拇囊炎之间没有明显的相关性。最后，负重CT被证明是评估所有测量参数的可靠方法。
II，前瞻性比较系列。
