Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
Department of Pediatric Orthopedics and Foot Surgery, Orthopedic Hospital Vienna-Speising, Vienna, Austria.
Arthroscopy. 2018 Feb;34(2):573-580. doi: 10.1016/j.arthro.2017.07.036. Epub 2017 Nov 1.
The purpose of this study was to evaluate the difference in accessibility of the talar dome during ankle arthroscopy between noninvasive distraction and maximum plantar flexion without distraction.
For this study, 20 matched pairs (n = 40) of anatomic ankle specimens were used. Two groups (distraction or maximum plantar flexion) were defined. Through the use of chondral picks, the accessibility of each technique was tested arthroscopically. Afterward, the ankle joint was dissected and the reach achieved was measured and compared between the 2 groups.
Through noninvasive distraction, 13.1 ± 4.4 mm of the talar dome was reached laterally and 16.7 ± 3.7 mm medially. Through plantar flexion, 18.1 ± 3.4 mm of the talar dome was reached laterally and 18.1 ± 3.4 mm medially. Statistical comparison revealed a significantly better reach in plantar flexion on the lateral side of the talar dome (P = .007). There was no significant difference medially.
Plantar flexion significantly improves reachability of the dome on the lateral side and it is equal to noninvasive distraction medially. Results of this study may allow for better access to the lesion of the talus.
Results of this study allow for a better planning of interventions in OCD of the talus.
本研究旨在评估踝关节镜检查中，非侵入性牵引与最大跖屈（不牵引）两种方法在距骨穹窿可及性方面的差异。
本研究使用了 20 对（n=40）匹配的解剖踝关节标本。将标本分为两组（牵引组或最大跖屈组）。通过使用软骨叉，对两种技术的可及性进行关节镜检查测试。之后，对踝关节进行解剖，并比较两组之间的到达距离。
通过非侵入性牵引，距骨穹窿外侧可达到 13.1±4.4mm，内侧可达到 16.7±3.7mm。通过跖屈，距骨穹窿外侧可达到 18.1±3.4mm，内侧也可达到 18.1±3.4mm。统计学比较显示，跖屈在距骨穹窿外侧的到达距离明显更好（P=0.007）。内侧则无显著差异。
跖屈显著提高了距骨穹窿外侧的可达性，与非侵入性牵引在距骨穹窿内侧的效果相当。本研究的结果可能为距骨病变的更好治疗提供依据。
本研究的结果有助于更好地规划距骨 OCD 的干预措施。
