使用负重计算机断层扫描和三维分析比较拇外翻足与正常足之间楔骨1-2关节的活动度
Comparison of Intercuneiform 1-2 Joint Mobility Between Hallux Valgus and Normal Feet Using Weightbearing Computed Tomography and 3-Dimensional Analysis.
作者信息
Kimura Tadashi, Kubota Makoto, Suzuki Naoki, Hattori Asaki, Marumo Keishi
机构信息
1 Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan.
2 Institute for High Dimensional Medical Imaging, The Jikei University School of Medicine, Tokyo, Japan.
出版信息
Foot Ankle Int. 2018 Mar;39(3):355-360. doi: 10.1177/1071100717744174. Epub 2017 Dec 4.
BACKGROUND
An association has been reported between hallux valgus and hypermobility of the first ray, but subluxation of the intercuneiform 1-2 joint was also suspected in some cases. However, dynamics of the intercuneiform 1-2 joint has seldom been investigated. This study used weightbearing computed tomography (CT) and a 3-dimensional (3D) analysis system to evaluate displacement of the intercuneiform 1-2 joint, intercuneiform 2-3 joint, and second cuneonavicular joint due to weightbearing in hallux valgus and normal feet.
METHODS
Patients were 11 women with hallux valgus (mean age, 56 years; mean hallux valgus angle, 43 degrees; mean first-second intermetatarsal angle, 22 degrees) and 11 women with normal feet (mean age, 57 years; mean hallux valgus angle, 14 degrees; mean first-second intermetatarsal angle, 9 degrees). Each patient was placed supine with the lower limbs extended, and CT was performed under nonweightbearing and weightbearing conditions (load equivalent to body weight). 3D models reconstructed from CT images were used to compare displacement of the intermediate cuneiform relative to the medial cuneiform under nonweightbearing and weightbearing conditions.
RESULTS
Relative to the medial cuneiform, the middle cuneiform was displaced by 0.1 and 0.8 degrees due to dorsiflexion, 0.2 and 1.0 degrees due to inversion, and 0.7 and 0.7 degrees due to abduction in normal feet and feet with hallux valgus, respectively, with the latter having significantly greater dorsiflexion ( P = .0067) and inversion ( P = .0019). There was no significant intergroup difference at the intercuneiform 2-3 joint and second cuneonavicular joint.
CONCLUSION
This study clarified the detailed load-induced displacement of the cuneiform 3-dimensionally. Compared with normal feet, hallux valgus feet had significantly greater mobility of the intercuneiform 1-2 joint, suggesting hypermobility of this joint.
LEVEL OF EVIDENCE
Level III, case-control study.
背景
已有报道称拇外翻与第一跖骨过度活动有关，但在某些情况下也怀疑第1-2楔骨间关节半脱位。然而，第1-2楔骨间关节的动力学很少被研究。本研究使用负重计算机断层扫描（CT）和三维（3D）分析系统来评估拇外翻足和正常足在负重时第1-2楔骨间关节、第2-3楔骨间关节和第二楔舟关节的位移。
方法
患者为11名拇外翻女性（平均年龄56岁；平均拇外翻角43度；平均第一、二跖骨间角22度）和11名足部正常的女性（平均年龄57岁；平均拇外翻角14度；平均第一、二跖骨间角9度）。每位患者仰卧，下肢伸直，在非负重和负重条件下（相当于体重的负荷）进行CT检查。从CT图像重建的3D模型用于比较非负重和负重条件下中间楔骨相对于内侧楔骨的位移。
结果
相对于内侧楔骨，正常足和拇外翻足的中间楔骨在背屈时分别位移0.1度和0.8度，内翻时分别位移0.2度和1.0度，外展时分别位移0.7度和0.7度，后者的背屈（P = 0.0067）和内翻（P = 0.0019）明显更大。在第2-3楔骨间关节和第二楔舟关节处，组间差异无统计学意义。
结论
本研究从三维角度阐明了楔骨详细的负荷诱导位移。与正常足相比，拇外翻足的第1-2楔骨间关节活动度明显更大，提示该关节过度活动。
证据水平
III级，病例对照研究。
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