Welck M J, Singh D, Cullen N, Goldberg A
Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom.
Foot and Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom.
Foot Ankle Surg. 2018 Aug;24(4):314-319. doi: 10.1016/j.fas.2017.03.005. Epub 2017 Mar 22.
Little is understood about the role that relative sesamoid displacement and chondral wear have on outcome after hallux valgus (HV) surgery. All existing methods to evaluate relative sesamoid displacement have limitations and furthermore, there have been no radiographic studies evaluating metatarso-sesamoid joint wear. Standing CT scan circumvents many of the existing problems in evaluation of relative sesamoid displacement, and also enables the first radiographic study assessing metatarso-sesamoid joint wear.
Fifty feet (in 43 patients) with symptomatic HV (Group A) were compared with a control group of 50 feet (50 patients) (Group B). All images were standardised to enable reproducible measurements. The hallux valgus angle, Intermetatarsal angle, sesamoid rotation angle, sesamoid position and metatarso-sesamoid joint space were measured in all patients.
The intra and inter-observer reliability correlation showed that the standing CT assessment of sesamoid position (1.000), rotation (0.991) and metatarso-sesamoid joint space (0.960) were highly reproducible. There was a highly significant difference (p<0.0001) in sesamoid position, sesamoid rotation and metatarso-sesamoid joint space between Group A and Group B.
Standing CT has been shown to be a reproducible and accurate method of assessing the relative sesamoid displacement and metatarso-sesamoid joint space narrowing. The results have been used to propose a novel standing CT based classification of hallucal sesamoids, considering the degree of displacement and wear. This classification may ultimately facilitate research to provide new insight into the effect relative sesamoid displacement and chondral wear have on outcomes from hallux valgus surgery.
关于籽骨相对位移和软骨磨损在拇外翻（HV）手术后的结果中所起的作用，人们了解甚少。所有现有的评估籽骨相对位移的方法都有局限性，此外，还没有影像学研究评估跖籽关节磨损情况。站立位CT扫描规避了评估籽骨相对位移时存在的许多现有问题，并且还能进行第一项评估跖籽关节磨损的影像学研究。
将50只患症状性HV的足（43例患者）（A组）与50只足的对照组（50例患者）（B组）进行比较。所有图像均进行标准化处理，以实现可重复测量。对所有患者测量拇外翻角、跖间角、籽骨旋转角、籽骨位置和跖籽关节间隙。
观察者内和观察者间的可靠性相关性显示，站立位CT对籽骨位置（1.000）、旋转（0.991）和跖籽关节间隙（0.960）的评估具有高度可重复性。A组和B组在籽骨位置、籽骨旋转和跖籽关节间隙方面存在高度显著差异（p<0.0001）。
站立位CT已被证明是一种评估籽骨相对位移和跖籽关节间隙变窄的可重复且准确的方法。考虑到移位和磨损程度，这些结果已被用于提出一种基于站立位CT的拇趾籽骨新分类方法。这种分类最终可能有助于开展研究，为籽骨相对位移和软骨磨损对拇外翻手术结果的影响提供新的见解。
