Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
J Orthop Res. 2019 Aug;37(8):1860-1867. doi: 10.1002/jor.24303. Epub 2019 Apr 24.
Patients with mechanic ankle instability experience increased tibiotalar and subtalar joint laxity. However, in vivo joint kinematics in functional ankle instability (FAI) patients and lateral ankle sprain (LAS) copers, especially during dynamic activities, are poorly understood. Ten FAI patients, 10 LAS copers, and 10 healthy controls were included in this study. A dual fluoroscopic imaging system was used to analyze the tibiotalar and subtalar joint kinematics during stair descent. Five key poses of stair descent were analyzed. Kinematic data from six degrees of freedom were calculated utilizing a solid modeling software. The range of motion and joint positions in each degree of freedom were compared among the three groups. The tibiotalar joints of FAI patients and LAS copers were significantly more inverted than those of healthy controls during the foot strike (p = 0.016, = 0.264). The subtalar joints of FAI patients were significantly more anteriorly translated (pose 2, p = 0.003, = 0.352; pose 3, p < 0.001, = 0.454; pose 4, p = 0.004, = 0.334), inverted (pose 4, p = 0.027, = 0.234; pose 5,p = 0.034, = 0.221), and externally rotated (pose 4, p = 0.037, = 0.217; pose 5; p = 0.004, = 0.331) than those of healthy controls during the mid-stance and the heel off. The FAI patients showed excessive tibiotalar inversion and subtalar joint hypermobility during stair descent. Meanwhile, the LAS copers maintained subtalar joint stability, and only showed excessive tibiotalar inversion in foot strike. These data provide insight into the mechanisms behind the development of FAI after initial LAS. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1860-1867, 2019.
患有机械性踝关节不稳定的患者会出现距骨和跗骨关节松弛度增加的情况。然而，功能性踝关节不稳定（FAI）患者和外侧踝关节扭伤（LAS）患者的踝关节在体内运动学，尤其是在动态活动中的情况，人们了解甚少。本研究纳入了 10 名 FAI 患者、10 名 LAS 患者和 10 名健康对照组。采用双荧光透视成像系统分析下楼梯时距骨和跗骨关节的运动学。分析了下楼梯的 5 个关键姿势。利用实体建模软件计算了六个自由度的运动学数据。比较了三组之间每个自由度的运动范围和关节位置。在足着地时，FAI 患者和 LAS 患者的距骨明显更外翻（p = 0.016， = 0.264）。FAI 患者的距骨更向前移位（姿势 2，p = 0.003， = 0.352；姿势 3，p < 0.001， = 0.454；姿势 4，p = 0.004， = 0.334）、内翻（姿势 4，p = 0.027， = 0.234；姿势 5，p = 0.034， = 0.221）和外旋（姿势 4，p = 0.037， = 0.217；姿势 5，p = 0.004， = 0.331），而健康对照组在中足站立和脚跟离地时，距骨更外翻，跗骨关节更不稳定。FAI 患者在下楼梯时距骨过度内翻和跗骨关节过度活动。同时，LAS 患者保持了跗骨关节的稳定性，仅在足着地时出现距骨过度内翻。这些数据为初次 LAS 后 FAI 发展的机制提供了深入了解。版权所有 2019 年骨科研究协会。由 Wiley Periodicals，Inc. 出版。J Orthop Res 37：1860-1867，2019。
