选择性关节融合术对后足关节三维活动范围的影响：一项尸体研究。
The influence of selective arthrodesis on three-dimensional range of motion of hindfoot joint: A cadaveric study.
作者信息
Jia Xiaoyang, Qiang Minfei, Chen Yanxi, Zhang Kun, Chen Song
机构信息
Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, 150 Jimo Rd, 200120 Shanghai, China.
Department of Orthopedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai 200032, China.
出版信息
Clin Biomech (Bristol). 2019 Oct;69:9-15. doi: 10.1016/j.clinbiomech.2019.06.011. Epub 2019 Jun 14.
BACKGROUND
The purpose of this study was to measure the three-dimensional range of motion of adjacent, unfused joint or joints after different arthrodesis of hindfoot.
METHODS
Sixteen fresh frozen cadaver feet were immobilized in the non-weight bearing position. The three-dimensional coordinates of markers in tarsal were measured in six directions (involving dorsiflexion-plantarflexion, eversion-inversion, and adduction-abduction) before and after single (involving subtalar joint, talonavicular joint, and calcaneocuboid joint) and double (talonavicular and calcaneocuboid joints) arthrodesis with a three-dimensional coordinate instrument. The range of motion of the joint was calculated with the least square method and matrix transformation.
FINDINGS
We found that the range of motion of joints in all direction was reduced significantly after any combination of selective arthrodesis (all p < 0.001). After arthrodesis of the subtalar joint, the motion of talonavicular joint was reduced by 72%, and that of calcaneocuboid joint by 36%. After arthrodesis of talonavicular joint, the motion of subtalar joint was diminished by 36%, and that of calcaneocuboid joint by 51%. After arthrodesis of calcaneocuboid joint, the motion of subtalar joint was decreased by 21%, and that of talonavicular joint by 42%. After double arthrodesis, the motion of subtalar joint was reduced by 62%.
INTERPRETATION
In single arthrodesis, subtalar arthrodesis had the greatest effect on the motion of unfused joints, and the least was the calcaneocuboid arthrodesis. The motion of the subtalar joint was eliminated more than half after double arthrodesis. The data provide a biomechanical rationale to ascertain the clinical implication of the arthrodesis.
背景
本研究旨在测量后足不同关节融合术后相邻未融合关节的三维活动范围。
方法
16只新鲜冷冻尸体足固定于非负重位。在单关节（包括距下关节、距舟关节和跟骰关节）和双关节（距舟关节和跟骰关节）融合术前、后，使用三维坐标仪测量跗骨标记物在六个方向（包括背屈-跖屈、外翻-内翻和内收-外展）的三维坐标。采用最小二乘法和矩阵变换计算关节活动范围。
结果
我们发现，任何选择性关节融合组合后，所有方向关节的活动范围均显著减小（所有p<0.001）。距下关节融合后，距舟关节活动度降低72%，跟骰关节降低36%。距舟关节融合后，距下关节活动度降低36%，跟骰关节降低51%。跟骰关节融合后，距下关节活动度降低21%，距舟关节降低42%。双关节融合后，距下关节活动度降低62%。
解读
在单关节融合中，距下关节融合对未融合关节活动度影响最大，跟骰关节融合影响最小。双关节融合后，距下关节活动度消除超过一半。这些数据为确定关节融合术的临床意义提供了生物力学依据。
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