Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
Gait Posture. 2019 Sep;73:262-268. doi: 10.1016/j.gaitpost.2019.07.377. Epub 2019 Jul 30.
Previous studies showed functional ankle instability (FAI) patients have morphological ligamentous abnormality, despite having no apparent joint laxity.
Whether tibiotalar and subtalar joints hypermobility exists in FAI patients during stance phase of walking, remains controversial.
Ten unilateral FAI patients, ten unilateral lateral ankle sprain (LAS) copers and ten healthy controls were included. A dual fluoroscopy imaging system was utilized to capture the fluoroscopic images of tibiotalar and subtalar joint during the stance phase of walking. Kinematic data from six degrees of freedom were calculated utilizing a solid modeling software. The range of motion and joint excursions about six degrees of freedom were compared among the three groups. The correlations between range of motion and Cumberland Ankle Instability Tool (CAIT) scores were assessed utilizing the Spearman's correlation coefficient (r).
During the stance phase, the FAI patients and LAS copers showed larger tibiotalar anterior/posterior translation than the healthy controls (FAI patients, p = .013; LAS copers, p = .002). The FAI patients also showed significantly larger lateral/medial translation (p = .035) and inversion/eversion rotation (p = .003) of subtalar joints than healthy controls. By contrast, the subtalar joints of the LAS copers were not different from those of the healthy controls in the lateral/medial translation (p = .459) and inversion/eversion rotation (p = .091). CAIT scores were negatively correlated with range of motion.
During the stance phase of walking, FAI patients showed significantly larger hypermobility of subtalar joints than healthy controls, contrary to the LAS copers. These findings justify the utilization of dual fluoroscopy imaging system to detect joint hypermobility in FAI patients. Treatment for FAI patients may require stabilization of the subtalar joint.
先前的研究表明，尽管功能性踝关节不稳（FAI）患者没有明显的关节松弛，但他们的韧带形态存在异常。
在步行的站立阶段，FAI 患者的距下关节和跗骨间关节是否存在过度活动，这仍然存在争议。
本研究纳入了 10 名单侧 FAI 患者、10 名单侧踝外侧扭伤（LAS）患者和 10 名健康对照者。使用双荧光透视成像系统在步行的站立阶段获取距骨和跗骨关节的荧光透视图像。利用实体建模软件计算六个自由度的运动学数据。比较三组之间六个自由度的运动范围和关节活动度。利用 Spearman 相关系数（r）评估运动范围与 Cumberland 踝关节不稳工具（CAIT）评分之间的相关性。
在站立阶段，FAI 患者和 LAS 患者比健康对照组的距骨前后平移更大（FAI 患者，p=0.013；LAS 患者，p=0.002）。FAI 患者的距骨外侧/内侧平移（p=0.035）和内翻/外翻旋转（p=0.003）也显著大于健康对照组。相比之下，LAS 患者的距骨外侧/内侧平移（p=0.459）和内翻/外翻旋转（p=0.091）与健康对照组无差异。CAIT 评分与运动范围呈负相关。
在步行的站立阶段，FAI 患者的距下关节过度活动度明显大于健康对照组，而 LAS 患者则相反。这些发现证明了使用双荧光透视成像系统来检测 FAI 患者的关节过度活动度是合理的。FAI 患者的治疗可能需要稳定距下关节。
