Malik Ali, Grant Elaine, Rhodenizer Joshua
Surgeon, Department of Podiatric Medicine and Surgery, St. John Hospital & Medical Center, Detroit, MI.
Surgeon, Department of Podiatric Medicine and Surgery, St. John Hospital & Medical Center, Detroit, MI.
J Foot Ankle Surg. 2020 Jan-Feb;59(1):91-94. doi: 10.1053/j.jfas.2018.10.007. Epub 2019 Nov 19.
The isolated talonavicular joint arthrodesis can be beneficial to correct midfoot deformities involving the talonavicular joint, including collapsing pes planovalgus. Studies show that isolated talonavicular arthrodesis has a higher nonunion rate because of micromotion; thus, other procedures should be used in conjunction with it. We sought to determine if adding an adjunctive medial calcaneal displacement osteotomy helps to reduce the ground reactive force and, therefore, the micromotion on the talonavicular joint. We used 4 below-knee limbs to study the force placed on the joint in an isolated talonavicular arthrodesis compared with the same procedure with an adjunctive calcaneal osteotomy under weightbearing simulation. A 0.5-inch circular force sensing resistor was placed within the talonavicular and used to check the force on the joint after a 5-lb force was added to the proximal limb. The resistance was quantified with force measured as a direct inverse. This procedure was performed 3 times for each limb. The mean resistance before and after calcaneal osteotomy was analyzed with use of the paired t test. In the pre-calcaneal osteotomy sites, the mean resistance given in 200 kΩ was 388.2 ± 565.9 compared with 1016.6 ± 482.7 in the post-calcaneal osteotomy sites (p = .02). Findings from this cadaver study indicate reduction in forces to the talonavicular joint with an adjunctive calcaneal osteotomy. We conclude that it can be a beneficial adjunctive procedure for patients at a high risk of nonunion, such as those with obesity or diabetes or those who smoke. These patients could benefit from the decreased micromotion that the adjunctive procedure allows.
单纯距舟关节融合术可能有助于矫正涉及距舟关节的中足畸形，包括扁平足外翻塌陷。研究表明，单纯距舟关节融合术由于微动而有较高的不愈合率；因此，应联合使用其他手术方法。我们试图确定附加跟骨内侧移位截骨术是否有助于降低地面反作用力，从而减少距舟关节的微动。我们使用4条膝下肢体，研究在负重模拟下，单纯距舟关节融合术与附加跟骨截骨术相比，施加在关节上的力。在距舟关节内放置一个0.5英寸的圆形力敏电阻，在近端肢体施加5磅力后，用于检查关节上的力。电阻通过力的直接反比测量进行量化。每条肢体进行3次该操作。使用配对t检验分析跟骨截骨术前和术后的平均电阻。在跟骨截骨术前的部位，平均电阻为200 kΩ时为388.2±565.9，而在跟骨截骨术后的部位为1016.6±482.7（p = 0.02）。这项尸体研究的结果表明，附加跟骨截骨术可降低距舟关节的受力。我们得出结论，对于不愈合风险高的患者，如肥胖、糖尿病患者或吸烟者，这可能是一种有益的辅助手术。这些患者可从辅助手术减少的微动中获益。
