Zeiss Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth, PO1 3DJ, UK.
UCL Institute of Orthopaedics & Musculoskeletal Science, Division of Surgery & Interventional Science, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK.
Sci Rep. 2020 Jan 23;10(1):1035. doi: 10.1038/s41598-020-57912-z.
Accurate in vivo quantification of subtalar joint kinematics can provide important information for the clinical evaluation of subtalar joint function; the analysis of outcome of surgical procedures of the hindfoot; and the design of a replacement subtalar joint prosthesis. The objective of the current study was to explore the potential of full weight-bearing clinical computed tomography (CT) to evaluate the helical axis and centre of rotation of the subtalar joint during inversion and eversion motion. A subject specific methodology was proposed for the definition of the subtalar joint motion combining three-dimensional (3D) weight-bearing imaging at different joint positions with digital volume correlation (DVC). The computed subtalar joint helical axis parameters showed consistency across all healthy subjects and in line with previous data under simulated loads. A sphere fitting approach was introduced for the computation of subtalar joint centre of rotation, which allows to demonstrate that this centre of rotation is located in the middle facet of the subtalar joint. Some translation along the helical axis was also observed, reflecting the elasticity of the soft-tissue restraints. This study showed a novel technique for non-invasive quantitative analysis of bone-to-bone motion under full weight-bearing of the hindfoot. Identifying different joint kinematics in patients with ligamentous laxity and instability, or in the presence of stiffness and arthritis, could help clinicians to define optimal patient-specific treatments.
准确的跗骨间关节运动学的体内定量分析可为跗骨间关节功能的临床评估、后足手术结果的分析以及替代式跗骨间关节假体的设计提供重要信息。本研究旨在探索在负重情况下行临床 CT 检查评估距下关节内翻和外翻时的螺旋轴和旋转中心的潜力。采用一种特定于个体的方法,结合三维负重成像和数字体层相关技术(DVC),对距下关节运动进行定义。计算得到的距下关节螺旋轴参数在所有健康受试者中均具有一致性,且与模拟载荷下的先前数据一致。引入了一种用于计算距下关节旋转中心的球体拟合方法,该方法表明旋转中心位于距下关节的中间关节面。还观察到沿螺旋轴的一些平移,这反映了软组织约束的弹性。本研究展示了一种新的技术,可在完整的后足负重情况下对骨对骨运动进行非侵入性定量分析。识别韧带松弛和不稳定患者以及僵硬和关节炎患者的不同关节运动学特征,有助于临床医生确定最佳的个体化治疗方案。