Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Carl J. Shapiro Department of Orthopaedics, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of South Carolina School of Medicine, Columbia, SC, USA.
Foot Ankle Int. 2020 Oct;41(10):1249-1255. doi: 10.1177/1071100720937297. Epub 2020 Jul 14.
Assessing and correcting malalignment is important when treating calcaneus fractures. The Harris axial view is commonly utilized to assess varus deformity but may be inherently inaccurate due to its tangential nature. The anterior-posterior (AP) calcaneal profile view is a novel radiographic view that is easily obtained with demonstrated increased accuracy for assessing calcaneal axial alignment.
Five nonpaired ankle cadaveric specimens were used in this investigation. Oblique osteotomies were created in relation to the long axis, and varus deformities were produced by inserting solid radiolucent wedges into the osteotomies to create models of 10, 20, and 30 degrees of angulation of the calcaneal tuberosity. Specimens were imaged using both the Harris axial view and the AP calcaneal profile view.
For cadavers with 10 degrees of actual varus angulation, the mean Harris axial view angle and the AP calcaneal profile view angle were 10.9 ± 4.8 (range, 5.5-16.0) degrees and 13.0 ± 5.5 (range, 7.3-20.9) degrees, respectively. For cadavers with 20 degrees of actual varus angulation, the mean Harris view angle and the AP calcaneal profile view angle were 11.5 ± 2 (range, 8.2-13.6) degrees and 18.1 ± 4.8 (range, 11.7-23.5) degrees, respectively ( = .005). On pairwise comparison with Bonferroni correction, there was a significant difference between the Harris axial view angle and both the AP calcaneal profile view angle ( = .012) and actual angulation ( = .011). For cadavers with 30 degrees of actual varus angulation, the mean Harris axial view angle and the AP calcaneal profile view angle were 18.3 ± 4.3 (range, 13.3-23.6) degrees and 28.3 ± 2.9 (range, 24.4-31.1) degrees, respectively ( < .001). On pairwise comparison with Bonferroni correction, there was a significant difference between the Harris axial view angle and both the AP calcaneal profile view angle ( = .001) and actual angulation ( < .001). There was no significant difference between the AP calcaneal profile view angle and actual angulation ( > .999).
The AP calcaneal profile view is a novel radiographic view that is easily obtained with demonstrated increased accuracy for assessing calcaneal axial alignment. While both views demonstrated similar measurement error for lesser degrees of varus malalignment, the AP calcaneal profile view demonstrated more accurate measurement of increasing heel varus compared with the Harris view.
The AP calcaneal profile view could be used in addition to other radiographic views when treating displaced, intra-articular calcaneus fractures to help optimize correction of hindfoot alignment.
在治疗跟骨骨折时，评估和纠正对线不良很重要。Harris 轴向视图常用于评估内翻畸形，但由于其切线性质，可能存在固有误差。前后（AP）跟骨侧位片是一种新的影像学视图，易于获得，并已证明其在评估跟骨轴向对线方面具有更高的准确性。
本研究使用了 5 个非配对的踝关节尸体标本。在长轴上创建斜行截骨，并通过将实心不透射线楔形物插入截骨处以创建跟骨结节成角 10、20 和 30 度的模型来产生内翻畸形。使用 Harris 轴向视图和 AP 跟骨侧位片对标本进行成像。
对于实际内翻角度为 10 度的尸体标本，Harris 轴向视图的平均角度和 AP 跟骨侧位片的平均角度分别为 10.9 ± 4.8（范围 5.5-16.0）度和 13.0 ± 5.5（范围 7.3-20.9）度。对于实际内翻角度为 20 度的尸体标本，Harris 视图的平均角度和 AP 跟骨侧位片的平均角度分别为 11.5 ± 2（范围 8.2-13.6）度和 18.1 ± 4.8（范围 11.7-23.5）度（ =.005）。通过 Bonferroni 校正的配对比较，Harris 轴向视图角度与 AP 跟骨侧位片角度（ =.012）和实际成角（ =.011）均有显著差异。对于实际内翻角度为 30 度的尸体标本，Harris 轴向视图的平均角度和 AP 跟骨侧位片的平均角度分别为 18.3 ± 4.3（范围 13.3-23.6）度和 28.3 ± 2.9（范围 24.4-31.1）度（ <.001）。通过 Bonferroni 校正的配对比较，Harris 轴向视图角度与 AP 跟骨侧位片角度（ =.001）和实际成角（ <.001）均有显著差异。AP 跟骨侧位片角度与实际成角之间无显著差异（>.999）。
AP 跟骨侧位片是一种新的影像学视图，易于获得，并已证明在评估跟骨轴向对线方面具有更高的准确性。虽然这两种视图对于较小程度的内翻畸形都表现出相似的测量误差，但与 Harris 视图相比，AP 跟骨侧位片在测量逐渐增加的跟骨内翻方面具有更准确的测量。
在治疗移位的关节内跟骨骨折时，AP 跟骨侧位片可以与其他影像学视图一起使用，以帮助优化后足对线的矫正。
