Gabrielli Alexandra S, Gale Tom, Hogan MaCalus, Anderst William
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Biodynamics Lab, University of Pittsburgh, Pittsburgh, PA, USA.
Foot Ankle Orthop. 2020 Mar 6;5(1):2473011420908796. doi: 10.1177/2473011420908796. eCollection 2020 Jan.
Ankle injuries and joint degeneration may be related to ankle bone morphology. Little data exist to characterize healthy hindfoot bone morphology. The purpose of this study was to characterize side-to-side symmetry and sex differences in ankle and hindfoot bone morphology, and to identify the primary shape factors that differentiate ankle and hindfoot bone morphology among individuals.
Computed tomography was used to create 3D surface models of the distal tibia, talus, and calcaneus for 40 ankle and hindfoot bones from 20 healthy individuals. Morphologic differences between left and right bones of the same individual and between males and females were determined. Statistical shape modeling was performed to identify primary shape variations among individuals.
Side-to-side differences in bone morphology averaged 0.79 mm or less. The average distal tibia in males was larger overall than in females. No significant sex difference was noted in the tali. The average female calcaneus was longer and thinner than the average male calcaneus. Variability in ankle and hindfoot bone morphology is primarily associated with articulating surface shape, overall length and width, and tendon/ligament attachment points.
In general, the contralateral ankle can serve as an accurate guide for operative restoration of native ankle morphology; however, specific regions demonstrate higher asymmetry.
Knowledge of regions of high and low bilateral symmetry can improve hindfoot and ankle reconstruction. Design of ankle prostheses can be improved by accounting for differences in bone morphology associated with sex and shape differences among individuals.
踝关节损伤和关节退变可能与踝关节骨形态有关。目前关于健康后足骨形态的特征数据较少。本研究的目的是描述踝关节和后足骨形态的左右对称性和性别差异，并确定个体间区分踝关节和后足骨形态的主要形状因素。
利用计算机断层扫描为20名健康个体的40个踝关节和后足骨创建胫骨远端、距骨和跟骨的三维表面模型。确定同一个体左右骨之间以及男性和女性之间的形态学差异。进行统计形状建模以识别个体间的主要形状变化。
骨形态的左右差异平均为0.79毫米或更小。男性的胫骨远端总体上比女性的大。距骨未发现明显的性别差异。女性跟骨平均比男性跟骨更长更细。踝关节和后足骨形态的变异性主要与关节面形状、整体长度和宽度以及肌腱/韧带附着点有关。
一般来说，对侧踝关节可作为恢复天然踝关节形态手术的准确指导；然而，特定区域显示出更高的不对称性。
了解双侧对称性高低的区域可改善后足和踝关节重建。考虑到与性别相关的骨形态差异和个体间的形状差异，可改进踝关节假体的设计。
