Department of Orthopedics/Sports Medicine Center, The First Affiliated Hospital of Army Medical University (Southwest Hospital of Gaotanyan Zhengjie), Shapingba District, Chongqing, 400038, China.
J Orthop Surg Res. 2022 Mar 5;17(1):144. doi: 10.1186/s13018-022-03028-1.
Congruency of the first metatarsophalangeal (MTP) joint is extremely important for the selection of surgical methods and prognosis, while radiographic evaluation methods are relatively lacking. The purpose of this article was to explore radiographic indicators for evaluating congruency of the first MTP joint.
We selected patients with hallux valgus who had a weightbearing X-ray in the outpatient system and measured their hallux valgus angle (HVA). In total, 183 cases of 245 feet with HVA greater than 15° were selected. The distal metatarsal articular angle (DMAA), metatarsophalangeal joint angle (MTPJA), congruency index (CI) and tibial sesamoid position (TSP) were measured and statistically analysed.
The higher the degree of hallux valgus was, the higher the proportion of incongruency of the first MTP joint. Significant differences were found in the DMAA, MTPJA and CI between the congruency and incongruency groups of patients with moderate-to-severe hallux valgus (P < 0.05). The areas under the curve (AUCs) of the receiver operating characteristic (ROC) curve for DMAA was 0.554 (P > 0.05). However, the MTPJA and CI were 0.906 and 0.884, the sensitivity values reached 0.791 and 0.949, the specificity values were 0.862 and 0.644, and the critical values were 10.67 and 0.765, respectively. The correlation test indicated that in the congruency group, the DMAA and HVA were positively correlated, but the MTPJA, CI and HVA had low correlation coefficients. The DMAA and HVA were not correlated in the incongruency group; however, the MTPJA and HVA were significantly positively correlated, and the CI and HVA showed a negative correlation (P < 0.05).
The MTPJA and CI are indicators that can be used to quantitatively evaluate the congruency of the first MTP joint, taking 10° and 0.765 as the demarcation points, respectively. Clinically, congruency of the MTP joint should be considered when choosing surgical methods for different degrees of hallux valgus, and the MTPJA and CI can be used as quantitative evaluation indicators.
Level III, Retrospective Comparative Study.
第一跖趾（MTP）关节的一致性对于手术方法的选择和预后至关重要，而影像学评估方法相对缺乏。本文旨在探讨评估第一 MTP 关节一致性的影像学指标。
我们选择门诊系统中存在拇外翻负重 X 线的患者，并测量其拇外翻角（HVA）。共选择 HVA 大于 15°的 245 足中的 183 例。测量并统计分析远端跖骨关节角（DMAA）、MTP 关节角（MTPJA）、一致性指数（CI）和胫骨籽骨位置（TSP）。
拇外翻程度越高，第一 MTP 关节的不一致性比例越高。中重度拇外翻患者的一致性和不一致性组在 DMAA、MTPJA 和 CI 方面存在显著差异（P<0.05）。DMAA 的受试者工作特征（ROC）曲线下面积（AUC）为 0.554（P>0.05）。然而，MTPJA 和 CI 的 AUC 分别为 0.906 和 0.884，灵敏度分别为 0.791 和 0.949，特异性分别为 0.862 和 0.644，临界值分别为 10.67 和 0.765。相关检验表明，在一致性组中，DMAA 和 HVA 呈正相关，而 MTPJA、CI 和 HVA 相关性较低。在不一致性组中，DMAA 和 HVA 不相关；然而，MTPJA 和 HVA 呈显著正相关，CI 和 HVA 呈负相关（P<0.05）。
MTPJA 和 CI 是可用于定量评估第一 MTP 关节一致性的指标，分别以 10°和 0.765 为界值。临床上，在选择不同程度拇外翻的手术方法时应考虑 MTP 关节的一致性，MTPJA 和 CI 可作为定量评估指标。
III 级，回顾性比较研究。
