模拟负重透视评估术中足后弓对线
Simulated Weightbearing Fluoroscopy to Assess Intraoperative Hindfoot Alignment.
机构信息
Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, the Fourth Clinical Medical College of Peking University, Beijing, China.
出版信息
Foot Ankle Int. 2023 May;44(5):469-476. doi: 10.1177/10711007231159377. Epub 2023 Mar 23.
BACKGROUND
Intraoperative evaluation of hindfoot alignment is one of the factors that may affect outcomes for foot and ankle reconstructive surgery. The present study was performed to evaluate the effect of simulated weightbearing fluoroscopy on the intraoperative assessment of hindfoot alignment reconstruction.
METHODS
The medical records of patients diagnosed with disorders of the foot and ankle with abnormal hindfoot alignment were retrospectively reviewed from November 2014 to November 2021. Hindfoot alignment view (HAV) fluoroscopy in the simulated weightbearing position and HAV radiographs were routinely recorded during and after surgery, respectively. The hindfoot alignment angle (HAA) and hindfoot alignment ratio (HAR) were measured on intraoperative and postoperative images, respectively.
RESULTS
Seventy-two women and 82 men (155 ankles) with a mean age of 45.48 years were included in the present study. The intraobserver and interobserver reliabilities of the HAA and HAR measurements were satisfactory. The intraoperative and postoperative HAA was -0.7 ± 4.8 degrees and -0.2 ± 5.0 degrees, respectively. The mean HAR on intraoperative fluoroscopy and postoperative radiographs was 37.4% ± 19.7% and 40.4% ± 18.2%, respectively. Simple regression analysis revealed a correlation between the intraoperative and postoperative HAA ( = 0.631, < .001) and HAR ( = 0.262, < .001). Univariate analysis suggested that the difference between the intraoperative and postoperative HAA was positively affected by the body mass index ( < .001).
CONCLUSION
The present study showed that intraoperative HAV fluoroscopy in the simulated weightbearing position is a potentially useful method to predict postoperative hindfoot alignment in the weightbearing position. Patients with a lower body mass index had smaller HAA deviations between intraoperative and postoperative measurements of hindfoot alignment.
LEVEL OF EVIDENCE
Level IV, retrospective case series.
背景
术中评估后足对线是影响足踝重建手术效果的因素之一。本研究旨在评估模拟负重透视对后足对线重建术中评估的影响。
方法
回顾性分析 2014 年 11 月至 2021 年 11 月期间因足踝畸形伴后足对线异常而就诊的患者的病历资料。术中及术后分别常规记录模拟负重位后足对线视图（Hindfoot Alignment View，HAV）透视和 HAV 平片。分别测量术中及术后图像上的后足对线角（Hindfoot Alignment Angle，HAA）和后足对线比（Hindfoot Alignment Ratio，HAR）。
结果
本研究共纳入 72 名女性和 82 名男性（共 155 足），平均年龄为 45.48 岁。HAA 和 HAR 的观察者内和观察者间可靠性均良好。术中及术后 HAA 分别为-0.7±4.8 度和-0.2±5.0 度。术中透视和术后 X 线片上的 HAR 均值分别为 37.4%±19.7%和 40.4%±18.2%。简单回归分析显示，术中 HAA 与术后 HAA （ = 0.631， < .001）和 HAR （ = 0.262， < .001）之间存在相关性。单因素分析表明，术中与术后 HAA 的差异受体重指数（body mass index，BMI）的影响（ < .001）。
结论
本研究表明，模拟负重位术中 HAV 透视是一种预测负重位后足对线的潜在有用方法。BMI 较低的患者，其术中与术后后足对线测量的 HAA 偏差较小。
证据等级
IV 级，回顾性病例系列研究。
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