Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea.
Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea.
J Orthop Sci. 2024 Sep;29(5):1248-1254. doi: 10.1016/j.jos.2023.08.014. Epub 2023 Oct 13.
Hindfoot malalignment can cause various foot and ankle problems. For better surgical performance and correction of hindfoot malalignments, reliable intraoperative determination of hindfoot alignment is essential. However, there is no standard method for the intraoperative assessment of hindfoot alignment. We devised an intraoperative modified Méary posteroanterior (IOPPA) view to assess intraoperative hindfoot alignment. This study aimed to compare this intraoperative method with other radiographic hindfoot alignment measurements.
Thirty-seven patients (47 feet) with various foot and ankle conditions scheduled to undergo surgery were prospectively recruited. Before surgery, the Saltzman, long axial, and modified Méary views were taken in a controlled and standardized fashion. IOPPA views were obtained under simulated weight bearing conditions using C-arm fluoroscopy in the operating room before surgery. The relationship between the IOPPA view and the three radiographic hindfoot alignments was evaluated using Pearson's correlation.
The mean hindfoot alignment angle was varus 3.50° (CI, varus 1.91 to 5.08) on the Saltzman view, varus 2.00° (CI, varus 0.60 to 3.39) on the long axial view, varus 0.13° (CI, valgus 1.41 to varus 1.67) on the modified Méary view, and varus 1.32° (CI, valgus 0.02 to varus 2.65) on IOPPA view. The IOPPA view and the three other hindfoot alignment views were found to be significantly correlated (r = 0.60 for the Saltzman view, r = 0.50 for the long axial view, r = 0.71 for the modified Méary view, P < .05). The intraobserver ICC (Intraclass Correlation Coefficient) value was 0.974 and interobserver ICC (Intraclass Correlation Coefficient) value was 0.988 for the IOPPA view (P < .001).
There was a statistically significant correlation between the IOPPA view and the other three hindfoot alignment views. We also found that interobserver and intraobserver ICC values were excellent. This study proposes that the IOPPA view can be used as a reliable intraoperative assessment tool for hindfoot alignment.
Prospective study.
后足对线不良可导致各种足踝问题。为了更好的手术效果和后足对线不良的矫正，术中可靠地确定后足对线至关重要。然而，目前还没有用于术中评估后足对线的标准方法。我们设计了一种术中改良的梅里后前位（IOPPA）视图来评估术中后足对线。本研究旨在比较这种术中方法与其他后足对线的放射学测量。
前瞻性招募了 37 名（47 足）患有各种足踝疾病的患者，计划接受手术。术前采用盐茨曼位、长轴位和改良梅里位进行标准、规范的摄片。术前在手术室中使用 C 臂透视机模拟负重条件下获取 IOPPA 位。使用 Pearson 相关分析评估 IOPPA 位与三种后足对线放射学测量的关系。
盐茨曼位的平均后足对线角度为内翻 3.50°（置信区间，内翻 1.91 至 5.08），长轴位为内翻 2.00°（置信区间，内翻 0.60 至 3.39），改良梅里位为内翻 0.13°（置信区间，外翻 1.41 至内翻 1.67），IOPPA 位为内翻 1.32°（置信区间，外翻 0.02 至内翻 2.65）。IOPPA 位与其他三种后足对线位均有显著相关性（盐茨曼位 r=0.60，长轴位 r=0.50，改良梅里位 r=0.71，P<.05）。IOPPA 位的观察者内 ICC（组内相关系数）值为 0.974，观察者间 ICC 值为 0.988（P<.001）。
IOPPA 位与其他三种后足对线位有统计学显著相关性。我们还发现观察者间和观察者内 ICC 值均为优。本研究提出，IOPPA 位可作为后足对线术中评估的可靠工具。
前瞻性研究。
