膝内翻时距下关节异常代偿能力的病理生理学
Pathophysiology of abnormal compensation ability of the subtalar joint in the varus knee.
作者信息
Miyazaki Kotaro, Maeyama Akira, Matsunaga Taiki, Ishimatsu Tetsuro, Yamamoto Takuaki
机构信息
Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University 7-45-1 Nanakuma, Jonan-ku, Fukuoka 810-0180, Japan.
出版信息
J Orthop Sci. 2024 Sep;29(5):1259-1264. doi: 10.1016/j.jos.2023.09.009. Epub 2023 Oct 16.
BACKGROUND
In recent years, the involvement of the compensation ability of the subtalar joint in lower extremity alignment has been reported. We previously showed that hindfoot alignment angle (HAA) is an indicator of compensation ability of the subtalar joint. The abnormal compensation ability of the subtalar joint was defined by the mobility of the subtalar joint, and evaluation of the mobility of the subtalar joint may help to further clarify the pathophysiology of abnormal compensation ability of the subtalar joint. This study was performed to evaluate the mobility of the subtalar joint and clarify the pathophysiology of abnormal compensation ability of the subtalar joint in the varus knee.
METHODS
Seventy-two knees of 72 patients aged ≥40 years with varus knee were included in this study. Preoperative radiographs were used for measurement of this study parameters. Based on our previous study, we defined HAA of ≥15.9°as abnormal compensation ability of the subtalar joint. The patients were divided into an abnormal group (A-group) and normal group (N-group). All measurement parameters were compared between the groups, and correlations between the HAA and each measurement parameter were analyzed.
RESULTS
The weight-bearing hindfoot angle (WBHA) (p < 0.001) and non-weight-bearing hindfoot angle (non-WBHA) (p = 0.003), were significantly greater in the A-group than in the N-group. Conversely, the ratio of change in hindfoot alignment (p = 0.006), were significantly smaller in the A-group than in the N-group. The HAA was positively correlated with WBHA (r = 0.66) and non-WBHA (r = 0.43) and negatively correlated with the ratio of change in hindfoot alignment (r = -0.32).
CONCLUSIONS
The pathophysiology of abnormal compensation ability of the subtalar joint in the varus knee is thought to involve a state of increased valgus of hindfoot alignment and an inability to move into normal hindfoot alignment.
LEVEL OF EVIDENCE
Level Ⅲ, retrospective study.
背景
近年来，有报道称距下关节的代偿能力与下肢对线有关。我们之前表明，后足对线角（HAA）是距下关节代偿能力的一个指标。距下关节的异常代偿能力由距下关节的活动度定义，评估距下关节的活动度可能有助于进一步阐明距下关节异常代偿能力的病理生理学。本研究旨在评估距下关节的活动度，并阐明膝内翻时距下关节异常代偿能力的病理生理学。
方法
本研究纳入了72例年龄≥40岁的膝内翻患者的72个膝关节。术前X线片用于测量本研究参数。根据我们之前的研究，我们将HAA≥15.9°定义为距下关节的异常代偿能力。患者被分为异常组（A组）和正常组（N组）。比较两组之间的所有测量参数，并分析HAA与每个测量参数之间的相关性。
结果
负重后足角（WBHA）（p < 0.001）和非负重后足角（非WBHA）（p = 0.003），A组显著大于N组。相反，后足对线变化率（p = 0.006），A组显著小于N组。HAA与WBHA（r = 0.66）和非WBHA（r = 0.43）呈正相关,与后足对线变化率呈负相关（r = -0.32）。
结论
膝内翻时距下关节异常代偿能力的病理生理学被认为涉及后足对线外翻增加和无法恢复到正常后足对线的状态。
证据水平
Ⅲ级，回顾性研究。
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