先天性垂直距骨与先天性斜距骨的定义及鉴别：关键并不主要在于距骨。

Defining and Differentiating Congenital Vertical Talus and Congenital Oblique Talus: It's Not Primarily About the Talus.

作者信息

Mosca Vincent S, Ganjwala Dhiren, Shah Hitesh

机构信息

Department of Orthopedics, Seattle Children's Hospital, Seattle, Washington.

Department of Orthopedics, University of Washington School of Medicine, Seattle, Washington.

出版信息

JB JS Open Access. 2024 Jul 11;9(3). doi: 10.2106/JBJS.OA.24.00014. eCollection 2024 Jul-Sep.

DOI:10.2106/JBJS.OA.24.00014

PMID:38994528

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11236389/

Abstract

BACKGROUND

Congenital vertical talus (CVT) and congenital oblique talus (COT) are rocker-bottom foot deformities that have similar names and no objective definitions. This has led to confusion for practitioners, as well as scientific challenges for researchers. Our goal was to provide objective radiographic criteria to define and differentiate CVT and COT.

METHODS

We evaluated 62 pairs of maximum dorsiflexion and plantar flexion lateral radiographs of infant feet that had been clinically diagnosed with CVT. The dorsiflexion tibiotalar angle, the plantar flexion talus-first metatarsal angle, and the plantar flexion foot center of rotation of angulation (foot-CORA) were measured using transparent overlay tools. Freehand measurements were made on a subset of 10 pairs of radiographs to confirm clinical applicability. Nine contralateral pairs of radiographs of normal feet were measured for comparison.

RESULTS

Specific values for the radiographic measurements were identified that, together, reliably differentiated the shapes of rocker-bottom feet with CVT, COT, and flexible flatfoot with a short tendo-Achilles (FFF-STA), as well as the shape of the normal foot. More severe and rigid rocker-bottom foot deformities were diagnosed with CVT. Less severe and more flexible deformities were diagnosed with COT.

CONCLUSIONS

CVT, COT, FFF-STA, and normal feet can be reliably differentiated using 2 angular measurements and 1 bone position measurement on dorsiflexion and plantar flexion lateral radiographs. Our data indicated that the differentiation of CVT and COT is based primarily on the rigidity of the navicular dislocation rather than the verticality of the talus. The data further supported the proposition that COT is a foot deformity along a spectrum of valgus/eversion deformities of the hindfoot that requires early treatment. Application of these diagnostic criteria should lead to clinical studies that identify a specific treatment, treatment outcome, and prognosis for each deformity.

LEVEL OF EVIDENCE

Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

先天性垂直距骨（CVT）和先天性斜距骨（COT）是摇椅底足畸形，名称相似且无客观定义。这给从业者带来了困惑，也给研究人员带来了科学挑战。我们的目标是提供客观的影像学标准来定义和区分CVT和COT。

方法

我们评估了62例临床诊断为CVT的婴儿足部最大背屈和跖屈侧位X线片。使用透明叠加工具测量背屈时的胫距角、跖屈时的距骨-第一跖骨角以及跖屈时足部角旋转中心（足部-CORA）。对10例X线片的子集进行徒手测量以确认临床适用性。测量9例正常足对侧的X线片作为对照。

结果

确定了影像学测量的特定值，这些值共同可靠地区分了CVT、COT、跟腱短的柔性扁平足（FFF-STA）的摇椅底足形状以及正常足的形状。CVT诊断为更严重和僵硬的摇椅底足畸形。COT诊断为不太严重和更灵活的畸形。

结论

通过对背屈和跖屈侧位X线片进行2个角度测量和1个骨位置测量，可以可靠地区分CVT、COT、FFF-STA和正常足。我们的数据表明，CVT和COT的区分主要基于舟骨脱位的僵硬程度而非距骨的垂直程度。数据进一步支持了COT是后足外翻/外翻畸形谱系中的一种足畸形且需要早期治疗的观点。应用这些诊断标准应能开展临床研究，确定每种畸形的具体治疗方法、治疗结果和预后。