Tarr R R, Resnick C T, Wagner K S, Sarmiento A
Clin Orthop Relat Res. 1985 Oct(199):72-80.
Six cadaveric legs were stripped of all soft tissue excluding the interosseous membrane and the tissues about the ankle joint and foot. Angular deformities were simulated in all planes to a maximum of 15 degrees for proximal, middle, and distal third levels following tibial resection and same-level fibular osteotomy. Anterior ankle arthrotomies allowed exposure to the tibiotalar joint so that contact area could be measured with pressure-sensitive film inserted between the tibia and talus. An angular deformity of 15 degrees or less produced no significant alteration in the contact area of the ankle joint for proximal and middle third tibial levels. Distal tibial deformities showed a dramatic change in the contact area, with as much as a 42% decrease in contact area for anterior deformities. The contact shape for distal third angular deformities of 10 degrees and 15 degrees in all planes also tended to elongate, with a shift to more lateral contact noted. Although minor degrees of angular malalignment had little effect on ankle contact for proximal and middle third levels, it would appear that distal third deformities produce a greater change in ankle joint contact; thus, fractures at the distal level should be managed to minimize the possibility of tibial malalignment.
六具尸体下肢去除了所有软组织，但保留了骨间膜以及踝关节和足部周围的组织。在胫骨切除和同水平腓骨截骨后，在所有平面模拟成角畸形，近端、中段和远端三分之一水平的最大成角为15度。踝关节前方切开术可暴露胫距关节，以便通过插入胫骨和距骨之间的压敏膜测量接触面积。对于胫骨近端和中段水平，15度或更小的成角畸形在踝关节接触面积上未产生显著改变。胫骨远端畸形在接触面积上呈现出显著变化，前方畸形的接触面积减少多达42%。所有平面上10度和15度的远端三分之一成角畸形的接触形状也趋于拉长，注意到接触点向更外侧偏移。尽管轻度的角向排列不齐对近端和中段水平的踝关节接触影响较小，但似乎远端三分之一畸形会使踝关节接触产生更大变化；因此，应处理远端水平的骨折，以尽量减少胫骨排列不齐的可能性。
