Shapiro F, Glimcher M J
J Bone Joint Surg Am. 1979 Jun;61(4):522-30.
Gross and histological abnormalities were demonstrated in a club-foot talus from a boy with multiple congenital anomalies who died when he was nine days old. Both tali were studied, the one from the club foot and the one from the normal foot. The gross anomalies involved the smaller size of the club-foot talus and the increased medial deviation of a stunted, misshapen head and neck region. Serial histological sections of both tali allowed for a three-dimensional geometric appreciation of both bones and an assessment of the nature and extent of histological and cytological features. The ossification center of the club-foot talus was absolutely and relatively smaller than that of the normal talus. It was eccentrically positioned, being more lateral and anterior than that of the normal talus. The marked histological abnormalities seen in the head and neck region of the club-foot talus involved extensive breaching of the endochondral sequence by vessels. The posterior aspect of the endochondral sequence and ossification center was normal. The extra-osseous and intra-osseous blood supply of the two tali was normal with the exception of the increased and irregular breaching of the endochondral sequence in the club-foot talus. This study demonstrates histological abnormalities in the head and neck region of the club-foot talus, which was most abnormal grossly. The eccentric position of the secondary ossification center as well as its related vascular abnormalities do not support a theory of developmental arrest of the talus but appear sufficiently abnormal to support the theory of a primary defect in the cartilage anlage. Clinically, one must bear in mind that early open reduction of the talocalcaneal navicular joint in a foot such as this would have served to reposition the navicular onto a talus that still was structurally abnormal.
在一名患有多种先天性异常的男婴（出生九天后死亡）的畸形足距骨中发现了大体和组织学异常。对双侧距骨进行了研究，一侧取自畸形足，另一侧取自正常足。大体异常包括畸形足距骨较小，以及发育不良、形状怪异的头部和颈部区域向内偏斜增加。对双侧距骨进行连续组织学切片，以便对两块骨头进行三维几何评估，并评估组织学和细胞学特征的性质和范围。畸形足距骨的骨化中心在绝对和相对意义上均小于正常距骨的骨化中心。它的位置偏心，比正常距骨更靠外侧和前方。在畸形足距骨的头部和颈部区域观察到明显的组织学异常，包括血管广泛破坏软骨内成骨序列。软骨内成骨序列和骨化中心的后部正常。除了畸形足距骨中软骨内成骨序列的破坏增加且不规则外，双侧距骨的骨外和骨内血供正常。本研究证明了畸形足距骨头部和颈部区域的组织学异常，该区域在大体上最为异常。次级骨化中心的偏心位置及其相关的血管异常不支持距骨发育停滞的理论，但似乎异常程度足以支持软骨原基存在原发性缺陷的理论。临床上，必须牢记，对于这样一只脚，早期对距跟舟关节进行切开复位，只能将舟骨重新定位到结构上仍异常的距骨上。
