Wagner K S, Tarr R R, Resnick C, Sarmiento A
Foot Ankle. 1984 Nov-Dec;5(3):131-41. doi: 10.1177/107110078400500306.
The effect of angular deformities of the tibial shaft on the area, location, and shape of the ankle joint contact during the normal extremes in the gait cycle was studied with the use of a cadaveric model. Six lower limbs were first examined radiographically and found to be free of pathology. These specimens were then stripped of soft tissues proximal to the ankle joint and had a custom-designed universal joint-plate inserted into the tibia at the proximal, middle, or distal third level. An anterior ankle arthrotomy was performed, and pressure sensitive film was inserted into the tibiotalar joint. Load was then applied with the ankle set in dorsiflexion or plantarflexion via metal wedges, and tibial deformities of 5, 10, and 15 degrees were simulated in varus, valgus, anterior bow, and posterior bow. Contact area and location changes were noted to be of greater magnitude with proximal and distal third tibial deformities than with middle third deformities. Varus and valgus deformities showed smaller contact area changes than anterior or posterior bow deformities. Contact area changes tended to be larger in dorsiflexion compared to plantarflexion for each level and degree of tibial angulation. Posterior bow deformities at all levels resulted in greater changes in contact area and shape than other deformities. The role of subtalar compensation, stiffness of the foot-ankle complex, and geometric factors are all thought to influence the changes noted. On the basis of this experimental study it would appear that angular deformity of the tibia less than 10 degrees would not significantly alter ankle joint contact.
利用尸体模型研究了胫骨干角畸形在步态周期正常极限范围内对踝关节接触面积、位置和形状的影响。首先对六个下肢进行X线检查，发现无病变。然后将这些标本踝关节近端的软组织剥离，并在胫骨近端、中段或远端三分之一处插入定制的通用关节板。进行前踝关节切开术，并将压敏膜插入胫距关节。然后通过金属楔块使踝关节处于背屈或跖屈状态施加负荷，并模拟5度、10度和15度的内翻、外翻、前弓和后弓胫骨畸形。结果发现，与中段畸形相比，胫骨近端和远端三分之一处的畸形导致的接触面积和位置变化幅度更大。内翻和外翻畸形的接触面积变化比前弓或后弓畸形小。对于胫骨成角的每个水平和程度，背屈时的接触面积变化往往比跖屈时更大。所有水平的后弓畸形导致的接触面积和形状变化都比其他畸形更大。距下关节代偿、足踝复合体的刚度和几何因素的作用都被认为会影响所观察到的变化。基于这项实验研究，似乎小于10度的胫骨角畸形不会显著改变踝关节接触。
