Astion D J, Deland J T, Otis J C, Kenneally S
Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York, N.Y. 10003, USA.
J Bone Joint Surg Am. 1997 Feb;79(2):241-6. doi: 10.2106/00004623-199702000-00012.
Arthrodesis of the subtalar joint, triple arthrodesis (involving the subtalar, talonavicular, and calcaneocuboid joints), double arthrodesis (involving the talonavicular and calcaneocuboid joints), arthrodesis of the talonavicular joint, and arthrodesis of the calcaneocuboid joint were simulated in a cadaver model, and the range of motion of each joint not involved in the simulated arthrodesis was measured with a three-dimensional magnetic space tracking system. The excursion of the posterior tibial tendon was also measured under all of these conditions. We found that any combination of simulated arthrodeses that included the talonavicular joint severely limited the motion of the remaining joints to about 2 degrees and limited the excursion of the posterior tibial tendon to 25 per cent of the preoperative value. Simulated arthrodesis of the calcaneocuboid joint had little effect on the range of motion of the subtalar joint, and it reduced the range of motion of the talonavicular joint to a mean of 67 per cent of the preoperative value; a mean of 73 per cent of the excursion of the posterior tibial tendon was retained. After simulated arthrodesis of the subtalar joint, a mean of 26 per cent of the motion of the talonavicular joint, 56 per cent of the motion of the calcaneocuboid joint, and 46 per cent of the excursion of the posterior tibial tendon was retained. The talonavicular joint is the key joint of the triple joint complex. The talonavicular joint had the greatest range of motion, and simulated arthrodesis of this joint essentially eliminated motion of the other joints of the complex.
在尸体模型中模拟距下关节融合术、三关节融合术（涉及距下、距舟和跟骰关节）、双关节融合术（涉及距舟和跟骰关节）、距舟关节融合术以及跟骰关节融合术，并使用三维磁性空间跟踪系统测量未参与模拟融合术的每个关节的活动范围。在所有这些情况下，还测量了胫后肌腱的偏移。我们发现，任何包含距舟关节的模拟融合术组合都会将其余关节的活动严重限制至约2度，并将胫后肌腱的偏移限制至术前值的25%。跟骰关节的模拟融合术对距下关节的活动范围影响不大，它将距舟关节的活动范围减少至术前值的平均67%；胫后肌腱偏移平均保留了73%。距下关节模拟融合术后，距舟关节活动平均保留26%，跟骰关节活动保留56%，胫后肌腱偏移保留46%。距舟关节是三关节复合体的关键关节。距舟关节的活动范围最大，该关节的模拟融合术基本上消除了复合体中其他关节的活动。
