Reeck J, Felten N, McCormack A P, Kiser P, Tencer A F, Sangeorzan B J
Harborview Medical Center, Department of Orthopaedic Surgery, University of Washington, Seattle 98104, USA.
Foot Ankle Int. 1998 Oct;19(10):674-82. doi: 10.1177/107110079801901005.
The goal of this study was to determine the magnitude of force transmission to the talus by its inferior articulations to provide insight into mechanisms involving acquired deformities of the hindfoot. Cadaver feet were mounted in a loading apparatus that applied axial force through the tibia and fibula as well as tensile loading of the tendons of extrinsic musculature. This also permitted positioning of the tibia in the sagittal plane. Eighteen specimens were tested in three selected positions of the gait cycle. In one series, pressure-sensitive film was inserted into the posterior and anteromedial facets of the talocalcaneal joint as well as into the talonavicular joint. In a second series, film was inserted between the talar head and the superomedial calcaneonavicular ligament. In stance position, the specimens were also tested without posterior tibial tendon (PTT) tension. Contact areas and force transmitted across the articulations were greatest in near toe-off position, in the posterior facet of the talocalcaneal joint. The talonavicular joint, the anteromedial facet of the talocalcaneal joint, and the calcaneonavicular ligament articulation showed sequentially decreasing amounts of contact area and force transmission. Mean pressures were similar across all articulations, except in the posterior facet in near toe-off position. From heel-strike to stance, to near toe-off, a trend to increasing contact area and force was noted. No difference in contact characteristics was found in the calcaneonavicular ligament articulation after PTT release. The contact force of the calcaneonavicular ligament against the talus was found to be much smaller than those of other talar articulations; however, its medially oriented direction must contribute to stabilization of the head of the talus against medial displacement. Loss of PTT tension was not found to alter the contact forces acting at the talar head in this model, which might indicate that it shares its talar stabilizing function with other structures.
本研究的目的是确定距骨通过其下关节传递的力的大小，以深入了解涉及后足后天畸形的机制。将尸体足安装在加载装置中，该装置通过胫骨和腓骨施加轴向力以及对外侧肌肉肌腱进行拉伸加载。这也允许在矢状面内定位胫骨。在步态周期的三个选定位置对18个标本进行了测试。在一个系列中，将压敏膜插入距下关节的后关节面和前内侧关节面以及距舟关节。在第二个系列中，将膜插入距骨头与跟舟内侧韧带之间。在站立位时，还在没有胫后肌腱（PTT）张力的情况下对标本进行了测试。在接近足趾离地位置时，距下关节后关节面的接触面积和通过关节传递的力最大。距舟关节、距下关节前内侧关节面和跟舟韧带关节的接触面积和力传递依次减少。除了接近足趾离地位置的后关节面外，所有关节的平均压力相似。从足跟触地到站立，再到接近足趾离地，观察到接触面积和力有增加的趋势。PTT释放后，跟舟韧带关节的接触特征没有差异。发现跟舟韧带对距骨的接触力远小于其他距骨关节的接触力；然而，其向内的方向必定有助于距骨头防止向内侧移位的稳定。在该模型中，未发现PTT张力丧失会改变作用于距骨头的接触力，这可能表明它与其他结构共同承担距骨稳定功能。
