Three-Dimensional Distance Mapping to Identify Safe Zones for Lateral Column Lengthening.

IF 2.4 2区医学 Q2 ORTHOPEDICS

Foot & Ankle International Pub Date : 2023-10-01 Epub Date: 2023-08-05 DOI:10.1177/10711007231185328

Ben Efrima, Agustin Barbero, Kuharajan Ramalingam, Cristian Indino, Camilla Maccario, Federico Giuseppe Usuelli

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引用次数: 0

Abstract

Background: Evans (E-LCL) and Hintermann LCL (H-LCL) lateral column lengthening osteotomies are standard surgical solutions for flexible, progressive collapsing feet. E-LCL is performed between the anterior and middle facets and endangers specific os calcis subtalar joint (OCST) subtypes without distinct facets. H-LCL is oriented between the posterior and middle facets and should be suitable for all OCSTs. Both osteotomies are associated with increased subtalar osteoarthritis, indicating iatrogenic damage. Distance mapping (DM) enables visualization of the relative distance between 2 articular surfaces represented by color patterns. This study aims to measure the safe zones for LCL using 3-dimensional (3D) models and DM; we hypothesize that it could be measured with high reproducibility.

Methods: Two raters categorized 200 feet across 134 patients into OCSTs based on the Bruckner classification. Four angles were measured independently. The proximal and distal extents of the posterior safe zone (PSZ) angles were determined for H-LCL osteotomies; similarly, the proximal and distal extents of the anterior safe zone (ASZ) angles were identified for E-LCL osteotomies. Consequently, the surface available for safe osteotomies were calculated. An interclass correlation was used to assess the agreement between the 2 raters. Additionally, analysis of variance and Mann-Whitney U test were used to compare the safe zones between OCSTs.

Results: The mean proximal and distal extents of the PSZ angles were 68 ± 7 and 75 ± 5 degrees from a line parallel to the lateral border of the calcaneus, respectively, and the proximal and distal extent of the ASZ angles were 89 ± 6 and 95 ± 5 degrees, respectively. There were no statistically significant differences between the OCSTs. Two raters measured the angles with good to excellent interrater and intrarater agreement. In 18 cases, we were unable to plan for H-LCL or E-LCL osteotomies.

Conclusion: Distance mapping could be used to measure the safe zone, tailor a preoperative plan, and potentially reduce the risk for iatrogenic damage in LCL. 3D models and DM can increase the reliability of preoperative plans in bones with complex 3D structures.

Level of evidence: Level III, retrospective comparative study.

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三维距离映射，以确定横向立柱加长的安全区域。

背景：Evans（E-LCL）和Hintermann LCL（H-LCL）侧柱延长截骨术是灵活、渐进性塌陷足的标准手术解决方案。E-LCL在前小面和中小面之间进行，危及没有明显小面的特定的距下骨关节（OCST）亚型。H-LCL定向在后小面和中小面之间，并且应该适用于所有OCST。这两种截骨术都与距下骨关节炎的增加有关，表明医源性损伤。距离映射（DM）能够可视化由颜色模式表示的2个关节表面之间的相对距离。本研究旨在使用三维（3D）模型和DM来测量LCL的安全区域；我们假设它可以以高再现性进行测量。方法：两名评分员根据布鲁克纳分类法将134名患者的200英尺分为OCST。分别测量了四个角度。H-LCL截骨术后安全区（PSZ）角度的近端和远端范围；类似地，E-LCL截骨术确定了前安全区（ASZ）角度的近端和远端范围。因此，计算了可用于安全截骨的表面。使用类间相关性来评估两位评分者之间的一致性。此外，方差分析和Mann-Whitney U检验用于比较OCST之间的安全区。结果：PSZ角的平均近端和远端范围为68 ± 7和75 ± 与平行于跟骨外侧边界的线分别成5度，ASZ角的近端和远端范围为89 ± 6和95 ± 分别为5度。OCST之间没有统计学上的显著差异。两位评分者测量角度时，评分者之间和评分者内部的一致性很好。在18例病例中，我们无法计划H-LCL或E-LCL截骨术。结论：距离图可用于测量LCL的安全区，制定术前计划，并有可能降低医源性损伤的风险。3D模型和DM可以提高具有复杂3D结构的骨骼的术前计划的可靠性。证据级别：三级，回顾性比较研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Foot & Ankle International 医学-整形外科

CiteScore

5.60

自引率

22.20%

发文量

144

审稿时长

2 months

期刊介绍： Foot & Ankle International (FAI), in publication since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. This journal is an ideal resource for highly-trained orthopaedic foot and ankle specialists and allied health care providers. The journal’s Founding Editor, Melvin H. Jahss, MD (deceased), served from 1980-1988. He was followed by Kenneth A. Johnson, MD (deceased) from 1988-1993; Lowell D. Lutter, MD (deceased) from 1993-2004; and E. Greer Richardson, MD from 2005-2007. David B. Thordarson, MD, assumed the role of Editor-in-Chief in 2008. The journal focuses on the following areas of interest: • Surgery • Wound care • Bone healing • Pain management • In-office orthotic systems • Diabetes • Sports medicine