后足关节固定方式和关节固定顺序对模拟站立时胫骨运动学的影响。

IF 2.4 2区 医学 Q2 ORTHOPEDICS
Foot & Ankle International Pub Date : 2023-10-01 Epub Date: 2023-08-05 DOI:10.1177/10711007231184224
Joaquin Palma, Jaeyoung Kim, Jeffrey W Hoffman, Scott J Ellis, Constantine A Demetracopoulos, Brett D Steineman
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引用次数: 0

摘要

背景:尽管后脚关节病可以缓解疼痛并矫正畸形,但它们与进行性胫距退变有关。目的是量化后足关节融合术(包括孤立的距下关节和距舟骨关节融合术)以及双关节融合术后胫足运动学的变化,并确定关节固定顺序是否影响胫足运动学。方法:对14具胫骨中段尸体标本进行足后关节置换术。标本首先接受距下关节或距舟骨关节的单独固定,然后固定其余关节进行双关节融合术。一个6自由度机器人依次模拟了完整、孤立和双关节融合术条件下水平行走的站立阶段。比较完整和关节融合术条件下胫骨的运动变化。随后的分析评估了关节固定顺序对胫足运动学的影响。结果:孤立性和双后脚关节炎在站立后期增加了胫足跖屈、内翻和内旋。单独关节融合术后发生的胫骨运动学变化在距下和距舟骨第一条件下的双关节融合术后保持一致。关节固定的顺序通过站立的某些部分影响胫足运动学,其中距舟骨第一双关节融合术与距下第一双关节相比增加了胫足跖屈、外翻和内旋。结论:在所有情况下,无论是孤立性还是双后脚关节病,胫骨运动学都有适度的改变。从孤立关节融合术到双关节融合术,胫足运动学的变化是一致的,并且根据首先进行的孤立后足关节融合术而变化。需要进一步的研究来评估观察到的胫足运动学变化的临床意义,特别是当它与相邻关节炎的发展有关时。临床相关性:这些发现可能与临床研究相关,该研究将后脚关节融合术作为相邻胫足关节炎的风险因素。一旦距下关节或距舟骨关节融合,避免第二关节的关节融合术可能不一定能保护胫距关节。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Hindfoot Arthrodeses and the Order of Joint Fixation Influence Tibiotalar Kinematics During Simulated Stance.

Background: Although hindfoot arthrodeses relieve pain and correct deformity, they have been associated with progressive tibiotalar degeneration. The objective was to quantify changes in tibiotalar kinematics after hindfoot arthrodeses, both isolated subtalar and talonavicular, as well as double arthrodesis, and to determine if the order of joint fixation affects tibiotalar kinematics.

Methods: Hindfoot arthrodeses were performed in 14 cadaveric mid-tibia specimens. Specimens randomly received isolated fixation of the subtalar or talonavicular joint first, followed by fixation of the remaining joint for the double arthrodesis. A 6-degree-of-freedom robot sequentially simulated the stance phase of level walking for intact, isolated, and double arthrodesis conditions. Tibiotalar kinematic changes were compared for the intact and arthrodesis conditions. A subsequent analysis assessed the effect of the joint fixation order on tibiotalar kinematics.

Results: Isolated and double hindfoot arthrodeses increased tibiotalar plantarflexion, inversion, and internal rotation during late stance. Tibiotalar kinematics changes occurring after isolated arthrodesis remained consistent after the double arthrodesis for both the subtalar- and talonavicular-first conditions. The order of joint fixation influenced tibiotalar kinematics through some portions of stance, where the talonavicular-first double arthrodesis increased tibiotalar plantarflexion, eversion, and internal rotation compared to the subtalar-first double.

Conclusion: Tibiotalar kinematics were modestly altered for all conditions, both isolated and double hindfoot arthrodeses. Changes in tibiotalar kinematics were consistent from the isolated to the double arthrodesis conditions and varied depending on which isolated hindfoot arthrodesis was performed first. Further research is needed to assess the clinical implications of the observed changes in tibiotalar kinematics, particularly as it pertains to the development of adjacent joint arthritis.

Clinical relevance: These findings may correlate with clinical research that has cited hindfoot arthrodesis as a risk factor for adjacent tibiotalar arthritis. Once either the subtalar or talonavicular joint is fused, avoiding the arthrodesis of the second joint may not necessarily protect the tibiotalar joint.

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来源期刊
Foot & Ankle International
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
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