{"title":"Windlass机制功能障碍与拇僵直相关：一项病例对照研究。","authors":"Takumi Kihara, Tadashi Kimura, Naoki Suzuki, Asaki Hattori, Mitsuru Saito, Makoto Kubota","doi":"10.2106/JBJS.24.00437","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The cause of hallux rigidus remains controversial. However, it is assumed that dysfunction of the windlass mechanism and metatarsus primus elevatus play a role in the pathology. Three-dimensional (3D) computed tomography (CT) imaging is ideal for analysis of movements of the foot, which involve 3D and rotational motion. The purpose of the present study was to compare the windlass mechanism in healthy normal feet with that in feet with hallux rigidus by 3D CT imaging.</p><p><strong>Methods: </strong>A total of 17 feet with hallux rigidus and 21 normal feet were selected. Hallux rigidus was classified as grade 1 or 2 with use of the Coughlin and Shurnas system. CT imaging was performed during weight-bearing and non-weight-bearing with the first metatarsophalangeal joint in a neutral position or in 30° of dorsiflexion. We measured the rotation of each joint and the height of the navicular during dorsiflexion and weight-bearing. We also compared changes in the tarsometatarsal joint and metatarsus primus elevatus in the neutral position between the non-weight-bearing and weight-bearing conditions.</p><p><strong>Results: </strong>During dorsiflexion, there were significant differences between the 2 groups in eversion and adduction at the talonavicular and talocalcaneal joints (p < 0.05), with less movement of bones in the hallux rigidus group. There was a significantly greater increase in height of the navicular in the control group than in the hallux rigidus group (1.2 ± 0.6 mm versus 0.7 ± 0.6 mm; p = 0.02). There was also a significant difference in metatarsus primus elevatus during the non-weight-bearing and weight-bearing conditions (p < 0.01).</p><p><strong>Conclusions: </strong>Hallux rigidus restricts the movement of the Chopart joint and hindfoot associated with dorsiflexion of the first metatarsophalangeal joint, suggesting an association between hallux rigidus and windlass mechanism dysfunction.</p><p><strong>Level of evidence: </strong>Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"558-564"},"PeriodicalIF":4.4000,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905900/pdf/","citationCount":"0","resultStr":"{\"title\":\"Dysfunction of the Windlass Mechanism Is Associated with Hallux Rigidus: A Case-Control Study.\",\"authors\":\"Takumi Kihara, Tadashi Kimura, Naoki Suzuki, Asaki Hattori, Mitsuru Saito, Makoto Kubota\",\"doi\":\"10.2106/JBJS.24.00437\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The cause of hallux rigidus remains controversial. However, it is assumed that dysfunction of the windlass mechanism and metatarsus primus elevatus play a role in the pathology. Three-dimensional (3D) computed tomography (CT) imaging is ideal for analysis of movements of the foot, which involve 3D and rotational motion. The purpose of the present study was to compare the windlass mechanism in healthy normal feet with that in feet with hallux rigidus by 3D CT imaging.</p><p><strong>Methods: </strong>A total of 17 feet with hallux rigidus and 21 normal feet were selected. Hallux rigidus was classified as grade 1 or 2 with use of the Coughlin and Shurnas system. CT imaging was performed during weight-bearing and non-weight-bearing with the first metatarsophalangeal joint in a neutral position or in 30° of dorsiflexion. We measured the rotation of each joint and the height of the navicular during dorsiflexion and weight-bearing. We also compared changes in the tarsometatarsal joint and metatarsus primus elevatus in the neutral position between the non-weight-bearing and weight-bearing conditions.</p><p><strong>Results: </strong>During dorsiflexion, there were significant differences between the 2 groups in eversion and adduction at the talonavicular and talocalcaneal joints (p < 0.05), with less movement of bones in the hallux rigidus group. There was a significantly greater increase in height of the navicular in the control group than in the hallux rigidus group (1.2 ± 0.6 mm versus 0.7 ± 0.6 mm; p = 0.02). There was also a significant difference in metatarsus primus elevatus during the non-weight-bearing and weight-bearing conditions (p < 0.01).</p><p><strong>Conclusions: </strong>Hallux rigidus restricts the movement of the Chopart joint and hindfoot associated with dorsiflexion of the first metatarsophalangeal joint, suggesting an association between hallux rigidus and windlass mechanism dysfunction.</p><p><strong>Level of evidence: </strong>Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.</p>\",\"PeriodicalId\":15273,\"journal\":{\"name\":\"Journal of Bone and Joint Surgery, American Volume\",\"volume\":\" \",\"pages\":\"558-564\"},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2025-03-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905900/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Bone and Joint Surgery, American Volume\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2106/JBJS.24.00437\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/31 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Bone and Joint Surgery, American Volume","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2106/JBJS.24.00437","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/31 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
背景：拇僵直的病因仍有争议。然而，据推测，起锚机制和上跖骨的功能障碍在病理上起作用。三维（3D）计算机断层扫描（CT）成像是分析涉及3D和旋转运动的足部运动的理想选择。本研究的目的是通过三维CT成像比较健康正常足与拇硬结足的windlass机制。方法：选取拇趾僵直足17只，正常足21只。使用Coughlin和Shurnas系统将拇僵硬分为1级或2级。在负重和非负重时，第一跖趾关节处于中立位或背屈30°时进行CT成像。我们测量了每个关节的旋转和舟骨在背屈和负重时的高度。我们还比较了非负重和负重两种情况下中立位时跗跖关节和上跖原骨的变化。结果：背屈时，两组距舟关节、距跟关节外翻、内收差异有统计学意义（p < 0.05），拇僵直组骨活动较少。对照组舟骨高度的增加明显大于拇僵直组（1.2±0.6 mm vs 0.7±0.6 mm）；P = 0.02)。非负重组和负重组的抬高跖骨量差异有统计学意义（p < 0.01）。结论：拇僵直限制了Chopart关节和后足的活动，并伴有第一跖趾关节背屈，提示拇僵直与windlass机制功能障碍有关。证据等级：预后III级。有关证据水平的完整描述，请参见作者说明。
Dysfunction of the Windlass Mechanism Is Associated with Hallux Rigidus: A Case-Control Study.
Background: The cause of hallux rigidus remains controversial. However, it is assumed that dysfunction of the windlass mechanism and metatarsus primus elevatus play a role in the pathology. Three-dimensional (3D) computed tomography (CT) imaging is ideal for analysis of movements of the foot, which involve 3D and rotational motion. The purpose of the present study was to compare the windlass mechanism in healthy normal feet with that in feet with hallux rigidus by 3D CT imaging.
Methods: A total of 17 feet with hallux rigidus and 21 normal feet were selected. Hallux rigidus was classified as grade 1 or 2 with use of the Coughlin and Shurnas system. CT imaging was performed during weight-bearing and non-weight-bearing with the first metatarsophalangeal joint in a neutral position or in 30° of dorsiflexion. We measured the rotation of each joint and the height of the navicular during dorsiflexion and weight-bearing. We also compared changes in the tarsometatarsal joint and metatarsus primus elevatus in the neutral position between the non-weight-bearing and weight-bearing conditions.
Results: During dorsiflexion, there were significant differences between the 2 groups in eversion and adduction at the talonavicular and talocalcaneal joints (p < 0.05), with less movement of bones in the hallux rigidus group. There was a significantly greater increase in height of the navicular in the control group than in the hallux rigidus group (1.2 ± 0.6 mm versus 0.7 ± 0.6 mm; p = 0.02). There was also a significant difference in metatarsus primus elevatus during the non-weight-bearing and weight-bearing conditions (p < 0.01).
Conclusions: Hallux rigidus restricts the movement of the Chopart joint and hindfoot associated with dorsiflexion of the first metatarsophalangeal joint, suggesting an association between hallux rigidus and windlass mechanism dysfunction.
Level of evidence: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
期刊介绍：
The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
