Subtalar Joint Instability and Calcaneal Spurs Associated with the Configuration of the Articular Facets of Adult Human Calcaneum in Indian Population
Subtalar Joint Instability and Calcaneal Spurs Associated with the Configuration of the Articular Facets of Adult Human Calcaneum in Indian Population
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DOI：
10.7860/jcdr/2016/20216.8444
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发表时间：
2016-09-01
影响因子：
0.2
通讯作者：
Vasudevava, Neelam
中科院分区：
文献类型：
--
作者：
Agarwal, Shilpi;Garg, Shilpi;Vasudevava, Neelam
导读：跟骨关节面形态的变化可能使人们易患关节不稳定、韧带松弛和距下关节关节炎的发展。了解这些变异对于骨科手术的治疗和诊断程序是必不可少的。目的：本研究的目的是确定跟骨关节面模式，并建立其与跟骨刺的相关性。材料与方法：对Maulana Azad医学院580例印度裔成年跟骨进行研究，观察关节面模式，并根据文献描述的五种模式进行分类。使用数字游标卡尺测量前、中关节突之间的分离。使用UTHSCSA图像工具软件计算前、内切面相交角度。目测观察跟骨刺。结果：580例跟骨中，66.55%的患者前、中关节面融合（模式一），27.59%的患者三关节面分离（模式二），5.52%的患者前关节面缺失（模式三），0.17%的患者三关节面融合（模式四），0.17%的患者中、后关节面融合（模式五）。模式III中存在显著的侧变异，以左侧为主。模式1的平均交角为147.700，模式2的平均交角为133.340。跟骨刺占61.38%，其中ⅰ型占43.62%，ⅱ型占14.66%，ⅲ型占2.76%。结论：I型和III型跟骨患者发生距下关节不稳定的风险大于II型跟骨患者。模式1交角为钝角，导致韧带松弛，关节不稳定。模式1在印度人群中更为常见，这一事实需要修改西方手术技术以适应印度的情况。骨刺的存在和关节突结构之间的关联被发现是显著的。
Introduction: Morphological variations of articular facets of calcaneum may predispose people to joint instability, ligamentous laxity and development of arthritic changes in the subtalar joint. Knowledge of such variations is essential for treatment and diagnostic procedures in orthopaedic surgeries.Aim: The aim of this study was to determine patterns of articular facets of calcanei and to establish its correlation with calcaneal spurs.Materials and Methods: The study was conducted on 580 adult calcanei of Indian origin at Maulana Azad Medical College and pattern of articular facets were observed and classified according to five patterns described in literature. A digital vernier calliper was used to measure separation between anterior and middle facet. Degree of intersecting angle between anterior and medial facets was calculated using UTHSCSA Image Tool software. The calcaneal spurs were observed by visual inspection.Results: Out of 580 calcanei, 66.55% had fused anterior and middle facets (Pattern I), 27.59% had all three facets separate (Pattern II), 5.52% had absence of anterior facet (Pattern III), 0.17% had all three facets fused (Pattern IV) and 0.17% had fused middle and posterior facets (Pattern V). A significant side variation was present in Pattern III with predominance on left side. Mean angle of intersection was 147.700 in Pattern I and 133.340 in Pattern II calcaneum. Calcaneal spurs were found in 61.38% out of which it was associated with Pattern I in 43.62%, Pattern II in 14.66% and Pattern III in 2.76%.Conclusion: Individuals with Pattern I and III calcaneum were found to be at a greater risk of subtalar joint instability than individuals with Pattern II. Angle of intersection was obtuse in Pattern I which resulted in ligament laxity and unstable joint. Pattern I was more common in Indian population and this fact necessitates modifications of the western surgical techniques to suit the Indian scenario. An association between the presence of spur and facet configuration was found to be significant.