Flexible Adult Acquired Flatfoot Deformity: Comparison Between Weight-Bearing and Non-Weight-Bearing Measurements Using Cone-Beam Computed Tomography.
Flexible Adult Acquired Flatfoot Deformity: Comparison Between Weight-Bearing and Non-Weight-Bearing Measurements Using Cone-Beam Computed Tomography.
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DOI：
10.2106/jbjs.16.01366
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发表时间：
2017-09-20
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影响因子：
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通讯作者：
Demehri, Shadpour
中科院分区：
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作者：
de Cesar Netto, Cesar;Schon, Lew C;Demehri, Shadpour
背景：成人获得性扁平足畸形的三维特征很难用x线片来描述。我们验证了这样一个假设，即负重（WB）锥束计算机断层扫描（CT）图像的测量比非负重（NWB）测量更有助于显示畸形的严重程度。方法：我们前瞻性地招募了12名男性和8名女性（平均年龄52岁，范围20至88岁），患有成人获得性平足畸形。受试者在站立（WB）和坐位（NWB）时接受锥形束CT扫描，并由3名独立观测者在矢状面、冠状面和轴向面进行多次测量。观察者内部和观察者之间的信度分别用Pearson或Spearman相关和类内相关系数（ICC）进行评估。测量值采用配对学生t检验或Wilcoxon秩和检验进行比较。P < 0.05被认为是显著的。结果：我们发现，总的来说，在NWB图像（平均ICC， 0.80；范围，0.49至0.99）和WB图像（平均ICC， 0.81；范围，0.39至0.99）上，测量结果在观察者内部和观察者之间都具有很大的可靠性。19个测量值中有18个在WB和NWB锥束CT图像之间存在差异，WB图像上有更明显的畸形。最可靠的测量,基于intraobserver和interobserver可靠性和WB和NWB图像之间的差异,是内侧cuneiform-to-floor距离,而平均29毫米(95%可信区间[CI] = 28日至31毫米)在NWB图像和18毫米(95% CI = 17到19毫米)在世行图片,和前脚掌弓角(意思是,13°(95% CI = 12°15°)和3.0°(95% CI = 1.4°到4.6°),分别)冠状视图和cuboid-to-floor距离(意思是,矢状面，分别为22mm [95% CI = 21 ~ 23mm]和17mm [95% CI = 16 ~ 18mm])和椎体到椎体的距离（平均38mm [95% CI = 36 ~ 40mm]和23mm [95% CI = 22 ~ 25mm]）。结论：使用高分辨率锥束CT可以获得与成人获得性扁平足畸形传统影像学参数类似的测量结果。与NWB图像相比，WB图像能更好地显示成人获得性柔性平足畸形患者骨性紊乱的严重程度。证据等级：诊断二级。有关证据水平的完整描述，请参见作者说明。
BACKGROUND: The 3-dimensional nature of adult acquired flatfoot deformity can be challenging to characterize using radiographs. We tested the hypothesis that measurements on weight-bearing (WB) cone-beam computed tomography (CT) images were more useful for demonstrating the severity of the deformity than non-weight-bearing (NWB) measurements.METHODS: We prospectively enrolled 12 men and 8 women (mean age, 52 years; range, 20 to 88 years) with flexible adult acquired flatfoot deformity. The subjects underwent cone-beam CT while standing (WB) and seated (NWB), and images were assessed in the sagittal, coronal, and axial planes by 3 independent observers who performed multiple measurements. Intraobserver and interobserver reliabilities were assessed with the Pearson or Spearman correlation and the intraclass correlation coefficient (ICC), respectively. Measurements were compared using paired Student t tests or Wilcoxon rank-sum tests. P < 0.05 was considered significant.RESULTS: We found that overall the measurements had substantial intraobserver and interobserver reliability on both the NWB images (mean ICC, 0.80; range, 0.49 to 0.99) and the WB images (mean ICC, 0.81; range, 0.39 to 0.99). Eighteen of 19 measurements differed between WB and NWB cone-beam CT images, with more pronounced deformities on the WB images. The most reliable measurements, based on intraobserver and interobserver reliabilities and the difference between WB and NWB images, were the medial cuneiform-to-floor distance, which averaged 29 mm (95% confidence interval [CI] = 28 to 31 mm) on the NWB images and 18 mm (95% CI = 17 to 19 mm) on the WB images, and the forefoot arch angle (mean, 13° [95% CI = 12° to 15°] and 3.0° [95% CI = 1.4° to 4.6°], respectively) in the coronal view and the cuboid-to-floor distance (mean, 22 mm [95% CI = 21 to 23 mm] and 17 mm [95% CI = 16 to 18 mm], respectively) and the navicular-to-floor distance (mean, 38 mm [95% CI = 36 to 40 mm] and 23 mm [95% CI = 22 to 25 mm], respectively) in the sagittal view.CONCLUSIONS: Measurements analogous to traditional radiographic parameters of adult acquired flatfoot deformity are obtainable using high-resolution cone-beam CT. Compared with NWB images, WB images better demonstrated the severity of osseous derangement in patients with flexible adult acquired flatfoot deformity.LEVEL OF EVIDENCE: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.