Subtalar Joint Axis in Patients With Symptomatic Peritalar Subluxation Compared to Normal Controls
Subtalar Joint Axis in Patients With Symptomatic Peritalar Subluxation Compared to Normal Controls
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DOI：
10.1177/1071100714546549
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发表时间：
2014-11-01
影响因子：
2.7
通讯作者：
Sangeorzan, Bruce J.
中科院分区：
文献类型：
--
作者：
Apostle, Kelly L.;Coleman, Nathan W.;Sangeorzan, Bruce J.
背景：骨盆外半脱位（PTS）的病因尚不清楚，可能是多因素的。后足后外侧半脱位的解剖易感性此前未被描述或研究。本研究的目的是描述与正常对照相比，有症状的PTS患者距下关节轴（STJA）的形态。方法：我们从医院记录中找出有症状的PTS患者进行手术纠正。在模拟负重CT （SWBCT）扫描上绘制距下关节后突轴的角度。以站立片上无足部畸形的患者为对照组进行比较。STJA定义为冠状位CT扫描距骨上丘与距骨后突之间的角度。计算每个切口的平均、最大和最小STJAs，从前到后跨越后突。还检查了整个后关节突的进展趋势。结果：排除后，20例患者的22脚被纳入研究组，并与20例对照组进行比较。我们发现，PTS患者的距下关节外翻方向增加。在PTS患者中，STJA开始于外翻，并通过后突从前向后发展为更大的外翻。对照组的STJA开始于轻微的内翻，在前三分之一和中三分之一交界处过渡到外翻，然后随着关节向后发展外翻增加。结论：距下关节冠状面外翻方向可能是PTS病因的解剖学贡献。证据等级：III级，比较系列。
Background: The etiology of peritalar subluxation (PTS) is poorly understood and likely mutifactorial. An anatomic predisposition for posterolateral subluxation of the hindfoot has not been previously described or investigated. The aim of the current study was to describe the morphology of the subtalar joint axis (STJA) in patients with symptomatic PTS compared to normal controls.Methods: We identified patients with symptomatic PTS who had undergone operative correction from hospital records. The angle of the axis of the posterior facet of the subtalar joint was made on simulated weight-bearing CT (SWBCT) scans. A control group of patients who had no foot deformity on standing films was used for comparison. The STJA was defined as the angle between the superior talar dome and the posterior facet of the talus on coronal CT scan. The mean, maximum, and minimum STJAs were calculated for each cut from anterior to posterior across the posterior facet. The trend in progression across the posterior facet was also examined.Results: After exclusions, 22 feet in 20 patients were included in the study group and compared to 20 control subjects. It was seen that patients with PTS had an increased valgus orientation of the subtalar joint. In patients with PTS the STJA began in valgus and progressed to even greater valgus from anterior to posterior across the posterior facet. The STJA in control subjects was seen instead to begin in slight varus and transition to valgus at the junction of the anterior and middle third and then increase in valgus as the joint progressed posteriorly.Conclusions: The valgus orientation of the coronal plane of the subtalar joint may represent an anatomic contribution to the etiology of PTS.Level of Evidence: Level III, comparative series.