New Radiographic Parameters Assessing Forefoot Abduction in the Adult Acquired Flatfoot Deformity
New Radiographic Parameters Assessing Forefoot Abduction in the Adult Acquired Flatfoot Deformity
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DOI：
10.3113/fai.2009.1168
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发表时间：
2009-12-01
影响因子：
2.7
通讯作者：
Deland, Jonathan T.
中科院分区：
文献类型：
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作者：
Ellis, Scott J.;Yu, Joseph C.;Deland, Jonathan T.
背景：根据距舟外展的程度，继发于胫骨后肌腱功能不全的II期扁平足可分为轻度(IIa)和重度(IIb)畸形。目前对这起绑架事件的评估很困难。我们假设两个新的前后位X线片参数，距舟外侧不一致角(IA)和不一致距离(ID)将显示出良好的可靠性，与现有的外展参数相关，并且在IIb畸形、IIa畸形和对照上有所不同。材料和方法：回顾连续接受扁平足再造的患者的术前X线片，并将其分为IIb期(n=32)和IIa期(n=8)畸形。第三组为非扁平足患者(n=30)。射线照片是由两名调查人员盲目测量的。信度评估采用组内相关系数(ICC)，与现有参数的相关性采用皮尔逊系数，组间比较采用方差分析。结果：IA的平均IC值分别为0.88和0.81。IA与覆盖角(r=0.86)和未覆盖百分比(r=0.76)有很好的相关性。IIb组的IA高于IIa组(p=0.007)，IIb组的IA高于对照组(p<；0.001)。ID具有很好的可靠性(ICC值分别为0.83和0.83)，但与其他两个外展参数的相关性较差(r=-0.59和-0.49)，无法区分三组(p=0.0528)。结论：此数据表明IA是可靠的，可能有助于II期扁平足畸形的亚型划分。
Background: Stage II flatfoot secondary to posterior tibial tendon insufficiency may be subclassified into mild (IIa) and severe (IIb) deformity based on the degree of talonavicular abduction. Current assessment of this abduction is difficult. We hypothesized that two new anteroposterior radiographic parameters, the lateral talonavicular incongruency angle (IA) and incongruency distance (ID) would demonstrate good reliability, correlate with current abduction parameters, and differ in IIb deformity, IIa deformity, and controls. Materials and Methods: Preoperative radiographs for consecutive patients undergoing flatfoot reconstruction were reviewed and subdivided into those with a Stage IIb (n = 32) or Stage IIa (n = 8) deformity. A third group of patients without flatfoot served as control (n = 30). Radiographs were measured blindly by two investigators. Reliability was assessed with intraclass correlation coefficients (ICC), correlation with existing parameters with Pearson coefficients, and comparison between groups with analysis of variance. Results: The mean intrarater and interrater ICC's for the IA (0.88 and 0.81, respectively) were high. The IA correlated well with the coverage angle (r = 0.86) and uncoverage percent (r = 0.76). The IA was higher in the IIb versus IIa patients (p = 0.007) and in the IIb group versus control (p < 0.001). The ID demonstrated excellent reliability (ICC's of 0.83 and 0.83), but correlated poorly with the two other abduction parameters (r = -0.59 and -0.49) and failed to differentiate between the three groups (p = 0.0528). Conclusion: This data suggests that the IA is reliable and may help subclassify Stage II flatfoot deformity.