Weightbearing CT scan of severe flexible pes planus deformities
Weightbearing CT scan of severe flexible pes planus deformities
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DOI：
10.3113/fai.2008.0199
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发表时间：
2008-02-01
影响因子：
2.7
通讯作者：
Pearce, Dawn
中科院分区：
文献类型：
--
作者：
Ferri, Melanie;Scharfenberger, Angela V.;Pearce, Dawn
背景：扁平足畸形的足部骨骼的三维关系很难用标准X线片进行评估。CT扫描证实了这些关系，但通常是在非负重模式下进行的。我们的目的是评估使用负重CT设备对严重柔性扁平足畸形患者的足部进行成像，并更好地定义发生的解剖学变化。材料和方法：设计并制造一种专用装置，在CT检查过程中模拟足部负重。18只正常足和30只疼痛的严重和灵活的扁平足足在非负重和负重状态下成像，设定为体重的50%。对扁平足和正常足的跗骨间关系进行了几次测量。在负重和非负重状态下，在冠状面测量舟状骨底到皮肤的距离、前足弓角和距下关节半脱位。采用t检验分析舟底至皮肤距离和前足弓角的测量值。结果如下：负重装置对正常足和扁平足足的足部构型有显著影响（p = 0.0008），对地板到皮肤的距离和前足足弓角分别有显著影响（p < 0.0001）。正常足和扁平足在非负重状态（p = 0.02）和负重状态（p = 0.01）的前足弓角方面存在显著差异。4例扁平足患者有距下关节半脱位的证据，在负重状态下更明显。在非负重状态（p = 0.05）或负重状态（p = 0.07）下，正常足与扁平足足的舟底至皮肤距离无显著差异。结论：器械的设计和构造旨在施加相当于50%体重的承重载荷，患者不适感极小或无。结果对足外形有显著影响，可用于评估扁平足畸形程度，指导临床治疗。扁平足患者与正常志愿者之间最显着差异的措施是前足弓角。因此，前足弓角可能是最有用的措施，为影像学诊断的灵活的扁平足，和程度的扁平足畸形。
Background: The three-dimensional relationships of the bones in the foot in a flatfoot deformity are difficult to assess with standard radiographs. CT scans demonstrate these relationships but are typically made in a nonweightbearing mode. Our objective was to assess the use of a weightbearing CT apparatus to image the feet in patients with severe flexible pes planus deformities and to better define the anatomical changes that occur. Materials and Methods: A specialized device was designed and constructed to simulate weightbearing to the feet during CT examination. Eighteen normal feet and 30 painful severe and flexible pes planus feet were imaged in both the non weightbearing and weightbearing states, set at 50% of body weight. Several measurements of intertarsal relationships were made of the pes planus and normal feet. Navicular floor to skin distance, forefoot arch angle, and subtalar joint subluxation were measured in the coronal plane in both the weightbearing and nonweightbearing states. T-tests were used to analyze measurements of navicular floor to skin distance and forefoot arch angle. Results: The weightbearing device had a significant effect on foot configuration for both normal and pes planus feet (p = 0.0008) and (p < 0.0001) respectively for both floor to skin distance and forefoot arch angle. There was a significant difference between normal feet and pes planus feet with regard to the forefoot arch angle in the nonweightbearing (p = 0.02) and weightbearing states (p = 0.01). Four of the pes planus patients had evidence of subtalar joint subluxation which was more pronounced in the weightbearing state. There was no significant difference between the navicular floor to skin distance in the normal versus pes planus feet in either the non weightbearing (p = 0.05) or the weightbearing states (p = 0.07). Conclusion: A device wets designed and constructed to apply a weightbearing load equal to that of 50% body weight with minimal to no patient discomfort. The resultant effects on foot configuration were significant, and are useful for assessment of degree of flexible flat foot deformity, thus guiding clinical management. The measure which most significantly differed between pes planus patients and normal volunteers was the forefoot arch angle. Forefoot arch angle may therefore be the most useful measure for the imaging diagnosis of flexible pes planus, and the degree of planus deformity.