How Do Hindfoot Fusions Affect Ankle Biomechanics: A Cadaver Model
How Do Hindfoot Fusions Affect Ankle Biomechanics: A Cadaver Model
复制标题
后足融合如何影响脚踝生物力学：尸体模型
DOI：
10.1007/s11999-015-4671-5
复制
发表时间：
2016
期刊：
影响因子：
--
通讯作者：
J. Kennedy
中科院分区：
文献类型：
--
作者：
I. Hutchinson;J. Baxter;S. Gilbert;M. Hogan;J. Ling;Stuart M. Saunders;Hongsheng Wang;J. Kennedy
虽然成功的距下关节融换术可以缓解疼痛，但需要考虑踝关节生物力学的改变，因为该手术可能会使剩余的后脚和胫距关节加速退行性变化。然而，离体距下关节融合术和Chopart关节加性融合对胫距关节生物力学的影响仍知之甚少。问题/目的：我们的问题是：距舟骨和跟骨八方关节的距下孤立融合和连续Chopart关节融合对胫骨关节(1)力学和(2)运动学在脚中性、倒置和外翻方向加载期间的影响是什么？方法对7例新鲜冷冻足进行了距骨穹顶关节面接触应力的大小和分布，同时对加载过程中距骨相对于胫骨的位置进行了跟踪。每只脚在未融合、完整的对照条件下负重，随后进行三种随机模拟后足关节融合术：距下、双关节（距下和距舟骨）和三关节（距下、距舟骨和跟骰骨）融合术。使用金属楔插入物在三种对齐方式下测试完整和关节融合术的情况：中性（平）、10°倒置和10°翻转。结果不同后足关节的生物距力学（总力和接触面积）和运动学（外旋）存在差异。距下关节融合术后，在中立位加载时检测到的总力（445±142 N, 95% CI, 340-550 N，相比588±118 N， 95% CI, 500-676 N, p < 0.001）和接触面积（282 mm2, 95% CI, 222-342 mm2, 95% CI, 265-407 mm2, p < 0.026）降低；这些变化也出现在足部外翻位置。后足关节融合也与加载期间胫距关节外旋增加有关：距下关节融合在中立加载位置（3.3°±1.6°，95% CI, 2°-4.6°，p = 0.004）和旋转加载位置（4.8°±2.6°，95% CI, 2.7°-6.8°，p = 0.043）；双关节融合术在中立位（4.4°±2°，95% CI, 2.8°-6°，p = 0.003）和倒立位（5.8°±2.6°，95% CI, 3.7°-7.9°，p = 0.002），三联关节融合术在所有负重位，包括中立位（4.5°±1.8°，95% CI, 3.1°-5.9°，p = 0.002），倒立位（6.4°±3.5°，95% CI, 3.6°-9.2°，p = 0.009）和倾斜位（3.6°±2°，95% CI, 2°-5.2°，p = 0.053）。最后，在距下关节融合术后，Chopart关节的附加融合似乎没有导致可获得标本数量的胫距接触力学或运动学的额外观察差异。通过尸体生物力学模型，我们确定了后足融合后加载过程中踝关节生物力学的一些可预测趋势。在我们的测试标本中，距下关节的融合似乎对踝关节负荷产生了主要影响。距下关节功能的丧失或缺陷可能足以改变踝关节负荷。这些发现值得考虑后足关节炎的治疗，也有助于确定伴随后足退变或关节融合术的踝关节置换术的生物力学目标。
BackgroundWhile successful subtalar joint arthrodesis provides pain relief, resultant alterations in ankle biomechanics need to be considered, as this procedure may predispose the remaining hindfoot and tibiotalar joint to accelerated degenerative changes. However, the biomechanical consequences of isolated subtalar joint arthrodesis and additive fusions of the Chopart’s joints on tibiotalar joint biomechanics remain poorly understood.Questions/purposesWe asked: What is the effect of isolated subtalar fusion and sequential Chopart’s joint fusions of the talonavicular and calcaneocuboid joints on tibiotalar joint (1) mechanics and (2) kinematics during loading for neutral, inverted, and everted orientations of the foot?MethodsWe evaluated the total force, contact area, and the magnitude and distribution of the contact stress on the articular surface of the talar dome, while simultaneously tracking the position of the talus relative to the tibia during loading in seven fresh-frozen cadaver feet. Each foot was loaded in the unfused, intact control condition followed by three randomized simulated hindfoot arthrodesis modalities: subtalar, double (subtalar and talonavicular), and triple (subtalar, talonavicular, and calcaneocuboid) arthrodesis. The intact and arthrodesis conditions were tested in three alignments using a metallic wedge insert: neutral (flat), 10° inverted, and 10° everted.ResultsTibiotalar mechanics (total force and contact area) and kinematics (external rotation) differed owing to hindfoot arthrodeses. After subtalar arthrodesis, there were decreases in total force (445 ± 142 N, 95% CI, 340-550 N, versus 588 ± 118 N, 95% CI, 500–676 N; p < 0.001) and contact area (282 mm2, 95% CI, 222–342 mm2, versus 336 ± 96 mm2, 95% CI, 265–407 mm2; p < 0.026) detected during loading in the neutral position; these changes also were seen in the everted foot position. Hindfoot arthrodesis also was associated with increased external rotation of the tibiotalar joint during loading: subtalar arthrodesis in the neutral loading position (3.3° ± 1.6°; 95% CI, 2°–4.6°; p = 0.004) and everted loading position (4.8° ± 2.6°; 95% CI, 2.7°–6.8°; p = 0.043); double arthrodesis in neutral (4.4° ± 2°; 95% CI, 2.8°–6°; p = 0.003) and inverted positions (5.8° ± 2.6°; 95% CI, 3.7°–7.9°; p = 0.002), and triple arthrodesis in all loaded orientations including neutral (4.5° ± 1.8°; 95% CI, 3.1°–5.9°; p = 0.002), inverted (6.4° ± 3.5°; 95% CI, 3.6°–9.2°; p = 0.009), and everted (3.6° ± 2°; 95% CI, 2°–5.2°; p = 0.053) positions. Finally, after subtalar arthrodesis, additive fusions at Chopart’s joints did not appear to result in additional observed differences in tibiotalar contact mechanics or kinematics with the number of specimens available.ConclusionsUsing a cadaveric biomechanical model, we identified some predictable trends in ankle biomechanics during loading after hindfoot fusion. In our tested specimens, fusion of the subtalar joint appeared to exert a dominant influence over ankle loading.Clinical RelevanceA loss or deficit in function of the subtalar joint may be sufficient to alter ankle loading. These findings warrant consideration in the treatment of the arthritic hindfoot and also toward defining biomechanical goals for ankle arthroplasty in the setting of concomitant hindfoot degeneration or arthrodesis.
登录
查看更多内容
模拟步态期间基于图像的加权邻近中心与直接测量的膝盖接触位置。
影响因子：
2.4
作者：
Wang,Hongsheng;Chen,Tony;Koff,MatthewF;Hutchinson,IanD;Gilbert,Susannah;Choi,Dan;Warren,RussellF;Rodeo,ScottA;Maher,SuzanneA
通讯作者：
Maher,SuzanneA
在模拟步态过程中，胫骨高原上的动态接触应力模式：归一化跨相关的新型应用。
影响因子：
2.4
作者：
Wang, Hongsheng;Chen, Tony;Torzilli, Peter;Warren, Russell;Maher, Suzanne
通讯作者：
Maher, Suzanne
影响因子：
--
作者：
Ko, Frank C.;Dragomir, Cecilia;Plumb, Darren A.;Goldring, Steven R.;Wright, Timothy M.;Goldring, Mary B.;van der Meulen, Marjolein C. H.
通讯作者：
van der Meulen, Marjolein C. H.
影响因子：
2.4
作者：
Imhauser, Carl W.;Siegler, Sorin;Toy, Jason R.
通讯作者：
Toy, Jason R.
影响因子：
--
作者：
Loeser, Richard F.;Goldring, Steven R.;Scanzello, Carla R.;Goldring, Mary B.
通讯作者：
Goldring, Mary B.