New anatomical reference systems for the bones of the foot and ankle complex: definitions and exploitation on clinical conditions.
New anatomical reference systems for the bones of the foot and ankle complex: definitions and exploitation on clinical conditions.
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DOI：
10.1186/s13047-021-00504-5
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发表时间：
2021-12-20
影响因子：
2.9
通讯作者：
Belvedere C
中科院分区：
文献类型：
--
作者：
Conconi M;Pompili A;Sancisi N;Leardini A;Durante S;Belvedere C
足部和踝关节复合体的所有骨骼的解剖参考系统(ARS)的完整定义是缺乏的。利用形态学方法，我们为这些骨骼提出了新的ARS，目的是高度可重复的，个体之间一致的，临床上可解释的，也适合于合理的运动学描述。对3例健康供者和3例扁平足患者的标本进行了负重CT扫描。根据所提出的方法对足部骨骼进行分割并定义ARS。为了评估可重复性，计算了操作者内和操作者间的类内系数(ICC)。一致性被评估为ARS位置和方向的标准偏差的平均值，包括在正常和平坦的足部。通过量化内侧纵弓和横弓的曲率变化，并根据这些新的ARS轴计算正常足和扁平足的Giann-Annon ier角，来评估临床可解释性。为了测试提供足部运动学的合理描述的能力，对平均螺旋轴(MHA)和ARS轴之间的对齐进行了量化。操作者间和操作者内的ICC均为0.99。平足和正常足的旋转一致性分别为4.7 ± 3.5°和6.2 ± 4.4°，平移一致性分别为4.4 ± 4.0 mm和5.4 ± 2.9 mm。在这两种情况下，一致性都好于使用主惯性轴实现的一致性。足弓的曲率变化被很好地描述，正常足和平足的Giann-Annoier角的测量结果与相应的临床观察相吻合。距骨距骨位MHA与ARS内侧轴夹角为12.3 ± 6.0，跟骨距骨位MHA与ARS前后位轴位夹角为17.2 ± 5.6，具有较好的关节运动学表征能力。提出的ARS定义是稳健的，并为从医学成像中三维描述足部和脚踝复合体的姿势和运动提供了坚实的基础。网上版载有补充材料，可在10.1186/s13047021-00504-5查阅。
A complete definition of anatomical reference systems (ARS) for all bones of the foot and ankle complex is lacking. Using a morphological approach, we propose new ARS for these bones with the aim of being highly repeatable, consistent among individuals, clinically interpretable, and also suited for a sound kinematic description. Three specimens from healthy donors and three patients with flat feet were scanned in weight-bearing CT. The foot bones were segmented and ARS defined according to the proposed approach. To assess repeatability, intra class coefficients (ICC) were computed both intra- and inter-operator. Consistency was evaluated as the mean of the standard deviations of the ARS position and orientation, both within normal and flat feet. Clinical interpretability was evaluated by providing a quantification of the curvature variation in the medial-longitudinal and transverse arches and computing the Djiann-Annonier angle for normal and flat feet from these new ARS axes. To test the capability to also provide a sound description of the foot kinematics, the alignment between mean helical axes (MHA) and ARS axes was quantified. ICC was 0.99 both inter- and intra-operator. Rotational consistency was 4.7 ± 3.5 ° and 6.2 ± 4.4° for the normal and flat feet, respectively; translational consistency was 4.4 ± 4.0 mm and 5.4 ± 2.9 mm for the normal and flat feet, respectively. In both these cases, the consistency was better than what was achieved by using principal axes of inertia. Curvature variation in the arches were well described and the measurements of the Djiann-Annoier angles from both normal and flat feet matched corresponding clinical observations. The angle between tibio-talar MHA and ARS mediolateral axis in the talus was 12.3 ± 6.0, while the angle between talo-calcaneal MHA and ARS anteroposterior axis in the calcaneus was 17.2 ± 5.6, suggesting good capability to represent joint kinematics. The proposed ARS definitions are robust and provide a solid base for the 3-dimensional description of posture and motion of the foot and ankle complex from medical imaging. The online version contains supplementary material available at 10.1186/s13047-021-00504-5.
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