Talar neck angle correlates with tibial torsion-Guidance for 3D and 2D measurements in total ankle replacement
Talar neck angle correlates with tibial torsion-Guidance for 3D and 2D measurements in total ankle replacement
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DOI：
10.1002/jor.24928
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发表时间：
2020-12-08
影响因子：
2.8
通讯作者：
Imhoff, Florian B.
中科院分区：
文献类型：
--
作者：
Flury, Andreas;Viehofer, Arnd F.;Imhoff, Florian B.
全踝关节置换术中距骨部件的轴向平面对线知之甚少，仍然是一个主要问题，特别是因为错位导致峰值压力和旋转扭矩增加。因此，需要进一步深入了解距骨的个体解剖及其与近端和远端骨性结构的关系。因此，三维（3D）的表面模型，50下肢，使用计算机断层扫描数据的患者没有踝关节骨关节炎。利用一种新的三维测量方法测量距骨颈扭转。然后，胫骨扭转和距下关节轴的方向进行了测量，并与距骨颈扭转。此外，还建立了距骨颈扭转的二维测量方法。胫骨外侧扭转与内侧距骨颈扭转、距骨颈轴向与距下关节轴向在横断面和额面上均存在显著相关性。新定义的3D测量方法显示出良好的评分者间和评分者内可靠性。距骨颈扭转的二维测量方法与三维测量方法具有良好的一致性。结果表明，胫骨、距骨和邻近关节的旋转轮廓是相互关联的，在全踝关节置换术（TAR）中应考虑到这一点。临床相关性：本研究提高了对距骨解剖结构及其与相邻骨性结构关系的整体认识。这种新颖的距骨颈扭转的二维测量方法可能会改善距骨部件在轴向平面中的定位，从而提高TAR的生存率。
Axial plane alignment of the talar component in total ankle arthroplasty is poorly understood and remains a major issue, especially since malpositioning results in increased peak pressure and rotational torque. Further profound knowledge regarding individual anatomy of the talus and its relation to proximal and distal osseous structures is therefore needed. Therefore, three-dimensional (3D) surface models of 50 lower extremities were generated using computed tomography data of patients without ankle osteoarthritis. The talus neck torsion was measured using a novel 3D measurement method. Then, tibial torsion and subtalar joint axis orientation were measured and correlated to the talus neck torsion. Moreover, a 2D measurement method of the talus neck torsion was developed. A statistically significant correlation was found between external tibia torsion and medial talus neck torsion, as well as talus neck axis and subtalar joint axis in the transversal and frontal plane. The novel defined 3D measurement methods indicated excellent inter-rater and intra-rater reliability. The 2D measurement method of the talus neck torsion was in good agreement with the 3D method. The results showed that the rotational profiles of the tibia, talus, and adjacent joints are interconnected, which should be considered in total ankle replacement (TAR). Clinical relevance: This study improves the overall understanding of the talar anatomy, as well as its relationship to adjacent osseous structures. The novel 2D measurement method of the talus neck torsion might improve talar component positioning in the axial plane corresponding to the patient's individual anatomy, and therefore improve the survival rate of TAR.