Changes in Chopart joint load following tibiotalar arthrodesis: in vitro analysis of 8 cadaver specimen in a dynamic model
Changes in Chopart joint load following tibiotalar arthrodesis: in vitro analysis of 8 cadaver specimen in a dynamic model
复制标题
DOI：
10.1186/1471-2474-8-80
复制
发表时间：
2007-08-08
影响因子：
2.3
通讯作者：
Wulker, N.
中科院分区：
文献类型：
--
作者：
Suckel, A.;Muller, O.;Wulker, N.
背景：在目前踝关节内关节病变的手术治疗讨论中，关节融合术与人工关节置换术处于竞争地位。到目前为止，还没有关于关节融合术后关节内负荷变化的有效生物力学发现。反对胫距关节融合术的一个论点是，距舟关节的长期退变通常与生物力学应力的变化有关。方法：我们使用一个动态模型来确定8具尸体的脚在模拟站立阶段的压力下距舟关节和跟骰关节的关节内力和峰值压力的变化。结果：关节融合术后所见的变化是平均力和最大压力从外侧转移到足内侧柱的趋势。距舟关节的平均受力从初始的92 N增加到100 N，跟方关节的平均受力从54 N减少到48 N，距舟关节的峰值压力从初始的3.9 MPa增加到4.4 MPa，跟方关节的峰值压力从3.3 MPa增加到3.4 MPa。距舟关节上的力和峰值压力增加，跟骰关节上的力减少，具有统计学意义。结论：动态模型显示，胫距关节融合术后足内侧柱上施加的力和峰值压力增加，从生物力学角度解释了临床观察到的长期足内侧背软骨退变现象。从测量得出的临床结论来看，为了获得更有利的长期临床结果，通过适当的鞋子调整，减少施加在内侧柱上的力，将其转移到外侧前足，是可取的。
Background: In the current discussion of surgical treatment of arthroses in the ankle joint, arthrodesis is in competition with artificial joint replacement. Up until now, no valid biomechanical findings have existed on the changes in intraarticular loads following arthrodesis. One argument against tibiotalar arthrodesis is the frequently associated, long-term degeneration of the talonavicular joint, which can be attributed to changes in biomechanical stresses.Methods: We used a dynamic model to determine the changes in intraarticular forces and peak-pressure in the talonavicular joint and in the calcaneocuboid joint on 8 cadaver feet under stress in a simulated stance phase following tibiotalar arthrodesis.Results: The change seen after arthrodesis was a tendency of relocation of average force and maximum pressure from the lateral onto the medial column of the foot. The average force increased from native 92 N to 100 N upon arthrodesis in the talonavicular joint and decreased in the calcaneocuboid joint from 54 N to 48 N. The peak pressure increased from native 3.9 MPa to 4.4 MPa in the talonavicular joint and in the calcaneocuboid joint from 3.3 MPa to 3.4 MPa. The increase of force and peak pressure on the talonavicular joint and decrease of force on the calcaneocuboid joint is statistically significant.Conclusion: The increase in imparted force and peak pressure on the medial column of the foot following tibiotalar arthrodesis, as was demonstrated in a dynamic model, biomechanically explains the clinically observed phenomenon of cartilage degeneration on the medial dorsum of the foot in the long term. As a clinical conclusion from the measurements, it would be desirable to reduce the force imparted on the medial column with displacement onto the lateral forefoot, say by suitable shoe adjustment, in order to achieve a more favourable long-term clinical result.