Dynamic Foot Bone Motion: Evaluation of Reconstructive Procedures

动态足骨运动：重建手术的评估

• 批准号: 8466815
• 负责人: William R. Ledoux
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-10-01 至 2012-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8466815
• 关键词: 20 year old; Affect; Age; Age-Years; Agreement; American; Arthrodesis; Bone callus; Bunion; Calibration; Censuses; Complex; Computer software; Custom; Data; Deformity; Diabetes Mellitus; Evaluation; Flatfoot; Flexor; Fluoroscope; General Population; Hammer Toes; Hypertension; Image; Immobilization; Incidence; Individual; Joints; Lateral; Lead; Letters; Link; Measurement; Measures; Medial; Metatarsal bone structure; Motion; Obesity; Older Population; Operative Surgical Procedures; Orthopedics; Osteotomy; Pathology; Patients; Population; Positioning Attribute; Prevalence; Procedures; Process; Recording of previous events; Research; Roentgen Rays; Source; Speed; Surgeon; System; Tendon Transfer; United States National Institutes of Health; Veterans; Walking; Work; abstracting; arm; bone; charge coupled device camera; clinical decision-making; clinical practice; clinically significant; diabetic; distraction; flexibility; foot; foot bone; human old age (65+); interest; kinematics; lateral column; multiple chronic conditions; orthotics; pressure

DESCRIPTION (provided by applicant): Project Summary/Abstract The pes planus deformity (flatfoot or peritalar subluxation) is the most common foot condition affecting patients of all ages in the U.S. Since the deformity often has a musculotendinous component and many patients have a history of diabetes, hypertension and obesity, the incidence of flatfoot is on the rise. The treatment for peritalar subluxation is not wel-standardized and may involve immobilization, orthotics, and in severe cases, surgical correction. These corective surgeries may include combinations of the folowing: tendon transfers or lengthenings, medial column plantar flexor osteotomies, medial column stabilizations, various hindfoot osteotomies and/or hindfoot arthrodeses. Of note is that there is little agreement among surgeons as to which surgical procedures to perform. The presence of hindfot valgus is a critical piece of information, as symptomatic flatfeet without hindfot valgus can often be corected with a medial column stabilization procedure; however, if hindfoot valgus is present, some measure of calcaneal osteotomy is required. While the specific type of osteotomy is dictated by the pathology of the flatfoot deformity, the most common hindfoot osteotomies (the medializing calcaneal osteotomy (MCO), the Evans calcaneal osteotomy, and the calcaneocuboid distraction arthrodesis (CCDA)) can all lead to increased lateral forefoot pressure. None of these procedures are ideal for pes planus with hindfoot valgus, forefoot abduction and a normal calcaneal pitch angle (a contraindication for lateral column procedures). Additionally, these osteotomies do not offer direct control of correction in all three planes. The calcaneal Z-osteotomy has been demonstrated to allow for correction in all three planes in feet with a varus hindfoot deformity. Recently, the Z-osteotomy has been has been described for corection of the pes planus deformity. The current clinical practice of the orthopaedic surgeon in our group is to perform a modified form of the calcaneal Z-osteotomy to treat pes planus with hindfoot valgus, forefoot abduction and a normal calcaneal pitch angle; however, this procedure has not been objectively studied. The purpose of this study is to compare and contrast the well-established calcaneal osteotomies (MCO and Evans) with the Z-osteotomy by studying bone pose, joint axis and plantar pressure pre- and post- surgery. We will use a highly specialized biplane fluoroscopic system to track the motion of the foot bones of interest. Our Specific Aims [1] To refine our existing biplane fluoroscopic system and [2] To study the fot bone motion of control (neutrally aligned) feet and flatfeet pre- and post-surgery with one of three possible calcaneal osteotomies: the MCO, Evans or Z-calcaneal osteotomy. We have two Philips BV-Pulsera C-arms that are configured to allow a subject to walk through the field of view of both systems while the foot is imaged. We aim to develop new software to track individual bones in high-speed fluoroscopic images, replace the existing CCD cameras with high-speed cameras and mount the X-ray sources and image intensifiers on customized posts that will greatly increase the flexibility of our biplane system. We will quantify the foot bone kinematics and plantar pressures 10 neutrally aligned subjects. We will also quantify the pre- and post-surgical foot bone kinematics and plantar pressures of 30 flat foot subjects, 10 of which will undergo either an MCO, an Evans calcaneal osteotomy or a Z-osteotomy.

描述（由申请人提供）： 项目摘要/摘要 扁平足畸形（平足或趾周半脱位）是影响美国所有年龄段患者的最常见足部疾病。由于该畸形通常具有肌腱成分，并且许多患者有糖尿病、高血压和肥胖病史，因此平足的发病率正在上升。会周半脱位的治疗尚未标准化，可能涉及固定、矫形器，在严重的情况下还需要手术矫正。这些矫正手术可包括以下组合：肌腱转移或延长、内侧柱跖屈肌截骨术、内侧柱稳定术、各种后足截骨术和/或后足关节融合术。值得注意的是，外科医生之间对于执行哪些手术程序几乎没有达成一致。后脚外翻的存在是一个重要的信息，因为没有后脚外翻的有症状的扁平足通常可以通过内侧柱稳定手术来矫正；然而，如果存在后足外翻，则需要采取一些跟骨截骨术。虽然截骨术的具体类型是由平足畸形的病理学决定的，但最常见的后足截骨术（内侧跟骨截骨术（MCO）、埃文斯跟骨截骨术和跟骰牵引​​关节固定术（CCDA））都可能导致前足外侧压力增加。这些手术对于后足外翻、前足外展和正常跟骨俯仰角（侧柱手术的禁忌症）的扁平足来说都不是理想的选择。此外，这些截骨术不能直接控制所有三个平面的矫正。跟骨 Z 形截骨术已被证明可以矫正后足内翻畸形的足部的所有三个平面。最近，Z形截骨术已被描述用于矫正扁平足畸形。目前本组骨科医生的临床实践是采用改良的跟骨Z形截骨术治疗后足外翻、前足外展、跟骨俯仰角正常的扁平足；然而，这一过程尚未得到客观研究。本研究的目的是通过研究手术前后的骨姿势、关节轴和足底压力，对成熟的跟骨截骨术（MCO 和 Evans）与 Z 截骨术进行比较和对比。我们将使用高度专业化的双平面荧光镜系统来跟踪感兴趣的足骨的运动。我们的具体目标 [1] 完善我们现有的双平面透视系统，[2] 研究控制（中性对齐）脚和扁平足手术前和术后的足骨运动，采用三种可能的跟骨截骨术之一：MCO、Evans 或 Z 跟骨截骨术。我们有两个飞利浦 BV-Pulsera C 形臂，其配置允许受试者在足部成像时穿过两个系统的视野。我们的目标是开发新的软件来跟踪高速透视图像中的单个骨骼，用高速摄像机取代现有的 CCD 摄像机，并将 X 射线源和图像增强器安装在定制的柱上，这将大大提高我们双翼飞机系统的灵活性。我们将量化 10 个中立对齐受试者的脚骨运动学和足底压力。我们还将量化 30 名平足受试者术前和术后的足骨运动学和足底压力，其中 10 名将接受 MCO、Evans 跟骨截骨术或 Z 形截骨术。