Dynamic Foot Bone Motion: Evaluation of Reconstructive Procedures

描述（由申请人提供）： 项目摘要/摘要扁平足畸形（扁平足或扁平足周围半脱位）是影响美国所有年龄段患者的最常见足部疾病。由于畸形通常具有肌肉肌腱成分，并且许多患者有糖尿病、高血压和肥胖症病史，扁平足的发病率正在上升。髋关节周围半脱位的治疗并不是很标准化，可能包括固定、矫形，严重者还需要手术矫正。这些矫正手术可能包括以下组合：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种外科手术几乎没有一致意见。后足外翻的存在是一个关键信息，因为症状性扁平足不伴后足外翻通常可以通过内侧柱稳定手术矫正;但是，如果后足外翻，则需要进行一些跟骨截骨术。虽然截骨术的具体类型取决于扁平足畸形的病理，但最常见的后足截骨术（内侧跟骨截骨术（MCO）、Evans跟骨截骨术和跟骰骨牵引关节固定术（CCDA））都可能导致前足外侧压力增加。这些手术都不适合伴有后足外翻、前足外展和正常跟骨俯仰角（外侧柱手术的禁忌症）的扁平足。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所有三个平面。最近，Z形截骨术已被描述为矫正扁平足畸形。我们组的骨科医生目前的临床实践是进行跟骨Z形截骨术的改良形式，以治疗后足外翻、前足外展和正常跟骨俯仰角的扁平足;然而，尚未对该手术进行客观研究。本研究的目的是通过研究术前和术后的骨姿势、关节轴和足底压力，比较和对比成熟的跟骨截骨术（MCO和Evans）与Z形截骨术。我们将使用高度专业化的双平面透视系统来跟踪感兴趣的足部骨骼的运动。我们的具体目标[1]改进我们现有的双平面透视系统[2]研究对照（中性对齐）足和扁平足在三种可能的跟骨截骨术（MCO、Evans或Z形跟骨截骨术）术前和术后的fot骨运动。我们有两个Philips BV-Pulsera C形臂，配置为允许受试者在足部成像时步行通过两个系统的视野。我们的目标是开发新的软件来跟踪高速透视图像中的个体骨骼，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立柱上，这将大大增加我们的双平面系统的灵活性。我们将量化10个中性对齐的受试者的足部骨骼运动学和足底压力。我们还将量化30名扁平足受试者手术前后的足部骨骼运动学和足底压力，其中10名将接受MCO、Evans跟骨截骨术或Z形截骨术。

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.