CAJ | 학술논문

目的探讨单纯距下关节融合术后中足关节的活动度改变和退变情况.方法回顾性分析1996年1月至2011年8月行距下关节融合并获得完整随访的37例患者资料,男27例,女10例;年龄13～74岁,平均42.6岁.采用健康调查简易量表(the MOS item short form health survey,SF-36)评分和美国足踝外科学会(American Orthopaedic Foot and Ankle Society,AOFAS)中足评分评价疗效.摄双足负重位X线片,观察中足关节是否有退变.双足在踝关节最大跖屈和最大背伸时摄侧位X线片,从矢状面测量Meary角,比较患侧与健侧跖跗关节活动度.患者站立于内翻30°和外翻30°斜面并摄踝关节正位X线片,从冠状面测量胫骨长轴与足前跖面所夹锐角(tibio-plantar angle,TPA),比较中足的活动度改变.行足踝部SPECT/CT检查,评估中足关节退变情况.结果 37例患者随访2～17年,平均9.2年.术前SF-36总分评分为(34.26±11.02)分,末次随访时为(77.59±12.57)分,两者比较有统计学差异;术前AOFAS中足评分为(86.14±16.79)分,末次随访时为(86.43±16.70)分,两者比较差异无统计学意义.矢状面,内侧跖跗关节活动度患侧约受限20％.冠状面,内翻时健侧与患侧TPA分别平均为61.32°和64.91°,患侧减小12.5％;外翻时双侧TPA分别平均为76.54°和82.28°,患侧减小约42.6％.SPECT/CT发现13例患者(35.1％,13/37)的距舟关节、21例(56.8％,21/37)的跟骰关节、10例(27.0％,10/37)的跖骰关节、5例(13.5％,5/37)的舟楔关节发生退变,但关节无明显疼痛.结论距下关节融合可导致中足的矢状面活动受限,冠状面活动代偿性增加,特别是外侧跗中和跖跗关节活动度增加,这使跗中关节更易出现轻度退变.
목적 탐토단순거하관절융합술후중족관절적활동도개변화퇴변정황.방법 회고성분석1996년1월지2011년8월행거하관절융합병획득완정수방적37례환자자료,남27례,녀10례;년령13～74세,평균42.6세.채용건강조사간역량표(the MOS item short form health survey,SF-36)평분화미국족과외과학회(American Orthopaedic Foot and Ankle Society,AOFAS)중족평분평개료효.섭쌍족부중위X선편,관찰중족관절시부유퇴변.쌍족재과관절최대척굴화최대배신시섭측위X선편,종시상면측량Meary각,비교환측여건측척부관절활동도.환자참립우내번30°화외번30°사면병섭과관절정위X선편,종관상면측량경골장축여족전척면소협예각(tibio-plantar angle,TPA),비교중족적활동도개변.행족과부SPECT/CT검사,평고중족관절퇴변정황.결과 37례환자수방2～17년,평균9.2년.술전SF-36총분평분위(34.26±11.02)분,말차수방시위(77.59±12.57)분,량자비교유통계학차이;술전AOFAS중족평분위(86.14±16.79)분,말차수방시위(86.43±16.70)분,량자비교차이무통계학의의.시상면,내측척부관절활동도환측약수한20％.관상면,내번시건측여환측TPA분별평균위61.32°화64.91°,환측감소12.5％;외번시쌍측TPA분별평균위76.54°화82.28°,환측감소약42.6％.SPECT/CT발현13례환자(35.1％,13/37)적거주관절、21례(56.8％,21/37)적근투관절、10례(27.0％,10/37)적척투관절、5례(13.5％,5/37)적주설관절발생퇴변,단관절무명현동통.결론 거하관절융합가도치중족적시상면활동수한,관상면활동대상성증가,특별시외측부중화척부관절활동도증가,저사부중관절경역출현경도퇴변.
Objective To evaluate the influence of simple subtalar arthrodesis to the motion and degeneration of midfoot.Methods Data of 37 patients (27 males,10 females) with an average age of 42.6 years who had undergone subtalar joint fusion from January 1996 to August 2011 were retrospectively analyzed.The MOS item short form health survey (SF-36),American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score were used.Midfoot sagittal and coronal motion were measured on ankle radiographs of maximum plantar flexion and dorsiflexion.On sagittal plane,the Meary angle was measured and the bilateral tarsometatarsal joints mobility was compared.On coronal plane,tibio-plantar angles (TPA) on 30 degrees varus slope and 30 degrees valgus slope were respectively measured on the anterio-posterior ankle X-ray films to observe the changes of midfoot activities.Besides,single photon emission computed tomography/computed tomography (SPECT/CT) of bilateral foot and ankle was taken to estimate the degeneration of midfoot joint.Results All the 37 patients were followed-up,with mean follow-up period of 9.2 years.The average SF-36 scores was increased from 34.26± 11.02 points preoperatively to 77.59± 12.57 points postoperatively.The average AOFAS midfoot scores were 86.14± 16.79 points preoperatively and 86.43± 16.70 points postoperatively without any statistical significant difference.On sagittal plane,medial tarsometatarsal joints mobility was limited by 20％.According to coronal plane of varus slope,the average TPA of healthy side and operated side were 61.32° and 64.91°,respectively,so the varus mobility of operated side was limited by 12.5％.While standing on the valgus slope,the average TPA of both sides were 76.54° and 82.28°,which indicated that valgus mobility of operated side was reduced by 42.6％.35.1％ patients of talonavicular joint,56.8％ patients of calcaneocuboid joint,and 27.0％ patients of metatarsal cuboid joint were found mild joint degeneration on SPECT/CT images without any clinical symptoms.Conclusion Subtalar arthrodesis can affect midfoot with less limit of sagittal mobility and more limit of coronal movement.And the lateral joints degeneration is more likely to happen for their compensatory activity.