跟骰关节固定对距下关节负重区的影响及其临床意义

目的探讨跟骰关节固定对距下关节负重区面积的影响程度及其临床意义。方法选取12侧新鲜尸体足标本,通过胫骨干轴向动态加载,应用压敏片测量比较跟骰关节固定前后,在大体足中立位、背屈跖屈、内收外展、内翻外翻运动中,距下关节负重区面积。结果跟骰关节固定后,在大体足不同运动状态下距下关节负重区面积较术前均不同程度增大(P＜0．05),为(32．54±7．45)%。结论跟骰关节固定可增加距下关节负重区面积,从而降低距下关节面单位面积的应力及增加距下关节稳定性。     

距下关节截骨牵伸融合新方法治疗陈旧性跟骨关节内骨折

目的 评价距下关节截骨牵伸融合对陈旧性跟骨关节内骨折的疗效.方法 6例(单足5例,双足1例)陈旧性跟骨关节内骨折,年龄17～52岁,平均31岁.6例(7足)均采用距下关节截骨牵伸融合新方法治疗.术中行距下关节截骨、Orthofix外固定支架固定,术后10天开始距下关节缓慢牵伸延长,至距下关节间隙牵开1～2cm结束,距下关节骨性融合后取出外固定支架开始负重行走.结果 平均随访18个月.6例距下关节平均在术后9个月得到骨性融合.采用AOFAS后足评分,7足平均评分由术前的26.6分提高到术后随访时的74.2分.结论 距下关节截骨牵伸融合对陈旧性跟骨关节内骨折是一种新的有效治疗方法.     

距下关节截骨缓慢延长治疗陈旧性跟骨骨折

目的 伴有距下关节损伤的陈旧性跟骨骨折,目前主要是采用距下关节原位融合术和距下关节牵伸骨块植入融合术治疗,在此介绍一种新手术方式,距下关节截骨外固定支架缓慢延长手术,并评估其疗效.方法 12例15足(单足9例,双足3例)陈旧性跟距关节骨折脱位,年龄16～53岁,平均33.6岁.闭合性7例(10足),开放型性5例(5足)...     

距骨骨折后缺血性坏死与功能预后的关系

目的 分析距骨骨折后缺血性坏死的发生率及功能预后.方法 回顾性分析2004年7月-2009年11月收治12例13足得到随访的距骨骨折的坏死发生率、足踝功能及致残率.按Hawkins分型:Ⅰ型2足,Ⅱ型4足,Ⅲ型5足,Ⅳ型2足.结果 12例随访11～52个月,平均19.6个月.8足出现距骨坏死,3足需处理,其中1足行踝关节融合,1足行距下关节融合,1足行减压植骨;另5足踝关节、距下关节功能良好,无距骨塌陷、骨关节炎表现.根据Maryland足部评分标准,优8足,良2足,可1足,差2足,优良率为77%.结论 距骨骨折脱位后缺血性坏死的发生率与骨折的部位及创伤能量相关,但其功能预后与缺血坏死并不相关.     

逆行髓内钉胫距跟关节融合治疗胫距、距下关节创伤性关节炎

目的 探讨应用逆行髓内钉行胫距跟关节融合术治疗合并胫距、距下关节严重创伤性关节炎的临床疗效.方法 自2003年6月至2006年6月,应用逆行髓内钉行胫距跟关节融合术治疗合并胫距、距下关节创伤性关节炎患者17例,术后疗效评估采用美国足踝外科协会(AOFAS)踝-后足功能评分标准.结果 14例术后获得随访,时间6～23个月,平均14.6个月.12例(86%)功能在术后平均11.6周(8～19周)达到骨性愈合,2例(14%)出现延迟愈合(17～19周),其中早期手术的2例(12%)诉足跟进针点疼痛;AOFAS踝-后足功能评分从术前的47分(43～55分)提高到术后的75分(69～86分).结论 逆行髓内钉胫距跟关节融合术是临床治疗踝关节和距下关节严重创伤性关节炎的一种有效方法,能有效缓解踝与后足疼痛,提高生活质量.     

儿童尺桡下关节脱位的测量及分型

为减少儿童尺桡下关节脱位的错漏诊。方法：对１８８例正常儿童和６８例尺桡下关节脱位和儿童腕部Ｘ线片进行分析。结果：提出一种新的划线测量才尺桡下间距、尺桡下端距两个概念、提出诊断中应注意的问题并将脱位进行了分型。结论：本方法对工作中判断尺桡下关节脱位有一定参考价值。     

关节镜下经皮穿针空心螺钉内固定融合治疗距下关节创伤性关节炎

目的 探讨关节镜下经皮穿针空心螺钉内固定融合治疗距下关节创伤性关节炎的方法并评价其临床疗效.方法 选择2006年4月-2009年12月收治的12例严重距下关节创伤性关节炎患者,其中男5例,女7例;年龄28～68岁,平均45.6岁.均为单纯距下关节病变,经保守治疗、疼痛控制无效,选择关节镜下经皮穿针空心螺钉内固定的距下关节融合术.患者术前、术后均采用美国足踝外科协会(America Orthopedic Foot and Ankle Society,AOFAS)踝-后足功能评分表进行临床随访,同时,采用X线摄片进行影像学评估.结果 术后平均随访21.2个月(6～48个月).12例患者AOFAS术前评分(54.67±5.28)分(43～61分),术后末次随访评分(89.17±3.56)分(78～95分),优良率为93%.术后X线片显示,11例距下关节骨性融合,平均融合时间为12.4周(9～15周).1例出现骨不连,行走后外踝下方疼痛,给予石膏靴固定制动3个月后复查X线片,距下关节骨性融合.结论 关节镜下经皮穿针空心螺钉内固定融合治疗距下关节创伤性关节炎可获得良好的临床疗效,是一种值得推荐的手术方法.     

青少年的距骨周围脱位

距骨周围脱位是指跟距关节(距下关节)和距舟关节同时脱位,但胫骨与距骨关节(髁关节)保持正常关系。距骨周围脱位根据足的方向分为内侧、外侧、前和后脱位四种类型,其中距骨内侧脱位型最常见。作者研究了124例18岁以下青少年的距骨骨折及/或脱位。所有病例均无距骨颈骨折所致距下关节脱位,因距骨颈骨折可造成距下关节分裂,故不应列入距骨周围脱位。共有5例确诊为距骨周围脱位,3例女性,2例男性,平均年龄14     

距下关节镜治疗训练伤致跗骨窦综合征临床效果观察

目的 观察距下关节镜治疗训练伤致跗骨窦综合征（STS）的临床效果。方法 选取联勤保障部队967医院自2015年6月至2021年1月收治的43例（44踝）训练伤致STS患者为研究对象。将患者随机分入距下关节镜组（n=21）和跗骨窦注射组（n=22）。距下关节镜组行距下关节镜治疗术,跗骨窦注射组行曲安奈德+利多卡因混合液跗骨窦注射术。两组患者术后随访6个月,比较两组患者术前和术后的视觉模拟评分法（VAS）评分、美国矫形外科足踝协会（AOFAS）评分。结果 43例患者均未出现感染、血管神经损伤、距骨坏死等并发症。距下关节镜组患者在关节镜下跗骨窦内均见明显的滑膜增生充血、瘢痕组织形成,部分患者跟距关节间隙可见软组织嵌顿。跗骨窦注射组术后3、6个月的VAS评分高于距下关节镜组,AOFAS评分低于距下关节镜组,差异有统计学意义（P <0.05）。结论 对于日常运动需求量高的患者,无论在缓解疼痛还是恢复运动功能方面,关节镜治疗训练伤致STS的临床效果均优于局部封闭治疗。     

26例距下关节脱位诊治分析

目的分析距下关节脱位的临床诊断和治疗效果。方法选择2001年1月～2010年1月收治的26例距下关节脱位患者临床资料,内侧距下关节脱位22例,外侧距下关节脱位4例。闭合手法牵引复位17例,切开复位9例。结果本组全部获随访,随访时间14～22个月,平均(17.7±3.9)个月。关节功能根据美国足踝外科协会AOFAS后足评分标准,术后功能优14例,良8例,可4例;优良率84.62%。结论距骨脱位应早期明确诊断,经过闭合手法复位或切开复位均获得较满意的疗效。     

Determination of subtalar joint axis location by restriction of talocrural joint motion

The location of the subtalar joint axis is an important determinant of the mechanical function of the foot. The moments of muscle forces and of the ground reaction force about the subtalar joint are dependent upon the location of this joint axis. There is substantial variation in subtalar axis location across subjects, but current methods for determining its location are often invasive or involve expensive imaging protocols. A novel technique for location of the subtalar axis is presented in which the talocrural joint is passively immobilized so that motion of the tibia relative to the calcaneus can be used to estimate the subtalar axis. This paper presents results of cadaver testing in which accuracy of the technique was assessed by comparing helical axes computed from calcaneus-tibia bone motions to axes computed from calcaneus-talus bone motions. Only small motions at the talocrural joint were observed, and good estimates of the subtalar axis (errors less than 15 degrees and 2mm) were achieved in four of six specimens.     

Ligament force and joint motion in the intact ankle: a cadaveric study

The aims of this study were to measure the forces in the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) and the motion in the tibiotalar and subtalar joints during simulated weight-bearing in eight cadaver ankle specimens. An MTS test machine was used to apply compressive loads to specimens held in a specially designed testing apparatus in which the ankle position (dorsiflexion-plantarflexion and supination-pronation) could be varied in a controlled manner. The forces in the ATFL and CFL were measured with buckle transducers. Tibiotalar motion and total ankle joint motion were measured with an instrumented spatial linkage. The specimens were positioned sequentially at 10° dorsiflexion, neutral, and 10° and 20° plantarflexion, and this sequence was repeated at 15° supination, neutral pronation/supination, and 15° pronation. Force and motion measurements were recorded in each of these positions with and without a 375 N compressive load simulating weight-bearing. From 10° dorsiflexion to 20° plantarflexion, all motion occurred in the tibiotalar joint. In contrast, the ratio of subtalar motion to tibiotalar motion was 3:1 for supination-pronation and 4:1 for internal-external rotation. Inverse loading patterns were observed for the ATFL and CFL from plantarflexion to dorsiflexion. Compressive loading did not affect CFL tension, but it magnified the pattern of increasing ATFL tension with plantarflexion. The largest increase in ATFL force was observed in supination and plantarflexion with a compressive load (76 ± 23 N), whereas CFL tension mainly increased in supination and dorsiflexion with a compressive load (109 ± 28 N). In conclusion, the results showed that the ATFL acted as a primary restraint in inversion, where injuries typically occur (combined plantarflexion, supination and internal rotation). Also, the subtalar joint was of primary importance for normal supination-pronation and internal-external rotation. Received: 29 April 1997 Accepted: 25 July 1997     

The increase of joint contact forces in foot joints with simulated subtalar fusion in healthy subjects

BackgroundSubtalar fusion usually leads to a satisfactory clinical outcome by eliminating the motion of the subtalar joint but can cause an aggravation of osteoarthritis after the subtalar fusion. Previous studies have investigated the effect of subtalar fusion in static testing using cadaver limbs, but there was no evidence of an aggravation of osteoarthritis.Research questionThe objective was to investigate the differences in foot joint kinematics and kinetics during a standing pose and walking with and without subtalar fusion, using a musculoskeletal simulation.MethodsFull-body joint kinematics, ground reaction force, and foot pressure of the healthy subjects were recorded during walking using an optical motion capture system. The models with and without subtalar fusion were constructed using the AnyBody Modeling System (AnyBody Technology, Aalborg, Denmark). The range of motion and contact forces in the individual foot joints with and without simulated subtalar fusion in healthy subjects were estimated using computational simulation and compared using the Wilcoxon signed-rank test. The change of motion in the Chopart’s joint was observed.ResultsNormalized to the subject’s body weight (BW), the average maximum contact forces in the tibiotalar and Lisfranc joints during walking were significantly increased by 2.6 and 0.9 BW with the simulated subtalar joint fusion, respectively. The simulated subtalar joint fusion increased joint contact forces significantly during walking, which can increase the risks of secondary arthritis in the adjacent joints.SignificanceThe subtalar joint fusion increased the joint contact forces in adjacent joints during walking implying that the fusion can increase the risk of secondary injuries in adjacent joints in the foot.     

A comparison of subtalar joint motion during anticipated medial cutting turns and level walking using a multi-segment foot model

The weight-bearing in-vivo kinematics and kinetics of the talocrural joint, subtalar joint and joints of the foot were quantified using optical motion analysis. Twelve healthy subjects were studied during level walking and anticipated medial turns at self-selected pace. A multi-segment model of the foot using skin-mounted marker triads tracked four foot segments: the hindfoot, midfoot, lateral and medial forefoot. The lower leg and thigh were also tracked. Motion between each of the segments could occur in three degrees of rotational freedom, but only six inter-segmental motions were reported in this study: (1) talocrural dorsi-plantar-flexion, (2) subtalar inversion–eversion, (3) frontal plane hindfoot motion, (4) transverse plane hindfoot motion, (5) forefoot supination–pronation twisting and (6) the height-to-length ratio of the medial longitudinal arch.The motion at the subtalar joint during stance phase of walking (eversion then inversion) was reversed during a turning task (inversion then eversion). The external subtalar joint moment was also changed from a moderate eversion moment during walking to a larger inversion moment during the turn. The kinematics of the talocrural joint and the joints of the foot were similar between these two tasks.During a medial turn, the subtalar joint may act to maintain the motions in the foot and talocrural joint that occur during level walking. This is occurring despite the conspicuously different trajectory of the centre of mass of the body. This may allow the foot complex to maintain its function of energy absorption followed by energy return during stance phase that is best suited to level walking.     

Osteoarthritis of the sternoclavicular joint. Radiographic features and pathologic correlation

Osteoarthritis (OA) of the sternoclavicular (SC) joint has been extensively characterized in the pathology literature, but the radiographic appearance of this entity has received comparatively little attention. To define the radiographic patterns of OA at this joint, we used high resolution PA radiographs (industrial grade film) to examine 55 SC joints obtained by block resection at autopsy. Ten of these also were selected for coronal complex motion tomography. Fifty cases were histologically correlated. Radiographic and pathologic material was evaluated by four criteria characteristic of OA: joint-space narrowing, osteophytes, sclerosis, and cysts. Each criterion was independently assessed for severity and distribution. Moderate or severe radiographic changes of OA were uncommon in specimens younger than age 40, but present in 53% older than age 60. Changes were typically bilateral, although a mild degree of asymmetry was common. OA was most severe along the inferior portion of the clavicular head, which comprises its articulating margin with the sternum. Complex motion tomography was generally more accurate than plain radiography for assessing OA in the ten specimens in which comparison was performed.     

Systematic ankle stabilization and the effect on performance

Stabilization of the ankle joint is used as a deterrent to injury, however, insufficient or excessive ankle control can cause negative effects. This study determined the effects of systematic changes in ankle and subtalar joint stabilization on performance through an obstacle course. Data were collected on six subjects as they completed two test procedures. Ankle range of motion in the sagittal and frontal planes was determined using a modified Inman apparatus. Completion time through an obstacle course, set up on a basketball court, was used as a measure of performance. High-top basketball shoes were constructed with pockets which allowed strips of plastic (stiffeners) to be positioned just anterior and posterior to the medial and lateral malleoli. Four shoe conditions were used including the shoe with no stiffeners. Significant differences (P less than 0.05) in eversion, flexion, and inversion were found between the shoe conditions. A general trend of decreased range of motion with increased restriction was observed. Significant differences (P less than 0.05) in performance were found between the shoe conditions, with a general trend of increased times with increased restriction. These results indicate that systematic changes in the range of motion of the ankle and subtalar joints can measurably affect performance.     

Reconstruction of the lateral ankle ligaments. A biomechanical analysis.

The purpose of this study was to perform a biomechanical analysis of several commonly performed operative procedures used to stabilize the lateral ankle. We performed the Evans, Watson-Jones, and Chrisman-Snook procedures on 15 cadaveric ankles and tested the ankles for stability, motion, and isometry of graft placement. The Evans procedure allowed increased anterior displacement, internal rotation, and tilt of the talus when compared to ankles with intact ligaments. Subtalar joint motion was restricted by the Evans procedure. The Watson-Jones procedure controlled internal rotation and anterior displacement of the talus, but was less effective in controlling talar tilt and also restricted subtalar joint motion. The Chrisman-Snook procedure allowed increased internal rotation and anterior displacement of the talus when compared to ankles with intact ligaments. The procedure was effective in limiting talar tilt, but restricted subtalar joint motion. Based on the biomechanical data obtained, we devised a lateral ankle reconstruction with bone tunnels that reproduce the anatomic orientation of both the anterior talofibular and calcaneofibular ligaments. This ankle ligament reconstruction resists anterior displacement, internal rotation, and talar tilt without restricting subtalar joint motion. Clinical relevance: We found considerable mechanical differences among the more commonly performed lateral ankle reconstructions. It is possible to locate bone tunnels and graft placement so that a more anatomic configuration is achieved.     

Comparison of modified Broström and Evans procedures in simulated lateral ankle injury

PURPOSE: The purpose of this study was to compare the modified Brostr?m and Evans procedures for simulated lateral ankle instability in cadaveric lower extremities. METHODS: Six normal cadaveric ankles were loaded with inversion and internal rotation stress through the range of ankle flexion, and three-dimensional motion of the calcaneus and talus relative to the tibia were measured. An ankle stability testing device and a magnetic tracking system were used. Testing was performed in the intact condition, unstable condition after sectioning both the anterior talofibular (ATFL) and calcaneofibular ligaments (CFL), after the Gould modification of the Brostr?m procedure, and after the Evans procedure. RESULTS: With inversion loading, both operations resulted in a significantly more stable ankle-hindfoot complex (calcaneal-tibial) than the unstable condition, but there was restricted motion after the Evans operation from neutral to plantarflexion. Tibiotalar inversion motion approximated normal after both operations, but subtalar motion was markedly restricted in the Evans procedure throughout the range of ankle flexion. With internal rotation loading, the Brostr?m operation stabilized the ankle-hindfoot joint complex in plantarflexion. The Evans operation improved internal rotation stability, but restricted motion in all positions. Both operations improved tibiotalar internal rotation stability, but not to normal. The subtalar internal rotation was the same as the intact condition after the Brostr?m operation, but markedly restricted after the Evans operation through the range of ankle flexion. CONCLUSIONS: Both operations improved ankle-hindfoot stability, but neither was successful in restoring it to normal as determined with the ankle stability testing device. The Evans procedure improved stability at the expense of creating abnormal subtalar function. The Brostr?m operation improved stability without excessively restricting subtalar movement, but was not effective in addressing the internal rotation laxity.     

Subtalar Dislocation in a Basketball Player

In brief: Easily mistaken for an ankle fracture during the initial examination, medial subtalar dislocation—also known as ‘basketball foot’—requires plaster immobilization for no more than 3 weeks. To extend immobilization beyond this time can lead to reduced range of motion in the subtalar joint, making it difficult for the athlete to resume sports activities. Encouraging toe motion while the patient is still in the cast prevents tendon adhesions. In this case report, the author discusses the importance of short-term immobilization and early rehabilitation for a 21-year-old basketball player recovering from medial subtalar dislocation.     

Portal safety and efficacy of anterior subtalar arthroscopy: a cadaveric study

Anterior subtalar arthroscopy was performed in 14 feet of 7 cadeveric bodies using the primary visualization and working portals. The cartilage of the anterior/middle calcaneal facet that can be reached was marked. The feet were dissected and the distances between the portals and surrounding cutaneous nerves were measured. Any damage to the ligaments of the sinus tarsi was noted. The percentage area of the articular cartilage that was marked was measured. In all specimens, the primary visualization portal tract passed through the lateral root of the inferior extensor retinaculum. The primary working portal tract passed through the lateral root in nine specimens (64%). Cervical ligament was intact in all specimens. In three specimens (21%), the primary visualization portal tract passed through the posterior edge of the intermediate root of the inferior extensor retinaculum. The interosseous talocalcaneal ligament was intact in all specimens. The primary visualization portal tract passed through the medial root of the inferior extensor retinaculum in eight specimens (57%). The primary working portal tract passed through the medial root of the inferior extensor retinaculum in one specimen. The average working area on the calcaneal facet was 95% ± 4% of the total articular surface. There was no case of nerve injury in all specimens. In conclusion, anterior subtalar arthroscopy is a minimally invasive approach to deal with pathologies of this joint without the need of extensive resection of the ligamentous structures of the sinus tarsi.