利用负重CT数据分析[足母]外翻患者第1跖趾关节匹配度的特征  

Characteristics of first metatarsophalangeal joint congruency analyzed through weight-bearing CT in hallux valgus

作　　者：王智[1] 张树[1] 孙超[1] 魏芳远[1] 曲峰 王显军[1] 张建中[1] 张明珠 WANG Zhi;ZHANG Shu;SUN Chao;WEI Fangyuan;QU Feng;WANG Xianjun;ZHANG Jianzhong;ZHANG Mingzhu(Foot and Ankle Surgery Center,Capital Medical University Affiliated Beijing Tongren Hospital,Beijing 100005,China)

机构地区：[1]首都医科大学附属北京同仁医院足踝外科中心,北京100005

出　　处：《中华骨与关节外科杂志》2020年第12期1012-1017,共6页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然基金项目(81773091)。

摘　　要：背景:[足母]外翻畸形存在关节匹配与不匹配两种情况。目的:通过负重CT回顾性研究关节匹配度在[足母]外翻畸形中的影响,分析关节匹配度丧失后关节的变化特征。方法:选取2019年1月至2020年1月门诊连续就诊的[足母]外翻患者纳入本研究,进行站立位负重CT检查。测量第1-2跖骨间角(IMA)、[足母]外翻角(HVA)、跖内收角(MAA)、第1跖骨关节面外翻角(DMAA)、第1跖骨旋转α角、正位籽骨分度与冠状位籽骨分度。测量结果通过SPSS进行分析。结果:纳入117例(211足)患者,全部女性,其中23例为单足,94例为双足。年龄19~84岁,平均(55.0±12.6)岁,211足的IMA平均14.1°±3.0°,HVA平均33.1°±10.5°,DMAA平均18.7°±7.9°,MAA平均15.7°±5.3°,第1跖骨旋转α角平均23.2°±7.2°。匹配组和不匹配组IMA、HVA、MAA、DMAA差异有统计学意义(P<0.05),而两组的旋转α角差异无统计学意义(P>0.05)。Spearman相关分析发现在两组中,IMA、HVA、DMAA与正位籽骨分度呈正相关。结论:[足母]外翻跖趾关节不匹配预示着更为严重的畸形和更严重的籽骨脱位。匹配与不匹配不影响第1跖骨旋前程度。DMAA角受第1跖骨旋转、IMA的影响。正位籽骨分度是判断第1跖骨内收和旋转三维改变的有效指标。Background:The joints in patients with hallux valgus can be classified as matching and mismatching.Objective:To investigate the effect of joint matching degree on hallux valgus through weight-bearing CT and the characteristics of joint when loss of matching degree.Methods:From January 2019 to January 2020,a cohort of patients with hallux valgus was included and had a weight-bearing CT scan in standing position.Intermetatarsal angle(IMA),hallux valgus angle(HVA),metatarsal adduction angle(MAA),first metatarsal distal articular angle(DMAA),first metatarsalαangle,anteroposterior sesamoid grading and coronal plane sesamoid grading were measured and analyzed by SPSS.Results:A total of 117 female patients(211 feet)were included including 23 patients of single foot and 94 patients of both feet with the mean age of(55.0±12.6)years old(range:19-84).The mean IMA was 14.1°±3.0°,the mean HVA was 33.1°±10.5°,the mean DMAA was 18.7°±7.9°,the mean MAA was 15.7°±5.3°,the mean first metatarsalαangle was 23.2°±7.2°.There were significant differences in IMA,HVA,MAA,DMAA between the matching group and mismatching group(P<0.05),however,the first metatarsal rotation on coronal plane had no significant difference.Spearman correlation analysis showed that IMA,HVA and DMAA had positive correlation with anteroposterior sesamoids grading.Conclusions:Patients with hallux valgus and incongruous joint have more severe deformity and higher percentage of sesamoids subluxation.Joint matching degree does not affect first metatarsal pronation angle.DMAA is correlated with IMA and first metatarsal rotation.Anteroposterior sesamoids grading is an effective parameter to evaluate both first metatarsal medial deviation and pronation.

关 键 词：[足母]外翻 第1跖骨旋转 籽骨分度 负重CT 

分 类 号：R687.3[医药卫生—骨科学]