后距下关节融合螺钉植入的影像学评估  

Imaging evaluation of screw placement for posterior subtalar joint fusion

作　　者：孔德海[1] 朱晓东[1] 冯德香[2] KONG Dehai;ZHU Xiaodong;FENG Dexiang(Department of Foot and Ankle Surgery,Binzhou Medical University Hospital,Binzhou 256603,Shandong,P.R.China;Department of Oncology,Binzhou Medical University Hospital,Binzhou 256603,Shandong,P.R.China)

机构地区：[1]滨州医学院附属医院足踝外科,山东滨州256603 [2]滨州医学院附属医院肿瘤科,山东滨州256603

出　　处：《滨州医学院学报》2021年第5期366-369,共4页Journal of Binzhou Medical University

摘　　要：目的通过测量距下关节周围各种角度指标,指导距下关节螺钉的植入。方法随机收集103名患者的踝关节侧位X线片,制定测量坐标,以经足跟最后方点的切线为y轴与经足跟最下方点的切线为x轴呈90°相交于O点,A点为距骨前外侧结节,B点为跟骨后关节面的最高点对应的距骨关节面。AB连线为有效后距下关节面,其测量后距下关节面与x轴的倾斜角a角,取AB连线的中点做AB的垂线,其与x轴的交点为进钉点P。设定x-y轴顶点O为进针点,测量后距下关节AB两点与顶点连线和x轴形成的角度分别为b、c角,算出AB中点的角度d角,d角与b、c角的关系为(b+c)/2=d,即为后距下关节有效关节面中点的角度。垂直于关节面的进钉角度为e角,90°-a角=e角,e角为经AB中点的且与AB垂直的线与x轴交汇的角度。结果a角=(32.61±6.41)°,b角=(45.25±3.10)°,c角=(57.99±3.02)°,d角=(51.62±2.95)°,e角=(57.39±6.41)°,不同性别各个角度之间的差异无统计学意义。e角大于d角,两者之间有约5.78°的差异,P<0.05。同时见P点比O点更靠近足跟负重点。结论以足跟部切线交点为进钉点,进钉角度在(45.25~57.99)°,其中(51.62±2.95)°为最佳进钉角度,能在减少并发症的情况下更好地固定距下关节。Objective To guide the screw implantation of subtalar joint by measuring various angles around subtalar joint.Methods Lateral imaging images of ankle joint of 103 patients were randomly collected,and the pre-determined measurement coordinates were:the y-axis of the tangent through the last square point of the heel and the x-axis of the tangent through the lowest point of the heel intersected at O,A was the anterolateral tubercle of the talus,and B was the talus articular surface corresponding to the highest point of the posterior articular surface of the calcaneus.The line AB was the effective posterior inferior articular surface,which measured the inclination angle a between the posterior inferior articular surface and the x-axis.The midpoint of AB was taken as the vertical line of AB,and its intersection with the x-axis was the entry point P.At the same time,the vertex o of x-y axis was set as the entry point,and the angles formed by the line between two points AB and the vertex and X axis were measured as angles b and c respectively.The angle d of the midpoint of AB was calculated.The relationship between angle d and angles b and c was(b+c)/2=d,which was the angle of the midpoint of the effective joint surface of the posterior subtalar joint.The angle perpendicular to the articular surface was e angle,90°-a angle=e angle,and e angle was the angle between the line passing through the midpoint of AB and perpendicular to AB and x axis.Results Angle a=(32.61±6.41)°,angle b=(45.25±3.10)°,angle c=(57.99±3.02)°,angle d=(51.62±2.95)°,angle e=(57.39±6.41)°,and there was no significant difference in gender.The e angle was larger than the d angle,and the difference between them was about 5.78°,(P<0.05).At the same time,point P was closer to the heel negative point than point O.Conclusion The heel tangent intersection point is the entry point,with the entry angle(45.25-57.99)°,and(51.62±2.95)°is the best entry angle,which can better fix the subtalar joint under the condition of reducing complications.

关 键 词：距下关节 关节融合 螺钉植入 影像学评估 

分 类 号：R684[医药卫生—骨科学]