利用负重CT评估第一跖骨旋前对跖趾关节匹配度的影响  

Effect and analysis of the first metatarsal rotation on the congruency of the first metatarsophalangeal joint in hallux valgus measured by CT

作　　者：王超[1] 王智[1] 张明珠 Wang Chao;Wang Zhi;Zhang Mingzhu(Foot and Ankle Surgery Center,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,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,北京100730

出　　处：《足踝外科电子杂志》2023年第2期24-29,共6页Electronic Journal of Foot and Ankle Surgery

基　　金：北京市百千万人才工程(2020A43)。

摘　　要：目的利用负重CT探讨第一跖骨旋前对[母]外翻中第一跖趾关节匹配度的影响。方法回顾性分析首都医科大学附属北京同仁医院2018年1月至2021年1月收治的46例(63足)患者的负重CT数据。纳入患者均经负重X线片评估为第一跖趾关节匹配。按有无[母]外翻畸形分为[母]外翻组32例(39足)和对照组14例(24足)。测量并比较两组患者的[母]外翻角(hallux valgus angle,HVA),第1、2跖骨间角(intermetatarsal angle,IMA),跖骨远端关节面角(distal metatarsal articular surface angle,DMAA)以及第1跖骨旋转角(the first metatarsal rotation angle,α角)。利用负重CT的CubeVue软件自带的旋转功能对所有患者的第一跖骨冠状面旋前进行纠正,纠正后再次测量关节匹配度。采用受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)评估α角预测假性匹配的效能并计算界值。结果共收集第一跖趾关节匹配的[母]外翻组32例患者(39足),其中女30例,男2例,平均年龄(47.8±2.3)岁;对照组14例患者(24足),均为女性,平均年龄(40.8±3.7)岁。两组患者的基线数据比较,差异无统计学意义(P>0.05),两组患者α角、IMA、HVA及DMAA比较,差异有统计学意义(P<0.05)。通过负重CT纠正第一跖骨冠状面旋前后,[母]外翻组有21足仍表现为匹配关节,18足表现为不匹配关节,与纠正前相比,差异有统计学意义(P<0.05);对照组有23足仍表现为匹配关节,有1足表现为不匹配关节,与纠正前相比,差异无统计学意(P>0.05)。ROC曲线分析显示,α角预测假性匹配的截断值为21.5°(灵敏度77.2%,特异度85.4%),曲线下面积(AUC)为0.875。结论第一跖骨旋前会影响第一跖趾关节匹配度的判断。当X线片表现为第一跖趾关节匹配、但α角大于21.5°时,有可能是假性匹配。因此在恢复关节匹配度时,应注意第一跖骨旋前的纠正。Objective To evaluate whether the first metatarsal pronation affects the judgment of metatarsophalangeal joint congruency using weight-bearing CT.Methods The weight-bearing CT data of Beijing Tongren Hospital Affiliated to Capital Medical University from January 2018 to January 2021 were retrospectively analyzed.The clinical data of 14 control patients(24 feet)without hallux valgus deformity were compared with preoperative data of 32 patients(39 feet)with hallux valgus deformity.All included patients had congruent metatarsophalangeal joints after weight-bearing X-ray evaluation.The hallux valgus angle(HVA),the first and second intermetatarsal angle(IMA),the distal metatarsal articular surface angle(DMAA),and the first metatarsal rotation angle(αAngle)were measured and compared between the two groups.The rotation function of the CubeVue software of weight-bearing CT was used to correct the coronal pronation of the first metatarsal in all patients,and the congruency of the metatarsophalangeal joint was measured again after correction.The receiver operating characteristic(ROC)curve was used to evaluate the efficiency ofαangle in predicting pseudo-congruency and calculate the threshold value.Results There were 32 patients(39 feet)in hallux valgus group,including 30 females and 2 males,with an average age of(47.8±2.3)years.In the control group,14 patients(24 feet)were female.The average age was(40.8±3.7)years.There was no significant difference in baseline data between the two groups(P>0.05).There were significant differences inαangle,IMA,HVA and DMAA between the two groups(P<0.05).After correcting the coronal rotation of the first metatarsal by weight-bearing CT,21 feet in the hallux valgus group still showed congruent joints and 18 feet showed incongruent joints,which was statistically significant compared with that before correction(P<0.05).In the control group,23 feet still showed congruent joints and 1 foot showed incongruent joint,compared with before correction,the difference was not statistically signific

关 键 词：[母]外翻 第一跖趾关节匹配度 负重CT 第一跖骨旋前 

分 类 号：R683.42[医药卫生—骨科学]