PDF(Pubmed)
Abstract：
BACKGROUND: Talar fractures often require osteotomy during surgery to achieve reduction and screw fixation of the fractured fragments due to limited visualization and operating space of the talar articular surface. The objective of this study was to evaluate the horizontal approach to the medial malleolus facet by maximizing exposure through dorsiflexion and plantarflexion positions.
METHODS: In dorsiflexion, plantarflexion, and functional foot positions, we respectively obtained the anterior and posterior edge lines of the projection of the medial malleolus on the medial malleolar facet. The talar model from Mimics was imported into Geomagic software for image refinement. Then Solidworks software was used to segment the medial surface of the talus and extend the edge lines from the three positions to project them onto the \"semicircular\" base for 2D projection. The exposed area in different positions, the percentage of total area it represents, and the anatomic location of the insertion point at the groove between the anteroposternal protrusions of the medial malleolus were calculated.
RESULTS: The mean total area of the \"semicircular\" region on the medial malleolus surface of the talus was 542.10 ± 80.05 mm2. In the functional position, the exposed mean area of the medial malleolar facet around the medial malleolus both anteriorly and posteriorly was 141.22 ± 24.34 mm2, 167.58 ± 22.36mm2, respectively. In dorsiflexion, the mean area of the posterior aspect of the medial malleolar facet was 366.28 ± 48.12 mm2. In plantarflexion, the mean of the anterior aspect of the medial malleolar facet was 222.70 ± 35.32 mm2. The mean overlap area of unexposed area in both dorsiflexion and plantarflexion was 23.32 ± 5.94 mm2. The mean percentage of the increased exposure area in dorsiflexion and plantarflexion were 36.71 ± 3.25% and 15.13 ± 2.83%. The mean distance from the insertion point to the top of the talar dome was 10.69 ± 1.24 mm, to the medial malleolus facet border of the talar trochlea was 5.61 ± 0.96 mm, and to the tuberosity of the posterior tibiotalar portion of the deltoid ligament complex was 4.53 ± 0.64 mm.
CONCLUSIONS: Within the 3D model, we measured the exposed area of the medial malleolus facet in different positions and the anatomic location of the insertion point at the medial malleolus groove. When the foot is in plantarflexion or dorsiflexion, a sufficiently large area and operating space can be exposed during surgery. The data regarding the exposed visualization area and virtual screws need to be combined with clinical experience for safer reduction and fixation of fracture fragments. Further validation of its intraoperative feasibility will require additional clinical research.
METHODS: In dorsiflexion, plantarflexion, and functional foot positions, we respectively obtained the anterior and posterior edge lines of the projection of the medial malleolus on the medial malleolar facet. The talar model from Mimics was imported into Geomagic software for image refinement. Then Solidworks software was used to segment the medial surface of the talus and extend the edge lines from the three positions to project them onto the \"semicircular\" base for 2D projection. The exposed area in different positions, the percentage of total area it represents, and the anatomic location of the insertion point at the groove between the anteroposternal protrusions of the medial malleolus were calculated.
RESULTS: The mean total area of the \"semicircular\" region on the medial malleolus surface of the talus was 542.10 ± 80.05 mm2. In the functional position, the exposed mean area of the medial malleolar facet around the medial malleolus both anteriorly and posteriorly was 141.22 ± 24.34 mm2, 167.58 ± 22.36mm2, respectively. In dorsiflexion, the mean area of the posterior aspect of the medial malleolar facet was 366.28 ± 48.12 mm2. In plantarflexion, the mean of the anterior aspect of the medial malleolar facet was 222.70 ± 35.32 mm2. The mean overlap area of unexposed area in both dorsiflexion and plantarflexion was 23.32 ± 5.94 mm2. The mean percentage of the increased exposure area in dorsiflexion and plantarflexion were 36.71 ± 3.25% and 15.13 ± 2.83%. The mean distance from the insertion point to the top of the talar dome was 10.69 ± 1.24 mm, to the medial malleolus facet border of the talar trochlea was 5.61 ± 0.96 mm, and to the tuberosity of the posterior tibiotalar portion of the deltoid ligament complex was 4.53 ± 0.64 mm.
CONCLUSIONS: Within the 3D model, we measured the exposed area of the medial malleolus facet in different positions and the anatomic location of the insertion point at the medial malleolus groove. When the foot is in plantarflexion or dorsiflexion, a sufficiently large area and operating space can be exposed during surgery. The data regarding the exposed visualization area and virtual screws need to be combined with clinical experience for safer reduction and fixation of fracture fragments. Further validation of its intraoperative feasibility will require additional clinical research.
摘要：
背景：由于距骨关节面的可视化和操作空间有限，距骨骨折通常需要在手术期间进行截骨术以实现骨折碎片的复位和螺钉固定。这项研究的目的是通过背屈和pi屈位置最大化暴露来评估内踝小平面的水平入路。
方法：在背屈中，跖屈,和功能性足部位置，我们分别获得了内踝在内踝小面上投影的前边缘线和后边缘线。将Mimics中的距骨模型导入到Geomagic软件中进行图像细化。然后使用Solidworks软件对距骨的内侧表面进行分割，并从三个位置延伸边缘线，以将其投影到“半圆形”底座上进行2D投影。不同位置的暴露区域，它占总面积的百分比，并计算了内踝前后突间沟插入点的解剖位置。
结果：距骨内踝表面的“半圆形”区域的平均总面积为542.10±80.05mm2。在功能定位上,前踝和后踝周围内踝小关节的平均暴露面积分别为141.22±24.34mm2，167.58±22.36mm2。在背屈，内踝小关节后部的平均面积为366.28±48.12mm2。在跖屈中，内踝小面前部的平均值为222.70±35.32mm2。背屈和足屈未暴露区域的平均重叠面积为23.32±5.94mm2。背屈和pi屈暴露面积增加的平均百分比为36.71±3.25％和15.13±2.83％。插入点到距骨顶部的平均距离为10.69±1.24mm,距骨滑车的内踝小关节边界为5.61±0.96mm，三角韧带复合体胫骨后部结节为4.53±0.64mm。
结论：在3D模型中，我们测量了不同位置的内踝小平面的暴露面积以及内踝沟插入点的解剖位置。当脚处于前屈或背屈时，手术期间可以暴露足够大的面积和手术空间。有关暴露的可视化区域和虚拟螺钉的数据需要与临床经验相结合，以更安全地复位和固定骨折碎片。进一步验证其术中可行性将需要额外的临床研究。
方法：在背屈中，跖屈,和功能性足部位置，我们分别获得了内踝在内踝小面上投影的前边缘线和后边缘线。将Mimics中的距骨模型导入到Geomagic软件中进行图像细化。然后使用Solidworks软件对距骨的内侧表面进行分割，并从三个位置延伸边缘线，以将其投影到“半圆形”底座上进行2D投影。不同位置的暴露区域，它占总面积的百分比，并计算了内踝前后突间沟插入点的解剖位置。
结果：距骨内踝表面的“半圆形”区域的平均总面积为542.10±80.05mm2。在功能定位上,前踝和后踝周围内踝小关节的平均暴露面积分别为141.22±24.34mm2，167.58±22.36mm2。在背屈，内踝小关节后部的平均面积为366.28±48.12mm2。在跖屈中，内踝小面前部的平均值为222.70±35.32mm2。背屈和足屈未暴露区域的平均重叠面积为23.32±5.94mm2。背屈和pi屈暴露面积增加的平均百分比为36.71±3.25％和15.13±2.83％。插入点到距骨顶部的平均距离为10.69±1.24mm,距骨滑车的内踝小关节边界为5.61±0.96mm，三角韧带复合体胫骨后部结节为4.53±0.64mm。
结论：在3D模型中，我们测量了不同位置的内踝小平面的暴露面积以及内踝沟插入点的解剖位置。当脚处于前屈或背屈时，手术期间可以暴露足够大的面积和手术空间。有关暴露的可视化区域和虚拟螺钉的数据需要与临床经验相结合，以更安全地复位和固定骨折碎片。进一步验证其术中可行性将需要额外的临床研究。
