我们先前报道了与对照组相比,外翻(HV)患者的第一meta骨(M1)头相对于地面的内旋增加。尽管如此,沿着内侧柱的这种超前征的起源和位置是未知的。最近的研究表明,进行性塌陷性足部畸形(PCFD)的存在,这是一种经常与HV相关的疾病,会强烈影响内侧柱冠状面排列。这项研究的目的是评估HV脚内侧柱骨的冠状旋转,带有PCFD放射标记的HV脚,和控制。我们假设HV中的超前脱将源于M1固有扭转和第一睑板关节错位的组合。
同一组36例HV和20例对照在年龄上匹配,性别,并使用体重指数。以前,通过尸体研究对测量结果进行了验证.使用这些指标,我们评估了舟骨的冠状面旋转,内侧楔形文字,以及M1相对于地面的底部和头部,使用称重CT图像。我们测量了36名HV受试者的Meary角和跟骨力矩臂。根据这些测量,我们将我们的队列细分为HV组和潜在的PCFDHV组。在HV之间进行了内侧柱骨冠状旋转的比较,PCFDHV,和对照组。
HV组22例,PCFDHV组14例。与对照组相比,两组第一跖骨头相对于地面的内旋增加(P<.001)。比较HV和对照组,在HV中,M1固有扭转的内旋增加8.3度(P<.001),而第一个骨掌关节的内旋错位为4.7度(P=.02)。在HV中还观察到第一个囊状关节的9.7度仰卧位(P<.001)。比较PCFDHV和对照显示舟骨内旋的显着增加(分别为,17.2±5.4和12.3±3.4度,P=.007)和PCFDHV中M1固有扭转(P=.02)的内旋增加5.5度,没有第一睑板和Naviculoconeform关节的错位。
M1头相对于地面的超前症源于HV中M1固有扭转的内旋增加和第一睑弓关节错位,虽然部分抵消了第一naviculoceform关节的上位错位。另一方面,PCFDHV患者从舟骨到M1头的整个内侧柱均表现出普遍的内旋位置,可能与PCFD中经常出现的中足和后足畸形有关。
III级,回顾性比较研究。
We previously reported an increase in
pronation of the first metatarsal (M1) head relative to the ground in hallux valgus (HV) patients compared to controls. Still, the origin and location of this hyperpronation along the medial column is unknown. Recent studies showed that presence of progressive collapsing foot deformities (PCFDs), which is a condition frequently associated with HV, can strongly influence the medial column coronal plane alignment. The objective of this study was to assess the coronal rotation of the medial column bones in HV feet, HV feet with radiologic markers of PCFD, and controls. We hypothesized that hyperpronation in HV will originate from a combination of M1 intrinsic torsion and first tarsometatarsal joint malposition.
The same cohort of 36 HV and 20 controls matched on age, gender, and body mass index was used. Previously, a validation of the measurements was carried out through a cadaveric study. Using these metrics, we assessed the coronal plane rotation of the navicular, medial cuneiform, and the M1 at its base and head with respect to the ground using weightbearing CT images. We measured the Meary angle and the calcaneal moment arm in our 36 HV subjects. We subdivided our cohort into an HV group and a potential PCFD HV group according to these measurements. Comparisons on medial column bones coronal rotation were performed between HV, PCFD HV, and control groups.
Twenty-two HV cases were included in the HV group and 14 in the PCFD HV group. Both groups presented an increase in
pronation of the first metatarsal head relative to the ground when compared to the control group (P < .001). Comparing HV and controls showed an 8.3 degrees increase in
pronation of M1 intrinsic torsion (P < .001) and a 4.7 degrees pronated malposition of the first tarsometatarsal joint (P = .02) in HV. A 9.7 degrees supinated malposition of the first naviculocuneiform joint (P < .001) was also observed in HV. Comparing PCFD HV and controls showed a significant increase in pronation of the navicular (respectively, 17.2 ± 5.4 and 12.3 ± 3.4 degrees, P = .007) and a 5.5 degrees increase in
pronation of M1 intrinsic torsion (P = .02) in PCFD HV, without malposition of the first tarsometatarsal and naviculocuneiform joints.
Hyperpronation of the M1 head relative to the ground originated from both increases in
pronation of M1 intrinsic torsion and first tarsometatarsal joint malposition in HV, although partially counterbalanced by a supinated malposition of the first naviculocuneiform joint. On the other hand, PCFD HV patients showed a generalized pronated position throughout the medial column from the navicular to the M1 head and may be related to the midfoot and hindfoot deformities frequently present in PCFD.
Level III, retrospective comparative study.