距下关节面的解剖形态学分型及临床意义

巴达拉胡 何春颖 张磊* 罗元发 贾文利 程翰文 扶世杰

doi:10.16098/j.issn.0529-1356.2019.05.015

PDF(249 KB)

解剖学报 ›› 2019, Vol. 50 ›› Issue (5) : 633-637. DOI: 10.16098/j.issn.0529-1356.2019.05.015

解剖学

距下关节面的解剖形态学分型及临床意义

巴达拉胡¹何春颖²张磊^3,4* 罗元发^3,4 贾文利⁵ 程翰文⁵ 扶世杰^3,4

作者信息 +

Anatomic classification of the subtalar joint surface and its clinical significance

BA-dalahu¹ HE Chun-ying²ZHANG Lei ^3,4* LUO Yuan-fa ^3,4 JIA Wen-lⁱ⁵ CHENG Han-wen⁵FU Shi-jie ^3,4

Author information +

文章历史 +

摘要

目的研究距下关节面的解剖学形态学特点，探讨其临床意义。方法选取365例人体干燥跟骨标本（性别、年龄不详），用游标卡尺测量跟骨前、中、后3个关节面长轴之和与短轴之和；用量角器分别测量跟骨后关节面的外缘延长线与前关节面的外侧延长线，并向前延伸至跟骨前关节突的前部形成的夹角即Gissane’s角和跟骨前突的最高点至后关节面最高点连线与后关节面切点至跟骨结节上缘连线相交构成的夹角即Bohler’s角。结果根据解剖形态学特点，发现距下关节面分为5型：Ⅰ型（189，51.78%）、Ⅱ型（80，21.92%）、Ⅲ型（51，13.97%）、Ⅳ型（37，10.14%）和Ⅴ型（8，2.19%）。其中，Ⅲ型的长轴之和（4.55±0.6） cm小于其他型别，差异具有统计学意义（P<0.05）；Ⅱ型的短轴之和（3.68±0.51） cm大于其他型别，差异具有统计学意义（P<0.05）；Ⅴ型的短轴之和（3.3±1.2） cm大于Ⅰ、Ⅲ、Ⅳ型，差异具有统计学意义（P<0.05）；Ⅲ型（128.74±6.34）°在Gissane’s角上小于Ⅰ、Ⅳ型，差异具有统计学意义（P<0.05）；Ⅱ型（28.69±7.51）°在Bohler’s角上小于Ⅰ、Ⅲ型，差异具有统计学意义（P<0.05）；在本次研究中，距下关节面的左右侧差异无统计学意义（P>0.05）。结论距下关节面存在5种变异，以Ⅰ型为主，其解剖形态学分型对临床诊治有一定的指导意义。

Abstract

Objective To study the anatomical and morphological characteristics of the subtalar joint surface and to explore its clinical significance. Methods Totally 365 dry calcaneus specimens (sex, age unknown) were selected. Its long axis sum and the short axis sum were measured using Vernier caliper. The Gissane’s angle (the angle was formed by two lines along the anterior and posterior articular surfaces of calcaneus respectively) and the Bohler’s angle (the angular measurement was formed by a line from the posterior calcaneal margin to the margin of the posterior facet and a second line from the margin of the posterior facet to the superior margin of the anterior calcaneal process) were measured using Goniometer. Results According to the anatomical morphology, the subtalar joint surface can be divided into 5 types: type Ⅰ (189, 51.78%), type Ⅱ (80, 21.92%), type Ⅲ (51, 13.97%), type Ⅳ (37, 10.14%) and type Ⅴ (8, 2.19%). The long axis sum of type Ⅲ (4.55±0.6) cm was significantly smaller than other types (P<0.05). With regard to the short axis sum, the type Ⅱ (3.68±0.51) cm was statistically larger than other types (P<0.05) and the type Ⅴ (3.3±1.2) cm was statistically larger than types Ⅰ, Ⅲ, Ⅳ (P<0.05). In term of Gissane’s angle, type Ⅲ (128.74±6.34) ° was statistically smaller than types Ⅰ, Ⅳ (P<0.05). In term of Bohler’s angle, type Ⅱ (28.69±7.51) ° was statistically smaller than types Ⅰ, Ⅲ (P<0.05). There was no statistically significant difference between left and right sides of the articular facets in this study (P>0.05). Conclusion In this experiment, there are five variations in the articular surface of calcaneal talus, mainly type Ⅰ, and its anatomical morphological classification has certain guiding significance for clinical diagnosis and treatment.

导出引用

巴达拉胡何春颖张磊罗元发贾文利程翰文扶世杰. 距下关节面的解剖形态学分型及临床意义[J]. 解剖学报. 2019, 50(5): 633-637 https://doi.org/10.16098/j.issn.0529-1356.2019.05.015

BA-dalahu HE Chun-ying ZHANG Lei LUO Yuan-fa JIA Wen-li CHENG Han-wen FU Shi-jie. Anatomic classification of the subtalar joint surface and its clinical significance[J]. Acta Anatomica Sinica. 2019, 50(5): 633-637 https://doi.org/10.16098/j.issn.0529-1356.2019.05.015

参考文献

［1］ Aydlng?z ü, Melih Topcuo?lu O, G?rmez A, et al. Accessory anterolateral talar facet in populations with and without symptoms: prevalence and relevant associated ankle MRI findings ［J］. AJR Am J Roentgenol, 2016, 207(4): 846-851.

［2］ Kr?henbühl N, Horn-Lang T, Hintermann B, et al. The subtalar joint: a complex mechanism ［J］. Efort Open Rev, 2017, 2(7): 309-316.

［3］ Hattori K, Sakuma E, Nakayama M, et al. An anatomic study of the accessory anterolateral talar facet ［J］. Folia Morphol (Warsz), 2015,74(1): 61-64.

［4］ Zhou RP, Mei J, Pan QX, et al. Comparative study on the stability of reconstructing the calcaneus defect with the Ⅱ-shaped and Ⅴ-shaped fibula flap in the initial stage ［J］. Acta Anatomica Sinica, 2011, 42(3): 410-414. (in Chinese)

周仁鹏, 梅劲, 潘庆祥, 等. Ⅱ型与Ⅴ型腓骨瓣修复跟骨缺失初期再造跟骨稳定性的比较［J］. 解剖学报, 2011, 42(3): 410-414.

［5］ Zhang XQ, Li HJ, Xiao ZhQ, et al. Minimally invasive treatment of Sanders type Ⅲ calcaneal fractures with mini-plate and internal column screw ［J］. Chinese Journal of Clinical Anatomy, 2019, 37(2): 201-205. (in Chinese)

张学全, 黎惠金, 肖智青, 等. 跗骨窦改良切口结合微型钢板及内侧柱螺钉治疗SandersⅢ型跟骨骨折［J］. 中国临床解剖学杂志, 2019, 37(2): 201-205.

［6］ Bernstein J, Ahn J. In brief: Fractures in brief: calcaneal fractures ［J］. Clin Orthop Relat Res, 2010, 468(12): 3432-3434.

［7］ Gondim Teixeira PA, Formery AS, Jacquot A, et al. Quantitative analysis of subtalar joint motion with 4D CT: proof of concept with cadaveric and healthy subject evaluation ［J］. AJR Am J Roentgenol, 2017, 208(1): 150-158.

［8］ Wei N, Zhou Y, Chang W, et al. Displaced intra-articular calcaneal fractures: classification and treatment ［J］. Orthopedics, 2017, 40(6): e921-e929.

［9］ Lui TH, Sin YH. Endoscopic revision subtalar arthrodesis ［J］. Arthrosc Tech, 2019, 8(3): e245-e250.

［10］Takeuchi N, Mae T, Fukushi JI, et al. Management of intra-articular calcaneal fractures: clinical results of reduction technique using a bone spreader ［J］. J Foot Ankle Surg, 2017, 56(5): 1025-1030.

［11］Jandová S, Pazour J. Limited versus extended lateral approach for osteosynthesis of calcaneal fractures-comparison of temporal and dynamic parameters of the gait Cycle ［J］. Acta Chir Orthop Traumatol Cech, 2018, 85(1): 57-61.

［12］Choisne J, Hoch MC, Alexander Ⅰ, et al. Effect of direct ligament repair and tenodesis reconstruction on simulated subtalar joint instability ［J］. Foot Ankle Int, 2017, 38(3): 324-330.

［13］Su YJ, Tong XY, Hu L. Chronic ankle instability: an analysis based on anatomical structure and biomechanical characteristics of the ankle joint ［J］. Chinese Journal of Tissue Engineering Research, 2015, 19(15): 2415-2419. (in Chinese)

苏应军, 童新延, 胡力. 以踝关节解剖结构及生物力学特征分析慢性踝关节不稳［J］. 中国组织工程研究, 2015, 19(15): 2415-2419.

［14］Majeed H, Barrie J, Munro W, et al. Minimally invasive reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular calcaneal fractures: a systematic review of the literature ［J］. Efort Open Rev, 2018, 3(7): 418-425.

［15］Qu H, Wei ShJ, Cai XH, et al. Relationships of changes in anatomical indicators of sanders Ⅲ type calcaneal fractures with postoperative efficacy ［J］. Orthopedic Journal of China, 2014, 22(12): 1057-1062. (in Chinese)

瞿浩, 魏世隽, 蔡贤华，等. Sanders Ⅲ型跟骨骨折解剖学指标的改变与术后疗效的关系［J］.中国矫形外科杂志, 2014, 22(12): 1057-1062.

［16］Park CH. Role of subtalar arthroscopy for displaced intra-articular calcaneal fractures ［J］. Clin Podiatr Med Surg, 2019, 36(2): 233-249.

［17］Li S. Wound and sural nerve complications of the sinus tarsi approach for calcaneus fractures ［J］. Foot Ankle Int, 2018, 39(9): 1106-1112.

［18］Bianchi S, Luong DH. Stress fractures of the calcaneus diagnosed by sonography: report of 8 cases ［J］. J Ultrasound Med, 2018, 37(2): 521-529.

［19］Tang SY, Zhu XM, Yang H, et al. Analysis of correlation between reduction quality of posterior subtalar articular surface ［J］. Orthopedic Journal of China, 2015, 23(16): 1448-1453. (in Chinese)

唐三元, 朱学敏, 杨辉, 等. 后距下关节面复位质量与跟骨骨折疗效的相关性研究［J］. 中国矫形外科杂志, 2015, 23(16): 1448-1453.

［20］Backes M, Spierings KE, Dingemans SA, et al. Evaluation and quantification of geographical differences in wound complication rates following the extended lateral approach in displaced intra-articular calcaneal fracturesa systematic review of the literature ［J］. Injury, 2017, 48(10): 2329-2335.

［21］Aibinder WR, Young EY, Milbrandt TA, et al. Intraoperative three-dimensional navigation for talocalcaneal coalition resection ［J］. J Foot Ankle Surg, 2017, 56(5): 1091-1094.

［22］Qiang M, Chen Y, Zhang K, et al. Measurement of three-dimensional morphological characteristics of the calcaneus using CT image post-processing ［J］. J Foot Ankle Res, 2014, 7(1): 19.

［23］Gonzalez TA, Ehrlichman LK, Macaulay AA, et al. Determining measurement error for bohler’s angle and the effect of X-ray obliquity on accuracy ［J］. Foot Ankle Spec, 2016, 9(5): 409-416.