Anatomic classification of the sustentaculum tali and its characteristics analysis

ZHANG Lei; LI Zhi-Qing; TANG Xiao-Gao; ZHOU Xin; LI Bing-Kun; FU Shi-Jie

doi:10.16098/j.issn.0529-1356.2022.04.015

PDF(2530 KB)

Acta Anatomica Sinica ›› 2022, Vol. 53 ›› Issue (4) : 515-519. DOI: 10.16098/j.issn.0529-1356.2022.04.015

Anatomy

Anatomic classification of the sustentaculum tali and its characteristics analysis

ZHANG Lei¹ LI Zhi-qing² TANG Xiao-gao¹ ZHOU Xin¹ LI Bing-kun¹ FU Shi-jie^1*

Author information +

History +

Abstract

Objective To explore the anatomical morphology and characteristics of the sustentaculum tali based on CT three-dimensional reconstruction, so to provide anatomical support for the treatment of calcaneal fractures with screw implantation. Methods From March 2019 to March 2020, a total of 336 adult calcaneal CT three-dimensional reconstruction images from the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University were collected after exclusion of inclusion criteria. The CT threedimensional reconstruction of calcaneus was classified according to the β, the prolate axial intersection between sustentaculum tali and calcaneus on the normal posterior. Reference points, β; AB, the distance from the inside of sustentaculum tali to the inside of posterior talar articular surface; AC, the distance from the inside of sustentaculum tali to the outside of posterior talar articular surface; AD, the distance from the inside of sustentaculum tali to lateral of calcaneal; AE, the distance from the inside of sustentaculum tali to medial process of calcaneal tuberosity; AF, the distance from the inside of sustentaculum tali to calcaneal tuberosity; AG, the distance from the inside of sustentaculum tali to lateral process of calconeal tuberosity. The results were statistically analyzed according to type, sex and body side. Results Under the β, the sustentaculum tali was classified into three types: typeⅠ(β<70°, 68 cases, 20.24%), type Ⅱ(70°≤β<80°, 153 cases, 45.54%), type Ⅲ(80°≤β<90°, 115 cases, 34.23%). For the distance of β, AB, AF, there were statistical differences between type Ⅲ and other types (P<0.05). For the distance of AE, there were statistical differences between type Ⅲ and typeⅠ(P<0.05). Meanwhile, for the distance of AB, AC, AD, AE, AF, AG, there were statistical differences between male and female (P<0.05). For the distance of β, AB, there were statistical differences between right and left (P<0.05). Conclusion Under the β, the sustentaculum tali is classified into three types, with the typeⅡas the main type. When treating calcaneal fractures with internal fixation, direction of screw implant can choose between 70° to 80° as soon as possible. The morphology and classification of sustentaculum tali are of certain clinical implication to treat calcaneal fractures.

Key words

Sustentaculum tali / Calcaneal fracture / Anatomical morphology / Classification / CT three-dimensional reconstruction / Human

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

ZHANG Lei LI Zhi-qing TANG Xiao-gao ZHOU Xin LI Bing-kun FU Shi-jie. Anatomic classification of the sustentaculum tali and its characteristics analysis[J]. Acta Anatomica Sinica. 2022, 53(4): 515-519 https://doi.org/10.16098/j.issn.0529-1356.2022.04.015

References

［1］Schepers T, van Lieshout EM, van Ginhoven TM, et al. Current concepts in the treatment of intra-articular calcaneal fractures: results of a nationwide survey ［J］. Int Orthop, 2008, 32(5): 711-715.

［2］Wang H, Pei H, Chen M, et al. Incidence and predictors of surgical site infection after ORIF in calcaneus fractures, a retrospective cohort study ［J］. J Orthop Surg Res, 2018, 13(1): 293.

［3］Rammelt S, Zwipp H. Fractures of the calcaneus: current treatment strategies ［J］. Acta Chir Orthop Traumatol Cech, 2014, 81(3): 177-196.

［4］Pelliccioni AA, Bittar CK, Zabeu JL. Surgical treatment of intraarticular calcaneous fractures of sanders’ types Ⅱ and Ⅲ. Systematic review ［J］. Acta Ortop Bras, 2012, 20(1): 39-42.

［5］Meena S, Gangary SK, Sharma P. Review Article: Operative versus nonoperative treatment for displaced intraarticular calcaneal fracture: a meta-analysis of randomised controlled trials ［J］. J Orthop Surg (Hong Kong), 2016, 24(3): 411-416.

［6］Mei J, Yu GR, Zhu H, et al. Anatomic characteristics and clinical significance of the sustentaculum tali of calcaneus ［J］. Chinese Journal of Clinical Anatomy, 2002, 20(1): 9-11. (in Chinese)

梅炯, 俞光荣, 朱辉, 等. 跟骨载距突的解剖特点及其临床意义［J］. 中国临床解剖学杂志, 2002, 20(1): 9-11.

［7］Wang B, Li T, Zhu YCh, et al. Anterior part of calcaneus and sustentaculum tali: anatomic relationship and clinical significance ［J］. Chinese Journal of Clinical Anatomy, 2012, 30(2): 131-135. (in Chinese)

王冰, 李涛, 朱裕成, 等. 跟骨前部与载距突关系的解剖学研究及其临床意义［J］. 中国临床解剖学杂志, 2012, 30(2): 131-135.

［8］Gras F, Marintschev I, Wilharm A, et al. Sustentaculum tali screw placement for calcaneus fractures-different navigation procedures compared to the conventional technique ［J］. Z Orthop Unfall, 2010, 148(3): 309-318.

［9］Liu BG, Pang QJ, Yu X, et al. Manufacture and clinical application of screw director of calcaneous sustentaculum tali for treatment of inter-articular calcaneal fractures ［J］. Chinese Journal of Reparative and Reconstructive Surgery,2015, 29(3): 296-300. (in Chinese)

刘丙根, 庞清江, 余霄, 等. 跟骨载距突螺钉导向器的研制与临床应用［J］. 中国修复重建外科杂志, 2015, 29(3): 296-300.

［10］Phisitkul P, Sullivan JP, Goetz JE, et al. Mximizing safety in screw placement for posterior facet fixation in calcaneus fractures: a cadaveric radio-anatomical study ［J］. Foot Ankle Int, 2013, 34(9): 1279-1285.

［11］Pang QJ, Yu X. The sustentaculum tali screw fixation for the treatment of Sanders type II calcaneal fracture: a finite element analysis ［J］. Pak J Med Sci, 2014, 30(5): 1099-1103.

［12］Pazour J, Krivohlavek M, Lukas R. Positions of sustentacular screw in osteosynthesis of calcaneal fractures: clinical and radiographic study ［J］. Acta Chir Orthop Traumatol Cech, 2016, 83(3): 182-185.

［13］Smerek JP, Kadakia A, Belkoff SM, et al. Percutaneous screw configuration versus perimeter plating of calcaneus fractures: a cadaver study ［J］. Foot Ankle Int, 2008, 29(9): 931-935.

［14］Qiang M, Chen Y, Zhang K, et al. Effect of sustentaculum screw placement on outcomes of intra-articular calcaneal fracture osteosynthesis: a prospective cohort study using 3D CT ［J］. Int J Surg, 2015, 19: 72-77.

［15］Liao LQ, Chen Ch, Wu K, et al. Anatomy of the safe zone of sustentaculum tali screw fixation ［J］.Acta Anatomica Sinica,2020, 51(4): 566-569. (in Chinese)

廖立青,陈尘,武凯,等.载距突置钉安全区域的解剖学特征［J］.解剖学报, 2020, 51(4): 566-569.

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

［17］De Boer AS, Van Lieshout EMM, Vellekoop L, et al. 2D and 3D assessment of sustentaculum tail screw fixation with or without screw targeting clamp ［J］. Injury, 2017, 48(12): 2864-2871.

［18］Wang Y, Liu BG, Pang QJ, et al. Comparison of fixation of sustentaculum tali of calcaneus aided by director for sustentaculum tali screwing and ordinary screwing guide ［J］. China Journal of Orthopaedics and Traumatology, 2016, 29(12): 1097-1103. (in Chinese)

王云, 刘丙根, 庞清江, 等. 载距突螺钉导向器与普通螺钉导向器辅助固定跟骨载距突疗效比较［J］. 中国骨伤, 2016, 29(12): 1097-1103.

［19］Zhang L, Wang J, Guo X, et al. Three-dimensional (3D) computed tomographic (CT) assessment of the sustentaculum tail to find distinctive characteristics: implications for surgery ［J］. Med Sci Monit, 2018, 24: 8417-8421.

［20］Badillo K, Pacheco JA, Padua SO, et a1. Muhidetector CT evaluation of calcaneal fractures ［J］. Radiographics, 2011, 31(1): 8l-92.

［21］Majeed H, Barrie J, Munro W. Minimally invasive reduction and percutaneous fixation 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.

［22］Gras F, Marintschev I, Wilharm A, et al. Sustentaculum tali screw placement for calcaneus fractures-different navigation procedures compared to the conventional technique ［J］. Z Orthop Unfall, 2010, 148(3): 309-318.

［23］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.

［24］Huang HJ, Ma XL, Ma JX, et al. Comparison of stress distrib on between normal and malunion cal-caneus ［J］. Chinese Journal of Orthopaedic, 2013, 33(4): 336-341. (in Chinese)

黄海晶, 马信龙, 马剑雄, 等. 正常与畸形愈合跟骨应力分布的比较研究［J］. 中华骨科杂志, 2013, 33(4): 336-341.

［25］McManus C. Half a century of handedness research: myths, truths; fictions, facts; backwards, but mostly forwards ［J］. Brain Neurosci Adv, 2019, 3: 2398212818820513.

Funding

National Natural Science Foundation of China (Youth Science Foundation Project);Health Commission of Sichuan Province Science and Research Project (Popularization and Application Project);Luzhou People's Government - Southwest Medical University Shi-zhen Zhong Academician Talent Team Sub-project;Luzhou People's Government-Southwest Medical University Science and Technology Strategic Cooperation Project;Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University Research Project (National Nature Foundation Training Program)