女性外翻引发籽骨嵴磨损的影响因素分析

doi:10.3760/cma.j.cn101202-20200211-00030

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摘要目的探讨女性

外翻引发籽骨嵴磨损的影响因素。方法回顾性研究。纳入2017年10月—2018年12月首都医科大学附属北京同仁医院门诊有症状的144例(237足)女性

外翻患者的负重CT影像资料。患者年龄19~84(53.79±13.04)岁。根据籽骨嵴是否磨损分为籽骨嵴磨损组与籽骨嵴无磨损组。比较两组患者年龄、第1~2跖骨间角(IMA)、

外翻角(HVA)、第1跖骨关节面外翻角(DMAA)、正位胫侧籽骨分度、冠状面籽骨分度、第1跖骨旋转角(α角)、第1跖骨底边旋转角(β角)。采用多因素logistic回归分析籽骨嵴磨损的影响因素。通过ROC曲线分析计算界值。结果 144例(237足)患者的IMA为13.85°±3.15°,HVA为31.52°±11.23°,DMAA为18.10°±8.08°,α角为22.78°±6.89°,β角为15.01°±6.45°。两组参数比较,除β角差异无统计学意义(Z=-1.171, P＞0.05)外,其他参数差异均有统计学意义(P值均＜0.05)。多因素logistic回归分析,年龄[比值比(95%可信区间)为1.05(1.02~1.09), P＜0.01]、冠状面籽骨分度[比值比(95%可信区间)为4.41(2.90~6.70), P<0.01]是籽骨嵴磨损的影响因素。ROC曲线分析显示,年龄界值为53.5岁(灵敏度85.1%、特异度56.6%),冠状面籽骨分度界值为1.5度(灵敏度90.4%、特异度67.8%)。结论女性

外翻患者中,籽骨嵴磨损与年龄和冠状面籽骨分度增加有关,与IMA、HVA、DMAA、正位籽骨分度及第1跖骨旋转角度无关。

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	张明珠
	张树
	何慧婧
	孙超
	王显军
	张建中
	魏芳远
	曲峰
	王智

Abstract：Objective To explore the risk factors influencing the intersesamoidal crista erosion infemale patients with hallux valgus.Methods Symptomatic female hallux valgus patients who underwent a weightbearing CT scan were reviewed from October 2017 to June 2018. A total of 144 patients (237 feet) aged 19-84 years (53.79±13.04) were included in the study. Two groups were identified by whether or not the inersesamoidal crista eroded. Parameters about hallux valgus included age, inter-metatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), tibial sesamoid grading on dorsoplantar view, coronal plane sesamoid grading, first metatarsal rotation angle (α angle), and first metatarsal bottom rotation angle (β angle). The two groups of data were compared by Student's t-test, Wilcoxon rank test, or chi-square test according to data type and distribution. Parameters that had significant differences were included in the logistic regression by the forward model, and risk factors of intersesamoidal crista erosion were calculated. Receiver operating characteristic (ROC) analysis was then used to determine the cut-off values.Results The 144 (237 feet) patients showed an IMA of 13.85°±3.15°, an HVA 31.52°±11.23°, a DMAA of 18.10°±8.08°, an α angle of 22.78°±6.89°, and a β angle of 15.01°±6.45°. Only the β angle had no statistical difference (Z=-1.171, P>0.05), and all other parameters were statistically significant (all P values<0.05). Logistic regression results showed that age [(OR(95% CI): 1.05(1.02-1.09), P＜0.01)] and coronal plane sesamoid grading [(OR(95% CI): 4.41(2.90-6.70), P<0.01)] were the risk factors for intersesamoidal crista erosion. ROC calculation showed that the cut-off value of age was 53.5 years old (sensitivity 85.1%, specificity 56.6%), and that of coronal plane sesamoid grading was 1.5 (sensitivity 90.4%, specificity 67.8%).Conclusions The intersesamoidal crista erosion in female patients with hallux valgus is affected by age and coronal plane sesamoid grading but not by IMA, HVA, DMAA, sesamoid grading on the dorsoplantar plane and first metatarsal rotation angle.

收稿日期: 2020-02-11

基金资助:国家自然科学基金(81773091);国家重点研发计划(2017YFC0108103)

通讯作者: 王智,Email: alviswild@163.com

引用本文:

张明珠, 张树, 何慧婧, 孙超, 王显军, 张建中, 魏芳远, 曲峰, 王智. 女性外翻引发籽骨嵴磨损的影响因素分析[J]. 中华解剖与临床杂志, 2020, 25(5): 478-483.
Zhang Mingzhu, Zhang Shu, He Huijing, Sun Chao, Wang Xianjun, Zhang Jianzhong, Wei Fangyuan, Qu Feng, Wang Zhi. Risk factors affected the intersesamoidal crista erosion in female patients with hallux valgus. Chinese Journal of Anatomy and Clinics, 2020, 25(5): 478-483.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20200211-00030 或 http://www.cjac.com.cn/CN/Y2020/V25/I5/478

[1]	王正义, 姜保国, 唐康来, 等. 外翻外科治疗专家共识[J]. 中华骨与关节外科杂志, 2018, 11(2): 87-95.Wang ZY, Jiang BG, Tang KL, et al. Expert consensus on the surgical treatment of hallux valgus[J]. Chinese Journal Bone and Joint Surgery, 2018, 11(2): 87-95.
[2]	Coughlin MJ, Saltzman CL, Mann RA. Sesamoids and accessory bones of the foot[M]// Surgery of Foot and Ankle. 9th Eedition. Philadelphia, PA: Mosby, 2013: 493-497.
[3]	Largey A, Canovas F, Roussanne Y, et al. Degenerative cartilage changes in metatarsosesamoidal joint and Scarf procedure results for hallux valgus: a prospective study of 100 cases[J]. Rev Chir Orthop Reparatrice Appar Mot, 2008, 94(7): 685-692. DOI:10.1016/j.rco.2007.12.019.
[4]	Katsui R, Samoto N, Taniguchi A, et al. Relationship between displacement and degenerative changes of the sesamoids in hallux valgus[J]. Foot Ankle Int, 2016, 37(12): 1303-1309. DOI:10.1177/1071100716661827.
[5]	Richter M, Seidl B, Zech S, et al. PedCAT for 3D-imaging in standing position allows for more accurate bone position (angle) measurement than radiographs or CT[J]. Foot Ankle Surg, 2014, 20(3): 201-207. DOI:10.1016/j.fas.2014.04.004.
[6]	Welck MJ, Singh D, Cullen N, et al. Evaluation of the 1st metatarso-sesamoid joint using standing CT-the Stanmore classification[J]. Foot Ankle Surg, 2018, 24(4): 314-319. DOI:10.1016/j.fas.2017.03.005.
[7]	Coughlin MJ. Hallux valgus in men: effect of the distal metatarsal articular angle on hallux valgus correction[J]. Foot Ankle Int, 1997, 18(8): 463-470. DOI:10.1177/107110079701800802.
[8]	Shima H, Okuda R, Yasuda T, et al. Radiographic measurements in patients with hallux valgus before and after proximal crescentic osteotomy[J]. J Bone Joint Surg Am, 2009, 91(6): 1369-1376. DOI:10.2106/JBJS.H.00483.
[9]	Eustace S, Williamson D, Wilson M, et al. Tendon shift in hallux valgus: observations at MR imaging[J]. Skeletal Radiol, 1996, 25(6): 519-524. DOI:10.1007/s002560050128.
[10]	董岩, 张建中, 孙超. 籽骨在足负重正位、籽骨轴位X线片上的位置关系[J]. 临床骨科杂志, 2008, 11(6): 508-511.DOI:10.3969/j.issn.1008-0287.2008.06.007.Dong Y, Zhang JZ, Sun C. The sesamoids position of hallux in the antero-posterior and weightbearing tangential radiograph[J]. Journal of Clinical orthopaedics, 2008, 11(6): 508-511. DOI:10.3969/j.issn.1008-0287.2008.06.007.
[11]	Kim Y, Kim JS, Young KW, et al. A new measure of tibial sesamoid position in hallux valgus in relation to the coronal rotation of the first metatarsal in CT SCANS[J]. Foot Ankle Int, 2015, 36(8): 944-952. DOI:10.1177/1071100715576994.
[12]	Yildirim Y, Cabukoglu C, Erol B, et al. Effect of metatarsophalangeal joint position on the reliability of the tangential sesamoid view in determining sesamoid position[J]. Foot Ankle Int, 2005, 26(3): 247-250. DOI:10.1177/107110070502600311.
[13]	Perera AM, Mason L, Stephens MM. The pathogenesis of hallux valgus[J]. J Bone Joint Surg Am, 2011, 93(17): 1650-1661. DOI:10.2106/JBJS.H.01630.
[14]	Shibuya N, Jasper J, Peterson B, et al. Relationships between first metatarsal and sesamoid positions and other clinically relevant parameters for hallux valgus surgery[J]. J Foot Ankle Surg, 2019, 58(6): 1095-1099. DOI:10.1053/j.jfas.2019.01.014.
[15]	Okuda R, Kinoshita M, Yasuda T, et al. Postoperative incomplete reduction of the sesamoids as a risk factor for recurrence of hallux valgus[J]. J Bone Joint Surg Am, 2009, 91(7): 1637-1645. DOI:10.2106/JBJS.H.00796.
[16]	Park CH, Lee WC. Recurrence of hallux valgus can be predicted from immediate postoperative non-weight-bearing radiographs[J]. J Bone Joint Surg Am, 2017, 99(14): 1190-1197. DOI:10.2106/JBJS.16.00980.
[17]	Talbot KD, Saltzman CL. Assessing sesamoid subluxation: how good is the AP radiograph?[J]. Foot Ankle Int, 1998, 19(8): 547-554. DOI:10.1177/107110079801900808.
[18]	Geng X, Zhang C, Ma X, et al. Lateral sesamoid position relative to the second metatarsal in feet with and without hallux valgus: a prospective study[J]. J Foot Ankle Surg, 2016, 55(1): 136-139. DOI:10.1053/j.jfas.2015.08.023.