女性外翻引发籽骨嵴磨损的影响因素分析

Risk factors affected the intersesamoidal crista erosion in female patients with hallux valgus

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。

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(αangle),and first metatarsal bottom rotation angle(βangle).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°,anαangle of 22.78°±6.89°,and aβangle of 15.01°±6.45°.Only theβangle 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.