单纯性踇外翻患者内侧楔骨远端关节倾斜与踇外翻关系的影像学研究

Radiographic study of relationship between medial cuneiform obliquity and simple hallux valgus

目的通过在足负重正位X线片测量与内侧楔骨远端关节倾斜相关的指标,研究其与踇外翻发生及严重程度间的关系。方法选择2018年1月—2021年2月符合标准的足负重正位X线片,测量踇外翻角(hallux valgus angle,HVA)、第1-2跖骨间夹角(intermetatarsal angle,IMA)、跖内收角(metatarsus adductus angle,MAA)、第1跖楔夹角(metatarsus cuneiform angle,MCA)、内侧楔骨远端关节倾斜角(distal medial cuneiform angle,DMCA)、第1跖骨近端关节倾斜角(proximal metatarsal articular angle,PMAA);记录第1跖楔关节(first tarsometatarsal,TMT)关节面形态。根据HVA将患者分为正常组(<15°)与踇外翻组(≥15°),比较两组患者年龄、性别、侧别、IMA、MAA、MCA、DMCA、PMAA以及TMT关节面形态。多元线性回归分析HVA、IMA的影响因素。结果 534例(679足)患者X线片符合选择标准纳入研究。其中,男220例,女314例;年龄18~82岁,平均36岁。根据HVA分组,正常组154例(168足),踇外翻组403例(511足)。两组患者性别及年龄比较,差异均有统计学意义(P<0.05);侧别比较差异无统计学意义(P>0.05)。踇外翻组IMA、MAA、MCA均大于正常组(P<0.05),DMCA与正常组比较差异无统计学意义(P>0.05)。两组TMT关节面形态均以曲面为主,差异无统计学意义(P>0.05)。经测量PMAA发现第1跖骨存在内收型、中立型和外展型3种形态,组间分型比较差异有统计学意义(P<0.05)。正常组外展型PMAA大于踇外翻组(P<0.05),内收型PMAA组间差异无统计学意义(P>0.05)。基于679足资料的多元线性回归分析显示,年龄、MCA、DMCA为HVA的影响因素(P<0.05),年龄、MAA、MCA、DMCA为IMA的影响因素(P<0.05)。结论内侧楔骨远端关节倾斜程度相对恒定,DMCA不能作为量化踇外翻的特征性角度,TMT关节面形态与踇外翻无明显关系;MAA、MCA、PMAA参与了踇外翻形成,而且MCA可以作为量化踇外翻程度的特征性角度。

Objective To investigate the relationship between hallux valgus and the indicators associated with medial cuneiform obliquity measured on feet weight-bearing anteroposterior X-ray films. Methods Based on the feet weight-bearing anteroposterior X-ray films taken between January 2018 and February 2021 and met the criteria, the hallux valgus angle(HVA), intermetatarsal angle(IMA), metatarsus adductus angle(MAA), metatarsus cuneiform angle(MCA),distal medial cuneiform angle(DMCA), and proximal metatarsal articular angle(PMAA) were measured and the morphology of the first tarsometatarsal(TMT) were recorded. According to the HVA, the X-ray films were divided into normal group(HVA<15°) and hallux valgus group(HVA≥15°). The gender, age, sides, IMA, MAA, MCA, DMCA,PMAA, and the morphology of TMT were compared between groups. The influencing factors of HVA and IMA were analyzed by multivariate linear regression analysis. Results X-ray films of 534 patients(679 feet) met the selection criteria and were included in the study. There were 220 males and 314 females, with an average age of 36 years(mean, 18-82 years). There were 154 cases(168 feet) in the normal group and 403 cases(511 feet) in the hallux valgus group. There were significant differences in gender and age between groups(P<0.05), and no significant difference in the side(P>0.05).The IMA, MAA, and MCA in the hallux valgus group were significantly bigger than those in the normal group(P<0.05);the difference in DMCA between the two groups was not significant(P>0.05). The TMT morphology of the two groups was mainly curved, and the difference in morphology classification was not significant(P>0.05). PMAA measurement showed that there were 3 kinds of metatarsal shapes: adductive metatarsal, neutral metatarsal, and abductive metatarsal,the difference in metatarsal shapes between groups was not significant(P>0.05). The PMAA of abductive metatarsal was significantly bigger in normal group than in hallux valgus group(P<0.05), there was no significant difference in PMAA of adductive metatarsal between groups(P>0.05). Multivariate linear regression analysis showed that age, MCA, and DMCA were the influencing factors of HVA(P<0.05), and age, MAA, MCA, and DMCA were the influencing factors of IMA(P<0.05). Conclusion The medial cuneiform obliquity is relatively constant and the DMCA can not be used as the characteristic angle to quantify hallux valgus. The morphology of TMT has no relationship with hallux valgus, while MAA,MCA, and PMAA are all factors to be considered, and MCA can be used as the characteristic angle to quantify hallux valgus.