Foot and Ankle Surgery最新文献

Purpose: The popularity of minimally invasive (MIS) foot surgery continues to grow. However, it comes with certain limitations that present notable challenges. One significant hurdle is the absence of direct visualization of neurovascular structures and tendons. The objective of this study is to present fluoroscopic heatmaps that illustrate the trajectories of major structures encountered during MIS midfoot procedures.

Methods: Sequential dissection was performed on nine below-knee cadaveric specimens and critical structures were identified and marked, including anterior tibialis tendon (ATT), extensor hallucis longus tendon (EHL), extensor digitorum longus tendon (EDL), superficial peroneal nerve (SPN) and dorsal neurovascular bundle (DNVB) were dissected. Subsequently, flexible wires were positioned and securely placed adjacent to the medial and/or lateral borders of these structures to visualize their trajectories on X-ray imaging. Anteroposterior (AP) and oblique fluoroscopic images of the foot, featuring a calibration marker, were obtained alongside standard photographs. All fluoroscopy images were adjusted to a uniform scale and standardized to a single foot fluoroscopy. The coordinates of the structures were marked on these standardized foot AP and oblique fluoroscopic views. These coordinates were then utilized to generate heatmaps.

Results: Successfully generated heatmaps encompassed the DNVB, ATT, EDL, EHL, and SPN, on AP and oblique fluoroscopic images of the foot. The color gradient used visually represents varying magnitudes, with red indicating the most frequent locations of the structures and blue signifying lower occurrences. These heatmaps also illustrate the highest-risk areas for iatrogenic injury to the structures during MIS procedures.

Conclusion: This study can empower surgical navigation and improve safety in MIS midfoot procedures by providing surgeons with a fluoroscopic heatmap detailing the trajectories of major anatomical structures. The findings from this study present a valuable opportunity to improve surgical accuracy and safety.

Background: Accurate localisation of symptomatic osteoarthritic (OA) lesions in the midfoot, hindfoot and ankle remains challenging due to their complex anatomy. Conventional radiographs have limitations in complex areas or overlapping structures. SPECT/CT has shown promising results in detecting symptomatic OA lesions, yet its superiority over MRI, the current standard for soft tissue pathology, remains uncertain. We designed the ProSPECT-trial to systematically investigate the diagnostic accuracy of SPECT/CT compared to MRI in OA of the foot and ankle.

Methods: The ProSPECT-trial is a non-randomised single-center prospective cohort study. Eligible patients with suspected OA of the midfoot, hindfoot and ankle are recruited. Diagnostic performance of SPECT/CT and MRI is assessed based on sensitivity, specificity, positive and negative predictive values. Intra- and interobserver reliability of both imaging modalities are evaluated. Imaging protocols include SPECT/CT using technetium-99^m hydroxymethylene disphosphonate (99mTc-HDP) and MRI without contrast agents. Anatomical regions are scored for OA presence using standardised radiographic- and clinical criteria. Diagnoses are confirmed via ultrasound-guided injections containing steroid and anaesthetics. With a calculated sample size of 369 patients, the study aims to show significant sensitivity and specificity differences between SPECT/CT and MRI, assuming a 15 % clinically relevant difference.

Implications: The ProSPECT trial assesses the diagnostic accuracy of SPECT/CT and MRI in midfoot, hindfoot, and ankle OA. The findings aim to standardise clinical decision-making and guide future treatment protocols, ultimately optimising patient care and resource utilisation in managing midfoot, hindfoot, and ankle OA.