Vasarhelyi Attila, Lubitz Jessica, Gierer Philip, Gradl Georg, Rösler Klaus, Hopfenmüller Werner, Klaue Kaj, Mittlmeier Thomas W F
University of Rostock, Trauma and Reconstructive Surgery, Schillingallee 35, Rostock, D-18055, Germany.
Foot Ankle Int. 2006 Dec;27(12):1115-21. doi: 10.1177/107110070602701219.
Substantial fibular torsional deformities were detected after surgery for ankle fractures combined with a lesion of the syndesmotic complex using a novel CT analyzing method.
In a prospective study, 61 patients with ankle fracture dislocations were treated with trans-syndesmotic screw fixation of the distal tibiofibular joint. Postoperative axial CT scans of both lower legs under standardized leg positioning conditions were made and analyzed with three different methods. Method 1 (M1) used proximal and distal CT planes of the lower leg for detection of the fibular torsional angle, method 2 (M2) considered only the angle at the distal tibiofibular joint, and method 3 (M3) measured the angles between the fibular and tibial tangents at the distal tibiofibular joint. Twenty patients with fibular torsional asymmetries of more than 10 degrees were evaluated clinically 6 to 34 months postoperatively with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score.
Thirty-five of the 61 patients had torsional side-to-side differences of more than 10 degrees. M1 and M2 showed statistically significant differences compared to M3 (p = 0.001). Validity was controlled by interobserver data, variation coefficients were low for M1 and M2. Clinically, six of 20 patients with torsional differences of more than 10 degrees had excellent results, while seven had good results and seven had moderately functional results. Six of the seven with moderate results had fibular torsional differences of more than 15 degrees, two of the seven patients with good outcomes. Torsional results of M1 and M2 correlated with the AOFAS score (r = -0.506).
Of the 61 ankle fractures with ruptures of the syndesmotic complex, 25% showed torsional side-to-side differences of more than 10 degrees on proximal and distal CT planes. This CT technique correlated with the AOFAS score and could help determine when early operative revision is indicated.
采用一种新型CT分析方法，在对踝关节骨折合并下胫腓联合复合体损伤进行手术后，检测到大量腓骨扭转畸形。
在一项前瞻性研究中，61例踝关节骨折脱位患者接受了下胫腓关节经下胫腓联合螺钉固定治疗。在标准化腿部定位条件下对双下肢进行术后轴向CT扫描，并采用三种不同方法进行分析。方法1（M1）使用小腿的近端和远端CT平面检测腓骨扭转角，方法2（M2）仅考虑下胫腓关节处的角度，方法3（M3）测量下胫腓关节处腓骨与胫骨切线之间的角度。20例腓骨扭转不对称超过10度的患者在术后6至34个月采用美国矫形足踝协会（AOFAS）踝-后足评分进行临床评估。
61例患者中有35例存在超过10度的扭转侧方差异。与M3相比，M1和M2显示出统计学上的显著差异（p = 0.001）。通过观察者间数据控制有效性，M1和M2的变异系数较低。临床上，20例扭转差异超过10度的患者中有6例结果优秀，7例结果良好，7例结果为功能中等。7例结果为中等的患者中有6例腓骨扭转差异超过15度，7例结果良好的患者中有2例。M1和M2的扭转结果与AOFAS评分相关（r = -0.506）。
在61例下胫腓联合复合体破裂的踝关节骨折中，25%在近端和远端CT平面上显示出超过10度的扭转侧方差异。这种CT技术与AOFAS评分相关，有助于确定何时需要早期手术翻修。
