Department of Orthopaedics, Tongji Hospital of Tongji University, Shanghai 200065, China.
Chin Med J (Engl). 2011 Dec;124(23):3912-8.
As precise positioning of ankle radiography is not possible, quantitative measurement of all syndesmotic parameters on repeated ankle X-ray films may be of little value. The purpose of this study was to provide a set of scientific and objective evaluation criteria for assessing the quality of ankle fracture reduction accurately and reliably by an intelligent combining three-dimensional (3-D) computed tomography (CT) measurement model.
From June 2008 to March 2011, all the thin-slice CT images of 100 cases (50 males and 50 females) with normal ankle joint scanned by 16-slice spiral CT were collected. Two-dimensional (2-D) and 3-D images of ankle joints were generated by using multiple planar reconstruction (MPR) and surface shaded display (SSD) respectively. The relevant parameters about bone structures and their relationship were measured and analyzed based on 3-D topological narrow division technique and 3-D measurement techniques combining essential elements of point, line and surface.
In this study, the mean distance from lateral malleolus tip to talocrural articular surface, the tip of medial malleolus anterior colliculus to talocrural articular surface and lateral malleolus tip to the tip of medial malleolus anterior colliculus were (22.83 ± 1.12) mm, (12.84 ± 1.09) mm, and (61.18 ± 2.03) mm respectively in male group, and (20.16 ± 1.00) mm, (10.30 ± 1.05) mm and (53.00 ± 1.40) mm respectively in female group. The above three parameters were correlated with gender, height and weight (P < 0.05). However, the mean perpendicular distance from lateral malleolus tip to the plane through the tip of medial malleolus anterior colliculus, the talocrural angle, later clear space, medial clear space, and the superior clear space were (9.93 ± 0.29) mm, (10.01 ± 0.38)°, (1.94 ± 0.16) mm, (2.78 ± 0.19) mm, and (3.14 ± 0.15) mm respectively in 100 cases, were not significance correlated with gender, height and weight (P > 0.05).
This study could provide a certain amount of relevant data for the standard of injured ankle anatomical reduction and the second surgery planning after malunion. The methods of measurement are reliable, reproducible, and easy to apply in practice.
由于踝关节 X 线摄影无法做到精确定位，因此对重复踝关节 X 射线片上所有联合参数进行定量测量可能价值不大。本研究旨在提供一套科学客观的评估标准，通过智能结合三维（3-D）计算机断层扫描（CT）测量模型，准确可靠地评估踝关节骨折复位质量。
2008 年 6 月至 2011 年 3 月，收集了 100 例（50 例男性和 50 例女性）正常踝关节 16 层螺旋 CT 薄层 CT 图像。分别采用多层面重建（MPR）和表面阴影显示（SSD）生成踝关节 2-D 和 3-D 图像。基于 3-D 拓扑细分技术和结合点、线、面基本要素的 3-D 测量技术，对骨结构及其关系的相关参数进行测量和分析。
在本研究中，男性组中外踝尖到距骨关节面的平均距离、内踝前结节尖到距骨关节面的平均距离和外踝尖到内踝前结节尖的平均距离分别为（22.83±1.12）mm、（12.84±1.09）mm 和（61.18±2.03）mm，女性组中分别为（20.16±1.00）mm、（10.30±1.05）mm 和（53.00±1.40）mm。以上三个参数与性别、身高和体重相关（P<0.05）。然而，外踝尖到通过内踝前结节尖的平面的垂直距离、距骨角、外侧间隙、内侧间隙和上侧间隙的平均距离分别为（9.93±0.29）mm、（10.01±0.38）°、（1.94±0.16）mm、（2.78±0.19）mm 和（3.14±0.15）mm，与性别、身高和体重无关（P>0.05）。
本研究可为受伤踝关节解剖复位的标准和畸形愈合后的二次手术规划提供一定数量的相关数据。测量方法可靠、可重复，易于在实践中应用。
