OrthoIndy, Indianapolis, IN 46202, USA.
J Orthop Trauma. 2012 Jul;26(7):433-8. doi: 10.1097/BOT.0b013e3182535f30.
Computed tomography (CT) is reported to be superior to plain radiography for imaging the syndesmosis, but CT criteria differentiating normal from abnormal tibiofibular relationships do not exist. The purpose of this study was to define normal tibiofibular relationships at the syndesmosis on axial CT imaging and to report the reliability of these measurements.
Thirty healthy volunteers underwent CT evaluation of bilateral ankles. Axial CT measurements consisted of tibiofibular clear space, tibiofibular overlap, anterior tibiofibular interval, and fibular rotation (θ(fib)). To assess reliability, 3 investigators independently made each CT measurement on 2 separate occasions.
Sixty ankles were included for analysis. CT measurements demonstrated excellent intrarater and interrater reliability. There was significant anatomic variability between individuals. Specifically, statistically significant gender differences were discovered in CT measurements of tibiofibular overlap and anterior tibiofibular interval. Variance between ankles of each subject was calculated. In an uninjured population, tibiofibular intervals do not vary by more than 2.3 mm, and the rotation of the fibula does not vary by more than 6.5° between ankles of the same person.
Measurements of tibiofibular relationships made on axial CT images are reliable. Because of significant anatomic variation between individuals, using a patient's contralateral ankle for comparison provides a precise definition of normal tibiofibular relationships. These criteria allow for the detection of subtle variations in the tibiofibular relationships indicating instability and provide a tool for postoperatively assessing the reduction of the injured syndesmosis.
据报道,计算机断层扫描(CT)在显示踝关节联合部方面优于普通 X 线摄影,但区分正常和异常胫腓骨关系的 CT 标准并不存在。本研究的目的是在轴向 CT 成像上定义正常的胫腓联合关系,并报告这些测量的可靠性。
30 名健康志愿者接受了双侧踝关节 CT 评估。轴向 CT 测量包括胫腓间隙、胫腓重叠、胫前腓间隔和腓骨旋转(θ(fib))。为了评估可靠性,3 位研究者分别在 2 个不同的时间独立进行了每个 CT 测量。
共纳入 60 个踝关节进行分析。CT 测量显示出良好的内部和内部可靠性。个体之间存在显著的解剖学变异性。具体而言,在胫腓重叠和胫前腓间隔的 CT 测量中发现了统计学上显著的性别差异。还计算了每个受试者的踝关节之间的方差。在未受伤的人群中,胫腓间隔的差异不超过 2.3mm,同一人的腓骨旋转差异不超过 6.5°。
在轴向 CT 图像上进行的胫腓关系测量是可靠的。由于个体之间存在显著的解剖学差异,因此使用患者的对侧踝关节进行比较可以精确地定义正常的胫腓关系。这些标准允许检测到胫腓关系中的细微变化,表明不稳定,并为术后评估受伤的联合部复位提供了一种工具。