下胫腓联合旋转移位的 CT 测量方法：可靠性和准确性。
Rotational malreduction of the syndesmosis: reliability and accuracy of computed tomography measurement methods.
机构信息
Orthopaedic Trauma Institute, San Francisco General Hospital, University of California, San Francisco, CA, USA.
出版信息
Foot Ankle Int. 2013 Oct;34(10):1403-10. doi: 10.1177/1071100713489286. Epub 2013 May 12.
BACKGROUND
Computed tomography (CT)-based indices may be superior to plain radiographs in determining the adequacy of reduction following operative fixation of the syndesmosis in unstable ankle fractures. This study assessed the reliability and accuracy of four CT-based methods for measurement of rotational malreduction of the fibula.
METHODS
A simulated Weber C ankle fracture was created by performing an osteotomy in 9 cadaver ankles. The fibula was rotated and fixed in neutral (0 degrees) and 10 to 30 degrees of internal and external rotation. Fifty-two CT images at the level of the syndesmosis were obtained in neutral and rotated positions and presented in random order to 3 independent observers. Measurements were made using commercial imaging software and 4 methods for interpreting CT scans. Interobserver reliability and accuracy were assessed and compared.
RESULTS
Methods 1 and 4 showed high anatomic variability. Methods 1, 2, and 4 had a test-retest repeatability of about 15 degrees. Method 1 varied erratically with direction and degree of malrotation (R (2) = 0.15) and did not permit specification of a neutral range. Method 2 varied consistently and systematically with direction and degree of malrotation (R (2) = 0.88). Receiver operating characteristic curve analysis indicated that method 2 identified malrotation better than did the other methods. Methods 3 and 4 were somewhat more difficult to perform.
CONCLUSIONS
Method 2, the angle between the tangent of the anterior tibial surface and the bisection of the vertical midline of the fibula at the level of the incisura, was fairly reliable and accurate and had greater ease of measurement compared with the other methods that were tested.
CLINICAL RELEVANCE
This study demonstrated that assessment of malrotation of fibular fractures by CT scan can be difficult. We believe that of the 4 methods tested in this study, method 2, the angle between the tangent of the anterior tibial surface and the bisection of the vertical midline of the fibula at the level of the incisura, was the most useful.
背景
与普通 X 光片相比，计算机断层扫描（CT）为基础的指数可能更能确定不稳定踝关节骨折手术后下胫腓联合复位的充分性。本研究评估了四种基于 CT 的测量腓骨旋转复位不良的方法的可靠性和准确性。
方法
通过在 9 个尸体踝关节上进行切开术，创建模拟 Weber C 踝关节骨折。将腓骨旋转并固定在中立（0 度）和内旋 10 至 30 度以及外旋 10 至 30 度的位置。在中立和旋转位置下获得 52 个踝关节下胫腓联合水平的 CT 图像，并以随机顺序呈现给 3 位独立观察者。使用商业成像软件和 4 种 CT 扫描解释方法进行测量。评估并比较了观察者间的可靠性和准确性。
结果
方法 1 和 4 显示出高度的解剖变异性。方法 1、2 和 4 的测试 - 重测重复性约为 15 度。方法 1 随着旋转的方向和程度的变化而不稳定（R（2）=0.15），并且不能指定中立范围。方法 2 随着旋转的方向和程度的变化而变化一致和系统（R（2）=0.88）。接收者操作特征曲线分析表明，方法 2 比其他方法更能识别旋转不良。方法 3 和 4 更难操作。
结论
方法 2，即胫骨前表面的切线与腓骨在切迹水平的垂直中线的二等分之间的角度，具有相当的可靠性和准确性，并且与测试的其他方法相比，具有更大的测量便利性。
临床相关性
本研究表明，通过 CT 扫描评估腓骨骨折的旋转不良可能很困难。我们认为，在本研究中测试的 4 种方法中，方法 2，即胫骨前表面的切线与腓骨在切迹水平的垂直中线的二等分之间的角度，是最有用的。
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