Lepojärvi Sannamari, Pakarinen Harri, Savola Olli, Haapea Marianne, Sequeiros Roberto B, Niinimäki Jaakko
*Department of Diagnostic Radiology; and †Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
J Orthop Trauma. 2014 Apr;28(4):205-9. doi: 10.1097/BOT.0b013e3182a59b3c.
The aim of our study was to assess the intersubject and intrasubject variations of distal tibiofibular syndesmosis on computed tomography (CT) scans and to define standardized measures to verify syndesmosis reduction.
A retrospective study of 107 CT scans of ankles with normal tibiofibular syndesmosis.
Main trauma center, university teaching hospital.
The CT scans of 64 patients were reviewed by 2 musculoskeletal radiologists.
Bilateral variation was estimated. The intra- and interobserver reliabilities were calculated using standardized measurement points. CT measurements included the length of the tibial incisura (LI), A width and P width of the incisura (PW), depth of the incisura, narrowest part of the incisura, and sagittal translation of the fibula.
In 97% of normal cases, the fibula is situated either centrally or anteriorly in the tibial incisura. There were significant differences in PW and LI between genders, and the difference between the PW and A width was significantly larger in males (2.7 mm, SD 2.1) than in females (1.9 mm, SD 1.6, P = 0.023, t test). Significant asymmetry was not detected between ankles in single subjects. All CT measurements demonstrated good inter- and intraobserver reliabilities.
If P translation of the fibula is present, malreduction should be considered. Sagittal translation measurements are not affected by the size of the joint or the gender of the patient, in contrast to traditionally used cross-sectional measurement methods.
我们研究的目的是评估计算机断层扫描（CT）上胫腓下联合的个体间和个体内变异，并定义标准化测量方法以验证联合复位情况。
对107例胫腓联合正常的踝关节CT扫描进行回顾性研究。
大学教学医院的主要创伤中心。
2名肌肉骨骼放射科医生对64例患者的CT扫描进行了评估。
评估双侧变异情况。使用标准化测量点计算观察者间和观察者内的可靠性。CT测量包括胫骨切迹长度（LI）、切迹A宽度和P宽度（PW）、切迹深度、切迹最窄部分以及腓骨的矢状面移位。
在97%的正常病例中，腓骨位于胫骨切迹的中央或前方。PW和LI在性别之间存在显著差异，男性的PW与A宽度之差（2.7mm，标准差2.1）显著大于女性（1.9mm，标准差1.6，P = 0.023，t检验）。在单一个体的双侧踝关节之间未检测到明显不对称。所有CT测量均显示出良好的观察者间和观察者内可靠性。
如果存在腓骨的P移位，则应考虑复位不良。与传统使用的横断面测量方法不同，矢状面移位测量不受关节大小或患者性别的影响。
