1 Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea.
2 Present address: Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Dongjak-gu, Seoul, Korea.
AJR Am J Roentgenol. 2016 Feb;206(2):366-72. doi: 10.2214/AJR.15.14861.
The purpose of this study was to evaluate the prevalence and common location of a coexisting osteochondral lesion of the distal tibia and fibula and of associated abnormalities of the ankle ligaments and tendons on MRI in patients with an osteochondral lesion of the talus (OLT).
A search of a database of MRI studies performed between July 2003 and January 2014 yielded MRI examinations of 297 feet with OLTs. Two readers reviewed the MRI examinations independently for the presence of an osteochondral lesion of the distal tibia and fibula and for concomitant ligament and tendon injuries. If an osteochondral lesion of the distal tibia and fibula was present, the reviewers also recorded the location (zones 1-10) and stage. Interobserver and intraobserver reliabilities were assessed using kappa statistics. The associations between a coexisting osteochondral lesion of the distal tibia and fibula and an OLT or a concomitant ankle injury were evaluated using the chi-square test.
Readers A and B identified 61 (20.5%) and 47 (15.8%) coexisting osteochondral lesions of the distal tibia and fibula, respectively, with good interobserver (κ = 0.73) and excellent intraobserver (κ = 0.97) reliabilities. The most common location of a coexisting osteochondral lesion of the distal tibia and fibula was zone 4 (29.5%) by reader A and zone 2 (21.3%) by reader B. Stage I and stage IIA were common (> 85%). The frequency of osteochondral lesions of the distal tibia and fibula was not significantly different according to the location or stage of OLT. Abnormalities in the tibialis posterior tendon and in the anterior and posterior talofibular, calcaneofibular, and deltoid ligaments were significantly more common in patients with a coexisting osteochondral lesion of the distal tibia and fibula than in those with an isolated OLT (p < 0.05).
A coexisting osteochondral lesion of the distal tibia and fibula is not rare on MRI in patients with an OLT and is related to a higher frequency of concomitant ankle ligament and tendon injuries.
本研究旨在评估 MRI 检查中距骨骨软骨病变（OLT）患者同时存在的胫骨和腓骨骨软骨病变以及踝关节韧带和肌腱相关异常的发生率和常见部位。
对 2003 年 7 月至 2014 年 1 月间数据库中的 MRI 检查进行检索，共获得 297 例 OLT 患者的 MRI 检查结果。2 位读者分别独立评估 MRI 检查是否存在胫骨和腓骨骨软骨病变以及并发的韧带和肌腱损伤。如果存在胫骨和腓骨骨软骨病变，两位读者还记录病变的部位（1-10 区）和分期。采用κ 统计评估观察者间和观察者内的可靠性。采用卡方检验评估同时存在的胫骨和腓骨骨软骨病变与 OLT 或并发的踝关节损伤之间的关系。
读者 A 和 B 分别识别出 61（20.5%）和 47（15.8%）例同时存在的胫骨和腓骨骨软骨病变，观察者间可靠性良好（κ=0.73），观察者内可靠性极好（κ=0.97）。读者 A 最常见的胫骨和腓骨骨软骨病变部位为 4 区（29.5%），读者 B 为 2 区（21.3%）。Ⅰ期和ⅡA 期病变较常见（>85%）。胫骨和腓骨骨软骨病变的位置或分期与 OLT 之间无显著差异。与孤立的 OLT 患者相比，同时存在胫骨和腓骨骨软骨病变的患者中，后胫骨肌腱和前、后距腓、跟腓和距下韧带异常更为常见（p<0.05）。
OLT 患者的 MRI 检查中同时存在胫骨和腓骨骨软骨病变并不少见，且与更高频率的并发踝关节韧带和肌腱损伤有关。
