Kim Beom Suk, Woo Sungmin, Kim Jae Young, Park Chankue
Department of Physical Medicine and Rehabilitation, The Armed Forces Daejeon Hospital, 90 Jaun-ro, Yuseong-gu, Daejeon, 34059, Korea.
Department of Radiology, The Armed Forces Daejeon Hospital, 90 Jaun-ro, Yuseong-gu, Daejeon, 34059, Korea.
Radiol Med. 2017 Oct;122(10):766-773. doi: 10.1007/s11547-017-0786-y. Epub 2017 Jun 29.
To retrospectively evaluate the radiologic findings for predicting rehabilitation outcomes in patients with chronic symptomatic os subfibulare.
38 patients with chronic lateral ankle pain and os subfibulare underwent a standardized rehabilitation program. Rehabilitation outcome was evaluated after ≥3 months of intervention as the following: good response group (n = 20) without the need for further treatment and poor response group (n = 18) who underwent surgery after rehabilitation. Size, shape and location of os subfibulare, anterior talofibular ligament abnormality and attachment to the os subfibulare, interposition of fluid signal intensity between the os subfibulare and the fibula, and bone marrow edema in the os subfibulare on radiographs and MRI were evaluated by two radiologists blinded to rehabilitation outcomes and were compared between the two groups.
The mean size of os subfibulare was significantly different between good and poor response groups: 7 versus 12 mm (p < 0.01), respectively. The prevalence of interposition of fluid signal intensity between the os subfibulare and the fibula and bone marrow edema in the os subfibulare on MRI was significantly different between the two groups (p < 0.01). However, other radiologic findings were not significantly different (p ≥ 0.08). The optimal size to classify the two groups was 9 mm with sensitivity of 83.3% and specificity of 80%. Inter-observer reliability was good to excellent (ICC = 0.991 for size and kappa = 0.735-0.923 for others).
MRI may be used to predict rehabilitation outcome in patients with chronic symptomatic os subfibulare.
回顾性评估影像学表现对慢性症状性腓下骨（副腓骨）患者康复结局的预测价值。
38例患有慢性踝关节外侧疼痛和腓下骨的患者接受了标准化康复方案。在干预≥3个月后评估康复结局，分为以下两组：无需进一步治疗的良好反应组（n = 20）和康复后接受手术的不良反应组（n = 18）。由两名对康复结局不知情的放射科医生评估X线片和MRI上腓下骨的大小、形状和位置、距腓前韧带异常及其与腓下骨的附着情况、腓下骨与腓骨之间的液体信号强度夹入情况以及腓下骨的骨髓水肿，并在两组之间进行比较。
良好反应组和不良反应组腓下骨的平均大小存在显著差异：分别为7 mm和12 mm（p < 0.01）。两组之间，MRI上腓下骨与腓骨之间液体信号强度夹入情况和腓下骨骨髓水肿的发生率存在显著差异（p < 0.01）。然而，其他影像学表现无显著差异（p≥0.08）。区分两组的最佳大小为9 mm，敏感性为83.3%，特异性为80%。观察者间可靠性良好至优秀（大小的组内相关系数ICC = 0.991，其他的kappa值 = 0.735 - 0.923）。
MRI可用于预测慢性症状性腓下骨患者的康复结局。
