Hakimian David, Khoury Amal, Mosheiff Rami, Liebergall Meir, Weil Yoram A
Department of Orthopaedics, Hadassah Hebrew University Hospital, POB 12000, 9112000, Jerusalem, Israel.
Skeletal Radiol. 2018 Apr;47(4):483-490. doi: 10.1007/s00256-017-2810-7. Epub 2017 Nov 11.
Malreduction in the axial plane (malrotation) following tibial fracture surgery is often undiagnosed. A few clinical and radiographic methods have been proposed for measuring tibial rotation intraoperatively, yet have failed to match the accuracy of computed tomography (CT). The aim of this study was to develop radiographic tools for future intraoperative assessment of the tibial shaft rotation profile.
The setting was a laboratory computerized analysis. Twenty lower limb CT scans were used to construct a three-dimensional (3D) model using AMIRA© software. A virtual 3D cylinder was implanted in the posterior condylar line and in the transmalleolar axis. The 3D models were used to simulate four standard knee and ankle plain radiographs. On each radiograph, four landmarks were depicted by two observers and their relation with the cylinder was measured and analyzed for accuracy and reproducibility. A cadaveric lower leg was implanted with two Kirschner wires. A CT scan was performed in addition to 2D fluoroscopy. The simulated radiographs and the fluoroscopy were compared for accuracy.
Measurement of the landmarks showed reliability in most of the knee anteroposterior and ankle mortise radiographs (coefficients of variation < 0.01 and = 0.01) respectively. Cadaveric measurement of the landmarks using real fluoroscopy and simulated radiographs were similar.
To date, no reliable and common methods have been reported for the evaluation of tibial axial rotation. We propose a model in which simple radiographic landmarks can be used to calculate a 3D coordinate system that accurately assesses the axial rotation angle of the tibial shaft.
胫骨骨折手术后矢状面复位不良（旋转不良）常未被诊断出来。已经提出了一些临床和影像学方法用于术中测量胫骨旋转，但均未达到计算机断层扫描（CT）的准确性。本研究的目的是开发影像学工具，用于未来术中评估胫骨干旋转情况。
研究采用实验室计算机分析。使用AMIRA©软件对20例下肢CT扫描数据构建三维（3D）模型。在髁后线和经踝关节轴植入虚拟3D圆柱体。利用3D模型模拟四张标准膝关节和踝关节平片。在每张平片上，两名观察者描绘四个标志点，并测量其与圆柱体的关系，分析其准确性和可重复性。在一具尸体小腿上植入两根克氏针。除二维透视外，还进行了CT扫描。比较模拟平片和透视的准确性。
在大多数膝关节前后位和踝关节榫眼位平片中，标志点测量显示出可靠性（变异系数分别<0.01和=0.01）。使用真实透视和模拟平片对尸体标志点进行测量结果相似。
迄今为止，尚未有可靠且通用的方法用于评估胫骨矢状面旋转。我们提出一种模型，其中简单的影像学标志点可用于计算三维坐标系，以准确评估胫骨干的矢状面旋转角度。
