Sung Ki Hyuk, Kwon Soon-Sun, Moon Seung Jun, Lee Seung Yeol
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, South Korea.
Department of Mathematis, College of Natural Sciences, Ajou University, Kyungki, South Korea.
J Orthop Sci. 2018 Jul;23(4):658-664. doi: 10.1016/j.jos.2018.03.003. Epub 2018 Mar 26.
The purpose of this study was to determine the reliability of numerous radiographic measurements of the skeletally immature ankle joint, timing of ossification of medial malleolus and appearance of tibial incisura and differences in the values of radiographic measurements based on age and sex.
This study included 590 subjects (0-15 years), who underwent ankle AP, lateral and mortise radiographs. Presence of the medial malleolus and incisura fibularis were recorded. Tibiofibular overlap, tibiofibular clear space, medial clear space, talar tilt, talocrural angle, relative fibular width and fibular position were measured.
All radiographic measurements showed good to excellent intraobserver and interobserver reliability (ICCs, 0.603 to 0.949). The timing of ossification of medial malleolus and appearance of tibial incisura between boys and girls were not different. Tibiofibular clear space on mortise views, and medial clear space on AP and mortise view significantly decreased by age. Tibiofibular overlap on AP and mortise views, relative fibular width on AP view significantly increased by age. Talocrural angle, tibiofibular overlap on AP view, tibiofibular clear space on AP and mortise views, medial clear space on AP and mortise views and fibular position were significantly larger in boys than in girls. The difference in tibiofibular overlap, tibiofibular clear space and medial clear space on AP view of both sides was <50% in 97.1%, 93.1%, and 97.2% of patients, respectively. The difference in tibiofibular overlap, tibiofibular clear space and medial clear space on mortise view of both sides was <50% in 98.0%, 96.5%, and 100% of patients, respectively.
For skeletally immature patients, the criteria for absolute radiographic values used in adults to assess distal tibiofibular syndesmosis or deltoid ligament injury cannot be applied, but comparison of both sides of ankle joint could help physicians to predict the need for additional evaluations.
本研究的目的是确定对骨骼未成熟踝关节进行的众多影像学测量的可靠性、内踝骨化时间和胫骨切迹的出现情况，以及基于年龄和性别的影像学测量值差异。
本研究纳入了590名0至15岁的受试者，他们接受了踝关节前后位、侧位和斜位X线片检查。记录内踝和腓骨切迹的存在情况。测量胫腓骨重叠、胫腓骨间隙、内侧间隙、距骨倾斜度、胫距关节角、相对腓骨宽度和腓骨位置。
所有影像学测量均显示出良好至优秀的观察者内和观察者间可靠性（组内相关系数，0.603至0.949）。男孩和女孩在内踝骨化时间和胫骨切迹出现情况方面没有差异。斜位片上的胫腓骨间隙以及前后位和斜位片上的内侧间隙随年龄显著减小。前后位和斜位片上的胫腓骨重叠、前后位片上的相对腓骨宽度随年龄显著增加。男孩的胫距关节角、前后位片上的胫腓骨重叠、前后位和斜位片上的胫腓骨间隙、前后位和斜位片上的内侧间隙以及腓骨位置均显著大于女孩。两侧前后位片上胫腓骨重叠、胫腓骨间隙和内侧间隙的差异分别在97.1%、93.1%和97.2%的患者中小于50%。两侧斜位片上胫腓骨重叠、胫腓骨间隙和内侧间隙的差异分别在98.0%、96.5%和100%的患者中小于50%。
对于骨骼未成熟的患者，不能应用成人用于评估胫腓下联合或三角韧带损伤的绝对影像学值标准，但踝关节两侧的比较有助于医生预测是否需要进一步评估。
