Amin Arsalan, Janney Cory, Sheu Christopher, Jupiter Daniel C, Panchbhavi Vinod K
Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (AA, CJ, VKP).
United States Navy, Washington, DC (CJ).
Foot Ankle Spec. 2019 Jun;12(3):211-217. doi: 10.1177/1938640018766631. Epub 2018 Apr 1.
Diagnosis of distal tibiofibular syndesmotic injuries includes assessment of radiographs; however, there exist no agreed on standard diagnostic criteria. Previous studies lack consistency with radiographic evaluation methods. The dynamic nature of the ankle joint supports analyzing anatomical parameters using weight-bearing films to assess for tibiofibular syndesmotic integrity. Weight-bearing tibiofibular syndesmosis radiographs of 39 male and 40 female patients were retrospectively analyzed by 3 investigators, at different levels of orthopaedic training. Measurements 1 cm above the tibial plafond for the anterior tibiofibular overlap (TFO) and tibiofibular clear space (TCS) were recorded and standardized by the fibular width (FW) at 2 time points. Data were compared to check for agreement between the sets of measurements for each rater and agreement between investigators, and to ascertain underlying gender differences. There was good intraobserver correlation (intraclass correlation coefficient [ICC] > 0.90) among investigators for each parameter. A significant difference in the TFO was noted between genders (P < .05). We establish the following radiographic (anteroposterior view) parameters for an intact syndesmosis: male patients, TCS <4.57 mm or TCS/FW <29% and TFO >9.29 mm or TFO/FW > 57%; female patients, TCS <4.28 mm or TCS/FW <30% and TFO >7.41 mm or TFO/FW >51%. Our study provides a more objective approach by utilizing weight-bearing radiographs and performing all measurements 1 cm above the tibial plafond. : Level IV.
下胫腓联合损伤的诊断包括对X线片的评估；然而，目前尚无公认的标准诊断标准。以往的研究在X线评估方法上缺乏一致性。踝关节的动态特性支持使用负重位片分析解剖参数，以评估下胫腓联合的完整性。3名不同骨科培训水平的研究者对39例男性和40例女性患者的负重下胫腓联合X线片进行了回顾性分析。记录胫骨平台上方1 cm处的胫腓前重叠（TFO）和胫腓间隙（TCS），并在两个时间点根据腓骨宽度（FW）进行标准化。比较数据以检查每个评分者的测量结果之间的一致性以及研究者之间的一致性，并确定潜在的性别差异。各研究者对每个参数的观察者内相关性良好（组内相关系数[ICC]>0.90）。性别之间的TFO存在显著差异（P<.05）。我们建立了完整下胫腓联合的以下X线（前后位）参数：男性患者，TCS<4.57 mm或TCS/FW<29%且TFO>9.29 mm或TFO/FW>57%；女性患者，TCS<4.28 mm或TCS/FW<30%且TFO>7.41 mm或TFO/FW>51%。我们的研究通过使用负重位片并在胫骨平台上方1 cm处进行所有测量提供了一种更客观的方法。：IV级。
