Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84132, USA.
Foot Ankle Surg. 2020 Feb;26(2):198-204. doi: 10.1016/j.fas.2019.02.002. Epub 2019 Feb 18.
Injuries to the distal tibio-fibular ligaments are common. While pronounced injuries can be reliably diagnosed using conventional radiographs, assessment of subtle syndesmotic injuries is challenging. This cadaver study determines the impact of loading on the assessment of incomplete and more complete syndesmotic injuries when using weightbearing computed tomography (CT) scans.
Fourteen paired male cadavers (tibial plateau to toe-tip) were included. A radiolucent frame held specimens in a plantigrade position while both non-weightbearing and weightbearing computed tomography (CT) scans were taken. The following conditions were tested: First, intact ankles (Native) were scanned. Second, one specimen from each pair underwent anterior inferior tibio-fibular ligament (AITFL) transection (Condition 1A), while the contralateral underwent deltoid transection (Condition 1B). Third, the remaining intact deltoid or AITFL was transected from each specimen (Condition 2). Finally, the distal tibiofibular interosseous membrane (IOM) was transected in all ankles (Condition 3). Eight different measurements were performed to assess the integrity of the distal tibio-fibular syndesmosis on axial CT scans.
Load application had no impact on most measurements. While incomplete syndesmotic injuries could not be identified, cadavers with more complete injuries differentiated from native ankles when assessed using axial CT images. No significant difference was evident between discrete AITFL or deltoid ligament transection.
In a cadaver model, load application had no effect on the assessment of the distal tibio-fibular syndesmosis in incomplete and more complete syndesmotic injuries. Only more complete injuries of the distal tibio-fibular syndesmosis could be identified using axial CT images.
下胫腓联合韧带损伤较为常见。虽然传统 X 线片能可靠地诊断明显的损伤，但评估轻微的下胫腓联合损伤具有挑战性。本尸体研究旨在确定负重状态下对使用负重 CT 扫描评估不完全和更完全的下胫腓联合损伤的影响。
纳入 14 对男性尸体（从胫骨平台到足尖）。在采用足跖屈位的情况下，采用一个不透射线的框架固定标本，同时进行非负重和负重 CT 扫描。对以下情况进行了测试：首先，对完整的踝关节（正常）进行扫描。其次，每对标本中的一个标本行前下胫腓韧带（AITFL）切断术（条件 1A），而对侧行三角韧带切断术（条件 1B）。第三，从每个标本中切断其余完整的三角韧带或 AITFL（条件 2）。最后，所有踝关节均切断下胫腓骨间膜（IOM）（条件 3）。进行了 8 项不同的测量来评估轴向 CT 扫描下下胫腓联合的完整性。
施加负荷对大多数测量值没有影响。虽然无法识别不完全的下胫腓联合损伤，但使用轴向 CT 图像评估时，有更完全损伤的尸体与正常踝关节不同。离散的 AITFL 或三角韧带切断术之间没有明显差异。
在尸体模型中，负荷应用对不完全和更完全的下胫腓联合损伤的下胫腓联合的评估没有影响。仅使用轴向 CT 图像才能识别更完全的下胫腓联合损伤。
