Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, OVL, Belgium.
Department of Orthopaedics, Amsterdam UMC, University of Amsterdam, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Skeletal Radiol. 2021 Jun;50(6):1141-1150. doi: 10.1007/s00256-020-03649-9. Epub 2020 Oct 30.
The role of the syndesmotic ankle ligaments as extrinsic stabilizers of the distal tibiofibular joint (DTFJ) has been studied extensively in patients with high ankle sprains (HAS). However, research concerning the fibular incisura as intrinsic stabilizer of the DTFJ has been obscured by a two-dimensional assessment of a three-dimensional structure. Therefore, we aimed to compare the morphometry of the incisura fibularis between patients with HAS and a control group using three-dimensional radiographic techniques.
Fifteen patients with a mean age of 44 years (SD = 15.2) diagnosed with an unstable HAS and twenty-five control subjects with a mean age of 47.4 years (SD = 6.5) were analyzed in this retrospective comparative study. The obtained CT images were converted to three-dimensional models, and the following radiographic parameters of the incisura fibularis were determined using three-dimensional measurements: incisura width, incisura depth, incisura height, incisura angle, incisura width-depth ratio, and incisura-tibia ratio.
The mean incisura depth (M = 4.7 mm, SD = 1.1 mm), incisura height (M = 36.1 mm, SD = 5.3 mm), and incisura angle of the control group (M = 137.2°, SD = 7.9°) differed significantly from patients with a HAS (resp., M = 3.8 mm, SD = 1.1 mm; M = 31.9 mm, SD = 3.2 mm; M = 143.2°, SD = 8.3°) (P < 0.05). The incisura width, incisura width-depth ratio, and incisura-tibia ratio demonstrated no significant difference (P > 0.05).
Our three-dimensional comparative analysis has detected a shallower and shorter fibular incisura in patients with HAS. This distinct morphology could have repercussion on the intrinsic or osseous stability of the DTFJ. Future prospective radiographic assessment could determine to what extend the fibular incisura morphology contributes to syndesmotic ankle injuries caused by high ankle sprains.
距腓联合（DFTJ）的下胫腓联合韧带作为外在稳定器的作用在高踝关节扭伤（HAS）患者中已得到广泛研究。然而，由于对三维结构的二维评估，关于腓骨切迹作为 DTFJ 内在稳定器的研究一直受到阻碍。因此，我们旨在使用三维放射技术比较 HAS 患者与对照组之间腓骨切迹的形态计量学。
本回顾性对照研究分析了 15 名平均年龄为 44 岁（SD=15.2）的患有不稳定 HAS 患者和 25 名平均年龄为 47.4 岁（SD=6.5）的对照组。获得的 CT 图像被转换为三维模型，并使用三维测量确定腓骨切迹的以下放射学参数：切迹宽度、切迹深度、切迹高度、切迹角度、切迹宽度-深度比和切迹-胫骨比。
对照组的平均切迹深度（M=4.7mm，SD=1.1mm）、切迹高度（M=36.1mm，SD=5.3mm）和切迹角度（M=137.2°，SD=7.9°）与 HAS 患者（分别为 M=3.8mm，SD=1.1mm；M=31.9mm，SD=3.2mm；M=143.2°，SD=8.3°）有显著差异（P<0.05）。切迹宽度、切迹宽度-深度比和切迹-胫骨比无显著差异（P>0.05）。
我们的三维对比分析发现 HAS 患者的腓骨切迹更浅、更短。这种独特的形态可能会对 DTFJ 的内在或骨性稳定性产生影响。未来的前瞻性放射评估可以确定腓骨切迹形态在多大程度上导致高踝关节扭伤引起的下胫腓联合损伤。
