一种基于 CT 的下胫腓关节精确三维位置分析的标准化方法。
A standardized approach for exact CT-based three-dimensional position analysis in the distal tibiofibular joint.
机构信息
Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
ZESBO - Centre for Research On Musculoskeletal Systems, University of Leipzig, Leipzig, Germany.
出版信息
BMC Med Imaging. 2021 Mar 6;21(1):41. doi: 10.1186/s12880-021-00570-y.
BACKGROUND
Assessment of tibiofibular reduction presents an intra- and postoperative challenge. Numerous two-dimensional measurement methods have been described, most of them highly dependent on leg orientation and rater. Aim of the present work was to develop a standardized and orientation-independent 3D based method for the assessment of syndesmotic joint position.
METHODS
In a retrospective single center study, 3D models of bilateral ankle joints, either after unilateral syndesmosis stabilization (operative group) or with no injury (native group) were superimposed (best fit matching) and aligned uniformly. Based on center of gravity calculations three orientation- and rater-independent parameters were determined: tibiofibular clears space (CS), vertical offset between both fibulae, and translation angle of the fibulae about tibia axis.
RESULTS
Bilateral CT datasets of 57 native and 47 postoperative patients were analyzed. In the native group mean CS was 2.7 (SD, 0.8; range, 0.7-4.9) mm, mean CS side difference was 0.62 (SD, 0.45) mm and mean translation angle was 1.6 (SD, 1.4) degrees regarding absolute values. The operative group was found to show a significantly higher CS side difference of 0.88 (SD, 0.75) mm compared to native group (P = .046). Compared to the healthy contralateral side, operated fibulae showed mean proximal displacement of 0.56 (SD, 1.67) mm (P = .025), dorsal displacement of 1.5 (SD 4.1) degrees (P = .017).
CONCLUSION
By using 3D best fit matching, orientation- and rater-dependent errors can be minimized. Large interindividual and small intraindividual differences of uninjured couples support previous recommendations for bilateral imaging.
TRIAL REGISTRATION
AZ 131/18-ek; AZ 361/19-ek LEVEL OF EVIDENCE: Level III.
背景
胫腓骨复位评估具有术中及术后挑战。已经描述了许多二维测量方法，其中大多数高度依赖于腿部的方位和评估者。本研究旨在开发一种标准化且不依赖方位的 3D 基于方法，用于评估下胫腓联合的位置。
方法
在一项回顾性单中心研究中，对双侧踝关节的 3D 模型进行了叠加（最佳拟合匹配）和统一对齐，这些模型要么是单侧下胫腓联合固定术后（手术组），要么是无损伤（自然组）。基于重心计算，确定了三个不依赖方位和评估者的参数：胫腓骨间隙（CS）、两腓骨之间的垂直偏移以及腓骨相对于胫骨轴的平移角度。
结果
对 57 例自然组和 47 例术后组的双侧 CT 数据集进行了分析。在自然组中，CS 的平均宽度为 2.7（标准差，0.8；范围，0.7-4.9）mm，CS 的平均侧方差异为 0.62（标准差，0.45）mm，平均平移角度为 1.6（标准差，1.4）度。与自然组相比，手术组的 CS 侧方差异明显更大，为 0.88（标准差，0.75）mm（P=0.046）。与健康的对侧相比，手术侧的腓骨近端移位平均为 0.56（标准差，1.67）mm（P=0.025），背侧移位 1.5（标准差 4.1）度（P=0.017）。
结论
通过使用 3D 最佳拟合匹配，可以最小化方位和评估者相关的误差。未受伤对侧的个体间和个体内差异较大，支持了对双侧成像的先前建议。
试验注册号
AZ 131/18-ek；AZ 361/19-ek
证据水平
III 级。
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