正常下胫腓联合运动的四维 CT 分析。
Four-Dimensional CT Analysis of Normal Syndesmotic Motion.
机构信息
University of Calgary, Calgary, AB, Canada.
出版信息
Foot Ankle Int. 2021 Nov;42(11):1491-1501. doi: 10.1177/10711007211015204. Epub 2021 Jun 4.
BACKGROUND
The syndesmosis ligament complex stabilizes the distal tibiofibular joint while allowing for small amounts of physiologic motion. When injured, malreduction of the syndesmosis is the most important factor that contributes to inferior functional outcomes. Syndesmotic reduction is a dynamic measure, which is not adequately captured by conventional computed tomography (CT). Four-dimensional CT (4DCT) can image joints as they move through range of motion (ROM). The aim of this study was to employ 4DCT to determine in vivo syndesmotic motion with ankle ROM in uninjured ankles.
METHODS
Uninjured ankles were analyzed in patients who had contralateral syndesmotic injuries, as well as a cohort of healthy volunteers with bilateral uninjured ankles. Bilateral ankle 4DCT scans were performed as participants moved their ankles between maximal dorsiflexion and plantarflexion. Multiple measures of syndesmotic width, as well as sagittal translation and fibular rotation, were automatically extracted from 4DCT using a custom program to determine the change in syndesmotic position with ankle ROM.
RESULTS
Fifty-eight ankles were analyzed. Measures of syndesmotic width decreased by 0.7 to 1.1 mm as the ankle moved from dorsiflexion to plantarflexion ( < .001 for each measure). The fibula externally rotated by 1.2 degrees with ankle ROM ( < .001), but there was no significant motion in the sagittal plane ( = .43). No participants with bilateral uninjured ankles had a side-to-side difference in syndesmotic width of 2 mm or greater.
CONCLUSION
4DCT allows accurate, in vivo syndesmotic measurements, which change with ankle ROM, confirming prior work that was limited to biomechanical studies. Side-to-side syndesmotic measurements are consistent within subjects, validating the method of templating syndesmotic reduction off the contralateral ankle, in a consistent ankle position, to achieve anatomic reduction of syndesmotic injury.
LEVEL OF EVIDENCE
Level II, prospective cohort study.
背景
距腓联合韧带复合体在稳定下胫腓联合的同时允许少量的生理性运动。当受伤时，距腓联合复位不良是导致功能结果不佳的最重要因素。距腓联合复位是一个动态的测量指标，常规的计算机断层扫描（CT）无法充分捕捉到这一指标。四维 CT（4DCT）可以对关节在运动范围内的运动进行成像。本研究的目的是利用 4DCT 来确定在未受伤的踝关节中，踝关节活动范围（ROM）时距腓联合的运动。
方法
对患有对侧距腓联合损伤的患者以及双侧未受伤的健康志愿者的未受伤踝关节进行分析。当参与者将踝关节从背屈到跖屈之间移动时，对双侧踝关节进行 4DCT 扫描。使用自定义程序从 4DCT 中自动提取多个距腓联合宽度测量值，以及矢状面平移和腓骨旋转，以确定距腓联合位置随踝关节 ROM 的变化。
结果
共分析了 58 个踝关节。当踝关节从背屈到跖屈时，距腓联合宽度减小了 0.7 到 1.1 毫米（每种测量方法均<0.001）。腓骨随着踝关节 ROM 外旋 1.2 度（<0.001），但矢状面没有明显运动（=0.43）。在双侧未受伤的踝关节中，没有参与者的距腓联合宽度差异达到 2 毫米或更大。
结论
4DCT 允许对与踝关节 ROM 相关的距腓联合进行准确的、活体的测量，这证实了先前仅限于生物力学研究的工作。在同一受试者中，双侧距腓联合的测量值是一致的，验证了通过模板化对侧踝关节来实现距腓联合损伤解剖复位的方法，即在一个一致的踝关节位置上。
证据等级
II 级，前瞻性队列研究。
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