University Hospital Virgen del Rocío, Seville, Spain.
Gerge Eliot Hospital, Nuneaton, UK.
Foot Ankle Surg. 2022 Jul;28(5):650-656. doi: 10.1016/j.fas.2021.07.014. Epub 2021 Jul 26.
Syndesmosis measurments and indices have been controversial and showed interindividual variability. The purpose of this study was to analyze, by conventional axial computed tomography images and a simulated load device, the uninjured tibiofibular syndesmosis under axial force and forced foot positions.
A total of 15 healthy patients (30 ankles) were studied using adjustable simulated load device (ASLD). This device allowed to perform bilateral ankle CT scans in two forced foot and ankle positions (30° of plantar flexion, 15° of inversion, 20° of internal rotation and 15° of dorsal flexion, 15° of eversion, 30° of external rotation). Axial load was applied simultaneously in a controlled manner (70% body weight). Measurements on the axial image of computed tomography were: syndesmotic area (SA), fibular rotation (FR), position of the fibula in the sagittal plane (FPS), depth of the incisura (ID) and direct anterior difference (ADD), direct middle difference (MDD) and direct posterior difference (PDD).
In patients without injury to the tibiofibular syndesmosis, the application of axial load and forced foot and ankle positions showed statistically significant differences on the distal tibiofibular measurements between the stressed and the relaxed position, it also showed interindividual variability : SA (median = 4.12 [IQR = 2.42, 6.63]) (p < 0.001), ADD (0.67 [0.14, 0.67]) (p < 0.001), MDD(0.45, [0.05, 0.9]) (p < 0.001), PDD (0.73 [-0.05, 0.73]) (p < 0.002). However, it did not detect statistically significant differences when the tibiofibular differences between the stressed and the relaxed position in one ankle were compared with the contralateral side: SA (-0.14, SD = 4.33 [95% CI = -2.53, 2.26]), ADD (-0.42, 1.08 [-1.02, 0.18]), MDD (0.29, 0.54 [-0.01, 0.59]), PDD (-0.1, 1.42 [-0.89, 0.68]). Interobserver reliability showed an Intraclass correlation coefficient of 0.990 [95% CI = 0.972, 0.997].
Wide interindividual variability was observed in all syndesmotic measurements, but no statistically significant differences were found when comparing one ankle to the contralateral side. Measuring syndesmosis alignment parameters, may only be of value, if those are compared to the contralateral ankle.
下胫腓联合的测量和指数一直存在争议,且具有个体间的可变性。本研究旨在通过常规轴向计算机断层扫描(CT)图像和模拟负荷装置,分析轴向力和足踝位置改变时,未受伤的胫腓联合。
共对 15 名健康患者(30 个踝关节)使用可调节模拟负荷装置(ASLD)进行研究。该装置允许在两种强制足踝位置(跖屈 30°,内翻 15°,内旋 20°和背屈 15°,外翻 15°,外旋 30°)下对双侧踝关节进行 CT 扫描。同时以可控的方式施加轴向负荷(70%体重)。在 CT 轴向图像上进行的测量包括:下胫腓联合面积(SA)、腓骨旋转(FR)、腓骨在矢状面的位置(FPS)、切迹深度(ID)、直接前差(ADD)、直接中差(MDD)和直接后差(PDD)。
在未受伤的胫腓联合患者中,施加轴向负荷和强制足踝位置会导致受应力位和未受应力位的下胫腓联合的远端测量值出现统计学显著差异,同时还存在个体间的可变性:SA(中位数=4.12[IQR=2.42,6.63])(p<0.001),ADD(0.67[0.14,0.67])(p<0.001),MDD(0.45[0.05,0.9])(p<0.001),PDD(0.73[-0.05,0.73])(p<0.002)。然而,当比较一只踝关节的受应力位和未受应力位的胫腓差异与对侧相比时,并未发现统计学上的显著差异:SA(-0.14,SD=4.33[95%CI=-2.53,2.26]),ADD(-0.42,1.08[-1.02,0.18]),MDD(0.29,0.54[-0.01,0.59]),PDD(-0.1,1.42[-0.89,0.68])。观察者间可靠性显示,组内相关系数为 0.990[95%CI=0.972,0.997]。
在所有下胫腓联合的测量中均观察到较大的个体间可变性,但当比较一只踝关节与对侧相比时,并未发现统计学上的显著差异。如果将胫腓联合的对线参数与对侧踝关节进行比较,这些参数可能才有价值。