Nischal Neha, Chandra Lalita Kakarala, Iyengar Karthikeyan P, Reilly Ian, Botchu Rajesh
Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
Department of Medicine and Surgery, JIPMER, Puducherry, India.
Skeletal Radiol. 2023 Feb;52(2):193-198. doi: 10.1007/s00256-022-04169-4. Epub 2022 Aug 31.
Haglund's deformity, an abnormality of the postero-superior corner of the calcaneum, is a common, critically debated cause of posterior heel pain. Several radiological indices such as Fowler-Philip angle, Ruch pitch, Chauveaux-Liet angle, calcaneal pitch angle, parallel pitch lines, and X-Y ratio have been described to measure this deformity. However, most of these lack specificity and have variable intra- and inter-observer reliability.
The study aims to describe a new radiological "angle of BRINK" (Botchu-Reilly-Iyengar-Nischal-Kakarala) to measure Haglund's deformity.
We performed a retrospective cohort analysis, assessing 20 weight-bearing lateral ankle radiographs of patients with Haglund's deformity (Haglund's cohort) and 100 radiographs without the deformity (normal cohort). Demographic details and angle of BRINK to measure Haglund's deformity were measured for each patient. Statistical analysis was performed using t-test and inter-observer reliability was calculated using kappa coefficient.
The mean angle of BRINK to measure Haglund's deformity in the normal cohort was 20.04° (SD 4.88), and in the Haglund's cohort was 25.1° (SD 3.3). This was statistically significant with a p-value of less than 0.0001. There was excellent intra- and inter-observer reliability with kappa value of 0.8.
Our proposed radiological angle of BRINK to measure Haglund's deformity is simple and easy to calculate on standard weight-bearing radiographs. Contrary to the traditional measurements used to estimate the deformity, it has shown a good intra- and inter-observer reliability and can support surgical decision-making process for management of patients with symptomatic Haglund's deformity.
Haglund畸形是跟骨后上角的一种异常，是足跟后部疼痛常见且备受争议的原因。已经描述了几种放射学指标，如Fowler-Philip角、Ruch间距、Chauveaux-Liet角、跟骨倾斜角、平行间距线和X-Y比率来测量这种畸形。然而，这些指标大多缺乏特异性，观察者内和观察者间的可靠性也各不相同。
本研究旨在描述一种新的用于测量Haglund畸形的放射学“BRINK角”（Botchu-Reilly-Iyengar-Nischal-Kakarala）。
我们进行了一项回顾性队列分析，评估了20例患有Haglund畸形患者的负重踝关节侧位X线片（Haglund队列）和100例无畸形患者的X线片（正常队列）。测量了每位患者的人口统计学细节和用于测量Haglund畸形的BRINK角。使用t检验进行统计分析，并使用kappa系数计算观察者间的可靠性。
正常队列中用于测量Haglund畸形的BRINK角平均为20.04°（标准差4.88），在Haglund队列中为25.1°（标准差3.3）。这具有统计学意义，p值小于0.0001。观察者内和观察者间的可靠性极佳，kappa值为0.8。
我们提出的用于测量Haglund畸形的放射学BRINK角在标准负重X线片上简单易算。与用于评估畸形的传统测量方法不同，它显示出良好的观察者内和观察者间可靠性，并且可以为有症状的Haglund畸形患者的手术决策过程提供支持。
