Wijetunga Chatura Gihan, Roebert Justin, Hiscock Richard John, Bedi Harvinder S, Roshan-Zamir Sasha, Wang Otis, Fraval Andrew, Tate Julie, Eden Maggie, Rotstein Andrew H
Radiologist and MSK Imaging Fellow, Victoria House Medical Imaging, South Yarra, Victoria, Australia.
Musculoskeletal Radiologist, Victoria House Medical Imaging, South Yarra, Victoria, Australia.
J Foot Ankle Surg. 2023 Mar-Apr;62(2):382-387. doi: 10.1053/j.jfas.2022.09.008. Epub 2022 Oct 7.
The uninjured contralateral feet of consecutive patients undergoing cone-beam weightbearing computed tomography for acute Lisfranc injury between July 2017 and October 2019 were retrospectively analyzed. Of these, any cases with history or radiological evidence of trauma to the Lisfranc interval were excluded. The area of the non-weightbearing (NWBA) and weightbearing (WBA) Lisfranc joint was calculated (in mm) using a novel technique. Area difference (AD) was calculated as WBA-NWBA. Area ratio (AR) was calculated as WBA/NWBA. A subset of cases was double-measured by 2 technologists to evaluate inter- and intraobserver variability. A total of 91 patients aged 15 to 74 years were included in the study. The measurement technique was reproducible with excellent intraobserver correlation (intraclass correlation coefficient [ICC]: 0.998, 95% confidence interval [CI]: 0.996-0.999) and high interobserver correlation (ICC: 0.964, CI: 0.939-0.979). The median NWBA was 83 (range 52-171) and median WBA was 86 (range 52-171). Median AD was 1 mm (range -3 to 10) and median AR was 1.01 (range 0.96-1.11). No significant difference was identified in AD or AR when adjusted for age, gender, patient-weight or weight put through the foot. Both AD and AR distributions were highly skewed toward 0 and 1, respectively. Based on 95% CI, normal reference range for AD is -1 to 7 mm and for AR is 0.98 to 1.09. Absolute area of the Lisfranc joint is highly variable between individuals. The Lisfranc joint is rigid with little to no physiologic widening in most subjects. The normal upper limit of widening of the Lisfranc area on weightbearing was 9%. Differences in age, sex, patient-weight or weight put through the foot were not significantly associated with the extent of joint widening.
对2017年7月至2019年10月期间因急性Lisfranc损伤接受锥形束负重计算机断层扫描的连续患者的未受伤对侧足部进行回顾性分析。其中，排除任何有Lisfranc间隙创伤史或影像学证据的病例。使用一种新技术计算非负重（NWBA）和负重（WBA）Lisfranc关节的面积（以毫米为单位）。面积差（AD）计算为WBA - NWBA。面积比（AR）计算为WBA/NWBA。一组病例由2名技术人员进行双测量，以评估观察者间和观察者内的变异性。共有91名年龄在15至74岁之间的患者纳入研究。测量技术具有可重复性，观察者内相关性极佳（组内相关系数[ICC]：0.998，95%置信区间[CI]：0.996 - 0.999），观察者间相关性高（ICC：0.964，CI：0.939 - 0.979）。NWBA的中位数为83（范围52 - 171），WBA的中位数为86（范围52 - 171）。AD的中位数为1毫米（范围 - 3至10），AR的中位数为1.01（范围0.96 - 1.11）。在根据年龄、性别、患者体重或足部负重进行调整后，AD或AR未发现显著差异。AD和AR分布分别高度偏向0和1。基于95%CI，AD的正常参考范围为 - 1至7毫米，AR为0.98至1.09。Lisfranc关节的绝对面积在个体之间差异很大。在大多数受试者中，Lisfranc关节僵硬，几乎没有或没有生理性增宽。负重时Lisfranc区域增宽的正常上限为9%。年龄、性别、患者体重或足部负重的差异与关节增宽程度无显著相关性。
