Institut Català de Traumatologia i Medicina de l'Esport (ICATME)-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Surgery and Morphologic Science, Orthopaedic Surgery Service, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain.
Arch Orthop Trauma Surg. 2024 Feb;144(2):879-885. doi: 10.1007/s00402-023-05099-z. Epub 2023 Oct 21.
The purpose of this study was to evaluate the reproducibility and the accuracy of distal tibiofibular syndesmosis (DTFS) as landmark to perform controlled varus tibial resections during total knee arthroplasty (TKA). The hypothesis was that DTFS can be used to perform an accurate 3° varus tibial cut.
A retrospective analysis on a consecutive series of standard weightbearing full-length anteroposterior views of the lower limbs radiographic images was conducted. For each radiograph, the hip-knee-ankle (HKA) angle, the angle between the tibial mechanical axis and the line connecting the centre of the tibial spines and the DTFS (tibiofibular angle, TFA) and the medial proximal tibial angle (MPTA) were calculated. Each measurement was carried out twice by three independent observers, and intra- and inter-observer measurement reliability were assessed using the intraclass correlation coefficient (ICC) analysis.
A total of 1296 lower limbs were analysed from a series of 648 weightbearing full-length anteroposterior radiographs. The ICC were > 90% for all measurements. The mean TFA value was 2.94 ± 0.68 (range 2.38-3.51). No differences were detected comparing the mean TFA value on the right and left limb (p = 0.795) as well as comparing the values in male and female patients (p = 0.691). Linear regression analysis did not find statistically significant correlation between TFA and MPTA, or TFA and HKA angles, respectively.
The distal tibiofibular syndesmosis is a reliable and easy reproducible radiographic landmark that can be used when planning a 3° varus tibial cut. Future studies are needed to confirm the validity of this method also in clinical settings.
IV, retrospective case series.
本研究旨在评估下胫腓联合（DTFS）作为在全膝关节置换术（TKA）中进行可控内翻胫骨截骨的标志的可重复性和准确性。假设是 DTFS 可用于进行准确的 3°内翻胫骨截骨。
对连续系列标准负重全长前后位下肢 X 线图像进行回顾性分析。对于每张 X 线片，计算髋膝踝角（HKA）、胫骨机械轴与连接胫骨棘中心和 DTFS 的线之间的夹角（胫腓骨角，TFA）以及内侧胫骨近端角（MPTA）。每个测量值由三位独立观察者进行两次测量，并使用组内相关系数（ICC）分析评估观察者内和观察者间测量的可靠性。
从一系列 648 张负重全长前后位 X 线片中分析了 1296 条下肢。所有测量的 ICC 均>90%。TFA 的平均值为 2.94±0.68（范围 2.38-3.51）。左右肢体的 TFA 平均值（p=0.795）以及男性和女性患者的 TFA 值（p=0.691）之间无差异。线性回归分析未发现 TFA 与 MPTA 或 TFA 与 HKA 角度之间存在统计学显著相关性。
下胫腓联合是一种可靠且易于重现的影像学标志，可用于计划 3°内翻胫骨截骨。需要进一步的研究来确认这种方法在临床环境中的有效性。
IV，回顾性病例系列。
