负重位踝关节X线摄影在人工踝关节置换术前的临床应用价值  

Clinical Value of Ankle Arthrography in Weight-Bearing Position Before Ankle Arthroplasty

作　　者：邹萌[1] 李真林[2] 潘雪琳[2] 杨帆[2] 樊敏[2] Zou Meng;Li Zhenlin;Pan Xuelin(Department of Radiology,Shangjin Hospital,West China Hospital of Sichuan University,Chengdu,Sichuan 610041;Department of Radiology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China)

机构地区：[1]四川大学华西医院上锦医院放射科,四川成都610041 [2]四川大学华西医院放射科,四川成都610041

出　　处：《四川医学》2021年第7期711-716,共6页Sichuan Medical Journal

摘　　要：目的通过与非负重位对比,探讨负重位踝关节X线摄影在人工踝关节置换术前的临床价值。方法连续纳入2018年3月至2020年1月临床需要进行踝关节置换的患者40例,分别行术前常规非负重位踝关节X线正侧位摄影和负重位踝关节X线正侧位摄影,并在术后1个月行负重位踝关节X线摄影的复查随访。测量胫骨前面角(Tibial Anterior Angle,TAS)、胫骨侧面角(Tibial Lateralsurface Angle,TLS)、胫骨踝穴角(Tibiocrural angle,TC)、距骨倾斜角(Talar tilt angle,TT)。由2位医生通过盲法对TAS、TLS、TC、TT进行测量、图像质量评分并进行统计分析。结果术前非负重位TAS为(90.07±3.45)°、负重位TAS(86.59±3.35)°,负重位TAS明显减小,差异有统计学意义(t=7.72,P<0.05);负重位TLS(82.38±4.17)°比非负重位TLS(77.80±4.13)°明显增大,差异有统计学意义(t=-12.90,P<0.05);负重位TT(4.13±3.44)°较非负重位TT(7.20±3.54)°明显减小,差异有统计学意义(t=17.46,P<0.05);负重位TC(74.13±2.67)°较非负重位TC(76.70±2.55)°明显减小,差异有统计学意义(t=7.78,P<0.05);图像主观质量评分差异均无统计学意义(P>0.05);术后TAS、TLS、TT、TC与术前负重位摄影比较差异均有统计学意义(P<0.05)。结论踝关节置换前负重位较非负重踝关节X线片关节力线和关节角度均有明显的变化,具有更大的临床价值,更有利于反应踝关节的真实情况并进行手术设计。Objective To investigate clinical values of ankle arthrography in weight-bearing position before ankle arthroplasty by comparing with non-weight-bearing position.Method From March 2018 to January 2020,40 patients who were clinically required to undergo ankle arthroplasty were included.Anteroposterior and lateral ankle X-ray at non-weight and weight-bearing position was performed as preoperative conventional.The weight-bearing position anteroposterior ankle X-ray was performed at 1 month after surgery.Tibial anterior angle(TAS),tibial lateralsurface angle(TLS),tibiocrural angle(TC)and talar tilt angle(TT)were measured by 2 doctors through blind method.Image quality was scored and statistically analyzed.Results Before operation,TAS in weight-bearing position(86.59±3.35)°was significantly decreased than in non-weight-bearing position(90.07±3.45)°with significant difference(t=7.72,P<0.05).TLS at weight-bearing position(82.38±4.17)°was significantly higher than that at non-weight-bearing position(77.80±4.13)°with significant difference(t=-12.90,P<0.05).TT at weight-bearing position(4.13±3.44)°was significantly lower than that at non-weight-bearing position(7.20±3.54)°with significant difference(t=17.46,P<0.05).TC at weight-bearing position(74.13±2.67)°was significantly lower than that at non-weight-bearing position(76.70±2.55)°with significant difference(t=7.78,P<0.05).There was no statistical significance in subjective quality score(P>0.05).After surgery,there were statistically significant differences in TAS,TLS,TT and TC compared with preoperative weight-bearing photography(P<0.05).Conclusion Compared with non-weight-bearing position,weight-bearing position before ankle joint replacement has obvious changes in joint force line and joint angle.It has greater clinical value that is more conducive to reflect real situation of ankle joint and conduct surgical design.

关 键 词：负重位 踝关节X线摄影 人工踝关节置换 

分 类 号：R814[医药卫生—影像医学与核医学]