正常成人下胫腓联合多层螺旋CT的影像学特征  

Multi-slice CT imaging characteristics of distal tibiofibular syndesmosis in healthy adults

作　　者：张程 丁文谦 谢晨学 郑国涛 李阳 赵士好 边劲松 Zhang Cheng;Ding Wenqian;Xie Chenxue;Zheng Guotao;Li Yang;Zhao Shihao;Bian Jinsong(Department of Joint and Sports Medicine,Cangzhou People's Hospital,Cangzhou 061000,China;Department of Hospital Infection-Control,Cangzhou People's Hospital,Cangzhou 061000,China;Department of Imaging,Cangzhou People's Hospital,Cangzhou 061000,China)

机构地区：[1]沧州市人民医院关节和运动医学科,沧州061000 [2]沧州市人民医院院感科,沧州061000 [3]沧州市人民医院影像科,沧州061000

出　　处：《中华创伤杂志》2023年第1期55-61,共7页Chinese Journal of Trauma

基　　金：河北省医学研究课题计划(20211309)。

摘　　要：目的测量正常成人下胫腓联合多层螺旋CT(MSCT)的影像学参数,为下胫腓联合损伤的诊断提供参考。方法通过沧州市人民医院影像报告数据库检索2019年5月至2021年5月110例正常成人踝关节MSCT的影像学资料,其中男56例,女54例;年龄18~60岁[(38.2±11.0)岁]。左踝59例,右踝51例。运用影像归档和通信系统(PACS)于MSCT上胫骨远端关节面上方10 mm处分别测量胫腓前间隙(L1)、胫腓后间隙(L2)、胫腓中间隙(L3)、切迹内腓骨深度(L4)、胫腓骨前缘的距离(L5)、胫腓骨后缘的距离(L6)、前胫腓联合角(A1)、腓骨旋转角(A2),根据性别、年龄段及侧别比较测量结果。观察"胫腓联合线"阳性率,并对下胫腓联合进行形态学分型。结果L1~L6、A1、A2在不同年龄段和侧别中比较,差异无统计学意义(P均>0.05)。男性和女性L4、L5、A1、A2差异无统计学意义(P均>0.05),而男性L1、L2、L3、L6较女性大(P<0.05或0.01)。男性"胫腓联合线"阳性率为80.4%(45/56),女性为74.1%(40/54);青年为77.2%(44/57),中年为77.4%(41/53);左踝为78.0%(46/59),右踝为76.5%(39/51)(P均>0.05)。下胫腓联合形态学分型为新月形61例(55.5%),梯形14例(12.7%),Ⅰ形3例(2.7%),M形17例(15.5%),V形10例(9.1%),Г形5例(4.5%)。结论在应用L1、L2、L3、L6作为成人下胫腓联合损伤诊断的参考时,需考虑性别因素,但无须考虑年龄及侧别因素,男性较女性下胫腓间隙宽,且腓骨位置更偏前;"胫腓联合线"具有较高的阳性率,且不受性别、年龄及侧别的影响,可为下胫腓联合损伤及解剖复位的判断提供新的思路;下胫腓联合的形态存在较多变异,应注意与X线上容易误诊为下胫腓联合分离相鉴别。Objective To measure the morphological parameters of distal tibiofibular syndesmosis in healthy adults using multi-slice CT(MSCT)so as to provide a reference for the diagnosis of distal tibiofibular syndesmosis injury.Methods The ankle MSCT imaging data in 110 normal adults were retrieved from the image report database of Cangzhou People's Hospital from May 2019 to May 2021,including 56 males and 54 females;aged 18-60 years[(38.2±11.0)years].There were 51 patients with imaging on the right ankle and 59 on the left ankle.Picture archiving and communication system(PACS)was used to measure parameters at 10 mm above the articular surface of the distal tibia on MSCT,including the anterior tibiofibular space(L1),posterior tibiofibular space(L2),middle tibiofibular space(L3),depth of fibula in notch(L4),distance of anterior tibiofibular edge(L5),distance of posterior tibiofibular edge(L6),anterior tibiofibular syndesmosis angle(A1),and fibular rotation angle(A2),and the measurements were compared by sex,age and side.The positive rate of"tibiofibular line"was observed.The morphological classification of distal tibiofibular syndesmosis was performed.Results There was no significant difference in L1-L6,A1 and A2 among different age and side(all P>0.05).No significant difference was found in L4,L5,A1 and A2 between males and females(P>0.05),but L1,L2,L3 and L6 were larger in males than in females(P<0.05 or 0.01).The positive rate of"tibiofibular line"was 80.4%(45/56)in males compared to 74.1%(40/54)in females(P>0.05),77.2%(44/57)in the youth compared to 77.4%(41/53)in the middle-aged,and 78.0%(46/59)in the left ankle compared to 76.5%(39/51)in the right ankle(all P>0.05).Morphological classification of distal tibiofibular syndesmosis was crescent in 61 patients(55.5%),trapezoid in 14(12.7%),I-shaped in 3(2.7%),M-shaped in 17(15.5%),V-shaped in 10(9.1%),Г-shaped in 5(4.5%).Conclusions When L1,L2,L3 and L6 are used as references in the diagnosis of adult distal tibiofibular syndesmosis injury,gender factors rather than age

关 键 词：踝关节 韧带 踝损伤 体层摄影术 人体测量术 

分 类 号：R684[医药卫生—骨科学]