下胫腓联合损伤的X线诊断研究

Diagnostic value of digital radiographic measurements for injury to the distal tibiofibular syndesmosis

目的通过对正常国人下胫腓联合及踝关节内侧间隙的数字化X线图像测量，探讨性别、年龄、身高、体质量对它们的影响，明确数字化X线检查在下胫腓联合损伤诊断中的意义。方法选取492例正常踝关节，应用直接数字X线摄影术拍摄标准踝关节正、侧位片及踝穴位片，图像数据传送至影像工作站，在灰度显示器上对图像进行“软阅读”，并利用PACS系统自带软件对下胫腓联合间隙、下胫腓联合重叠影、踝关节内侧间隙、腓骨宽度及腓前距进行模拟测量，对所得数据进行统计学处理，说明其与性别、年龄、身高及体质量的关系。结果正常成人下胫腓联合间隙参考值范围为（3．98±0．78）mm、踝穴位为（3．67±0．68）mm，下胫腓联合重叠影参考值范围为（7．06±1．98）mm、踝穴位为（2．34±0．84）mm，踝关节内侧间隙参考值范围为（4．04±0．50）mm，腓骨宽度的参考值范围为（14．39±1．86）mm，腓前距参考值范围为（4．99±4．04）mm.下胫腓联合间隙、下胫腓联合重叠影、腓前距及内踝间隙与性别、年龄、身高、体质量问的决定系数及P值分别为R^2a=0．229，P〈0．01；R^2a=0．066，P〈0．01；R^2a=0．032，P〈0．01；R^2a=0．059，P〈0．01。结论下胫腓联合间隙与身高、体质量、性别、年龄存在强相关性，小适合作为下胫腓联合损伤的评估指标；下胫腓重叠影、内踝闻隙、腓前距与身高、体质量、性别、年龄仔在弱相关性，町作为评估下胫腓联合早期损伤的重要指标。

Objective To identify the effects of gender, age, height and weight on the diagnostic value of digital radiographic measurements for injury to the distal tibiofibular syndesmosis. Methods The tibiofibular joint and ankle joint space in the digital X-ray films of 492 normal Chinese people （306 males and 186 females） were measured. Their average age was 35.2 （range, 13 to 82） years old. Their average height was 169. 2（range, 152.3 to 190.4） cm. Their average weight was 64. 8 （range, 42.3 to 97.4） kg. To assess the integrity of ankle and syndesmosis, we measured, on the AP and lateral radiographs of ankle and ankle mortise, tibiofibular clear space, tibiofibular overlap, medial clear space, width of fibula and the distance between the distal tip of the anterior aspect of the tibia and the point of anterior cortex of the fibula intersecting the articular line （abbreviated as the distance）. Correlation of the parameters and coefficients of determination were assessed. Results The tibioflbular clear space （3.98± 0.78） mm was the most affected by gender, age, weight and height than the other parameters. The tibiofibular overlap width was （7.06 ± 1.98） mm, the medial clear space width （4.04±0.50） ram, the width of fibula （14.39± 1.86） mm and the distance （4.99±4.04） mm, The tibiofibular clear space had a signifieant correlation with the gender, age, height and weight （ R^2a= 0. 229, P 〈 0.01）, but the other parameters had no significant correlation. Conclusion In digital X-ray films, the tibiofibular overlap, the medial clear space and the distance between the distal tip of the anterior aspect of the tibia and the point of anterior cortex of the fibula intersecting the articular line can be used for early and accurate diagnosis of injuries to the distal tibiofibular syndesmosis.