CT联合双X线透视成像评估支具对功能性踝关节不稳患者运动学影响的研究

A Combination of CT and Dual X⁃ray Dynamic Fluoroscopy to Evaluate the Effects of Brace on the Kinematic Indexes of Patients with Functional Ankle Instability

目的:利用CT联合双X线动态透视成像评估支具对功能性踝关节不稳(FAI)患者运动学指标的影响。方法:对8例FAI患者(3男5女,10只脚,其中2例患者为双侧)和10名健康志愿者(6男4女,10只脚)行踝关节CT薄层扫描、行走中双X线透视成像,经CT三维骨骼模型重建以及与双X线透视成像融合后,计算FAI患者佩戴支具前后、与健康对照者的胫距关节和距下关节的六自由度运动学数据。结果:对于胫距关节,未佩戴支具FAI患者的内外位移(P=0.023)、前后位移(P=0.005)自由度大于正常对照组,而旋转自由度未见明显统计学差异;佩戴支具后,FAI患者内外翻自由度明显减少(P=0.037),佩戴支具FAI患者的前后(P=0.002)、内外(P=0.001)、近远(P=0.041)自由度均大于正常对照组。对于距下关节,未佩戴支具FAI患者的内外旋(P=0.004)、内外位移(P=0.001)自由度明显大于正常对照组;佩戴支具后,FAI患者内外翻自由度明显减小(P=0.007),佩戴支具FAI患者的内外(P=0.001)、近远(P=0.008)自由度仍远大于正常对照组。结论:佩戴支具可改善FAI患者关节活动度,CT结合双X线动态透视成像能准确评价支具对FAI患者行走中运动学指标影响。

Purpose:To evaluate the effects of brace on the kinematic indexes of patients with functional ankle instability(FAI)by a combination of CT and dual X-ray dynamic fluoroscopy.Methods:Eight patients with FAI(3 males and 5 females,10 feet,2 of which were bilateral)and 10 normal controls(6 males and 4 females,10 feet)underwent CT thin layer scanning and dual X-ray fluoroscopy in walking,After the reconstruction of CT 3D bone model and fusion with double X-ray fluoroscopy,the 6-DOF kinematics data of tibiotalar joint and subtalar joint of FAI patients before and after wearing brace and healthy controls were calculated.Results:For the tibiotalar joints,the freedom degree of internal and external displacement(P=0.023)and anteroposterior displacement(P=0.005)of FAI patients without braces were greater than those of the normal control group,and there was no statistically significant difference in rotation freedom;With braces,the freedom degree of varus or valgus was significantly reduced(P=0.037),and the freedom degree of the FAI patients wearing braces anteroposterior(P=0.002),medial and lateral(P=0.001),near and far(P=0.041)were all greater than that of the normal control group.For the subtalar joints,the freedom degree of internal and external rotation(P=0.004)and internal and external displacement(P=0.001)of FAI patients without braces was significantly greater than that of the normal control group;With braces,the freedom degree of varus or valgus was significantly reduced(P=0.007),and the internal and external(P=0.001)and near-far(P=0.008)freedom degree of FAI patients with braces were still much greater than those of normal control group.Conclusion:The brace can improve the joint mobility of FAI patients.The combination of CT and dual X-ray dynamic fluoroscopy imaging can accurately evaluate the effect of the brace on the kinematic indexes of FAI patients during walking.