基于踝关节正位X射线的外踝放射学研究及其临床意义

Radiologic study of lateral malleolus and their clinical significances:a research based on anteroposterior X-ray of ankle

目的通过对踝关节正位X射线的外踝特征进行观察分析和放射学测量,为外踝解剖复位提供量化标准。方法选取我院120名正常成人标准踝关节X射线正位片,观察踝关节X射线正位片上平行间隙、“硬币”征、Shenton线,并分析性别、年龄对这些指标的影响及相关性。测量并对比男女性的距小腿角、腓踝角、外踝垂直高度、内外踝高度差、下胫腓间隙宽度、下胫腓重叠宽度,分析外踝垂直高度与年龄的相关性。结果120例踝关节正位X射线中平行间隙阳性率为100%;性别、年龄对“硬币”征和Shenton线的阳性率影响不显著(P>0.05)。男性和女性间距小腿角、腓踝角、下胫腓间隙宽度、下胫腓重叠宽度比较差异均无统计学意义(P>0.05);男性外踝垂直高度、内外踝高度差大于女性(P<0.05);男性、女性外踝垂直高度与年龄无相关性(r=-0.086、0.058,P=0.516、0.659)。结论在判断外踝解剖复位时,踝关节正位X线上的平行间隙、“硬币”征和Shenton线可作为踝穴位以外的一种补充,性别和年龄对其没有影响;在应用距小腿角、腓踝角、下胫腓间隙宽度、下胫腓重叠宽度作为外踝解剖复位参考标准时,无需考虑性别因素;而在应用外踝垂直高度、内外踝高度差作为成人外踝解剖复位参考标准时,需考虑性别,但外踝垂直高度无需考虑年龄因素。

Objective To observe and measure lateral malleolus in anteroposterior X-ray of ankle,in order to provide quantitative standard for the anatomical reduction of lateral malleolus.Methods The standard anteroposterior X-ray of ankle in 120 normal adults were selected.The parallel space,"coin"sign and Shenton line were observed on the anteroposterior X-ray of ankle,and the impact and correla⁃tion of gender and age on these indicators were analyzed.Then the talo-crural angle,fibular ankle angle,lateral ankle vertical height,medial and lateral ankle height difference,tibiofibular clear space width and tibiofibular overlap width of males and females were measured and compared,and the correlation between the lateral ankle vertical height and age was analyzed.Results The positive rate of parallel space in 120 cases of anteroposterior X-ray of ankle was 100%.The gender and age had no significant effect on the positive rates of the"coin"sign or the Shenton line(P>0.05).There was no significant difference in the talo-crural angle,fibular ankle angle,tibiofibular clear space width or tibiofibular overlap width between males and females(P>0.05).The lateral ankle vertical height and medial and lateral ankle height difference of males were greater than those of females(P<0.05).There was no correlation between the lateral ankle vertical height and age in both males and females(r=-0.086,0.058;P=0.516,0.659).Conclusion When evaluating the anatomical reduction of the lateral malleolus,the parallel space,"coin"sign and Shenton line in anteroposterior X-ray of ankle can be a supplement to the ankle mortise X-ray,and the gender and age have no effect on the above indicators.There is no need to consider gender when applying talo-crural angle,fibular ankle angle,tibiofibular clear space width and tibiofibular overlap width as reference standards for anatomical reduction of the lateral malleolus;when using lateral ankle vertical height,medial and lateral ankle height difference as the reference standards for anatomical reduction of adult lateral malleolus,gender should be considered,but the lateral ankle vertical height does not need to consider for age.