基于磁共振成像外踝韧带修复术腓骨内钉道角度测量

Measuring the angle of the fibular internal anchor hole after lateral ankle ligament repair basic on ankle magnetic resonanceimaging

目的 基于慢性踝关节外侧不稳(CLAI)患者术后磁共振成像,探索外踝韧带修复术钉道角度的分布规律。方法 回顾性分析自2018年3月至2023年1月于中国中医科学院望京医院骨关节二科接受外踝韧带修复术的52例CLAI患者的临床资料。基于患者术后磁共振成像,采集腓骨及钉道各定位点的空间坐标,通过向量法计算钉道与腓骨长轴及距骨外侧面的夹角,进行统计分析。结果 52例患者均使用双锚钉,上位钉道与腓骨长轴成角(48.35°±12.45°),变异系数25.7%,与矢状面成角(9.73°±7.26°),至内侧面最短距离为(2.82±2.70)mm;下位钉道与腓骨长轴成角(47.41°±12.44°),变异系数26.2%,与矢状面成角(9.89°±7.16°),至内侧面最短距离为(3.29±2.25)mm。钉道平均轴角(47.88°±12.39°),变异系数25.9%,平均面角(9.81°±7.17°),至内侧面平均最短距离为(3.05±2.49)mm。结论 双锚钉修复方案中,两组钉道与腓骨长轴成角均呈正态分布,与理论安全角度(45°)无统计学差异,但总体分布离散程度较大,提示手持器械置钉操作存在一定误差,术中钉道角度控制准确性可以进一步提高,以避免肌腱摩擦等并发症的发生。

Objective To describe the distribution of anchor hole angle in external ankle ligament repair surgery based on postoperative magnetic resonance imaging measurement of chronic lateral ankle instability(CLAI)patients.Methods The clinical data of 52 CLAI patients who underwent lateral ankle ligament repair surgery in the Second Osteoarthrosis Ward,Wangjing Hospital of CACMS from March 2018 to January 2023 were retrospectively analyzed.Based on postoperative ankle joint magnetic resonance imaging of patients,spatial coordinate data of positioning points on fibula,and anchor hole were collected.The angle between the anchor hole and the fibula long axis and the external surface of the talus trochlear was calculated using vector method,and statistical analysis was conducted.ResultsAll the 52 patients were fixed with double suture anchors.The angle between upper anchor hole and the long axis of the fibula was(48.35°±12.45°),25.7%as coefficient of variation;the angle between anchor hole and the sagittal plane was(9.73°±7.26°),and the shortest distance from anchor to the internal surface of the fibula was(2.82±2.70)mm.The angle between the lower anchor hole and the long axis of the fibula was(47.41°±12.44°),26.2%as coefficient of variation,the angle between anchor hole and the sagittal plane was(9.89°±7.16°),and the shortest distance from anchor to the internal surface of the fibula was(3.29±2.25)mm.The average axial angle of the anchor hole was(47.88°±12.39°),25.9%as coefficient of variation,the average surface angle was(9.81°±7.17°),and the average shortest distance from anchor to the internal side of the fibula was(3.05±2.49)mm.Conclusion In the double anchor fixation scheme,the angles of each anchor hole was normally distributed,with no statistical difference from the standard angle(45°),but the degree of dispersion is large,and the accuracy of intraoperative control of the anchor hole angle should be further improved,to prevent the penetration of the fibula and the occurrence of complications.