中国骨与关节外科
中國骨與關節外科
중국골여관절외과
CHINESE BONE AND JOINT SURGERY
2014年
4期
331-335
,共5页
张超%王旭%马昕%黄加张%张益钧%王晨%许鉴%陈立
張超%王旭%馬昕%黃加張%張益鈞%王晨%許鑒%陳立
장초%왕욱%마흔%황가장%장익균%왕신%허감%진립
X线%投射角度%踝关节参数%评估
X線%投射角度%踝關節參數%評估
X선%투사각도%과관절삼수%평고
X-ray%Projective angle%Ankle joint parameters%Evaluation
背景：临床手术中通常用X线来确认踝关节骨折治疗时的解剖复位。但由于踝关节的各参数存在个体差异，因此，摄片时足的旋转角度无法准确控制。目前，对于投射角度对踝关节评估的研究较少。目的：本研究通过不同旋转角度对踝关节进行透视，评估相关参数对下胫腓联合及三角韧带损伤诊断的可靠性。方法：取8具新鲜下肢尸体标本，分别在正常情况以及建立腓骨短缩和（或）三角韧带损伤模型后，“C”型臂X线机以5°为间隔，从-30°至30°逐一测量内踝间隙、胫距上间隙、胫腓间隙及胫腓重叠的距离。结果：正常情况下，内踝间隙平均为（2.58±0.59）mm，胫距上间隙为（2.89±0.56）mm，胫腓间隙为（3.03±0.72）mm，胫腓重叠为（4.25±3.14）mm。建立腓骨短缩和（或）三角韧带损伤模型后，内踝间隙及胫腓间隙变大，而胫距上间隙及胫腓重叠变小。所有参数值均随X线投射角度的改变而发生相应变化。结论：胫腓间隙受透照角度的影响较小，是判断下胫腓联合损伤较为可靠的影像学参数。内踝间隙始终小于胫距上间隙，一旦内踝间隙超过胫距上间隙，则应怀疑三角韧带损伤，或存在外踝短缩畸形的可能。胫腓重叠不会出现负值，如果出现负值，意味着下胫腓联合存在损伤。
揹景：臨床手術中通常用X線來確認踝關節骨摺治療時的解剖複位。但由于踝關節的各參數存在箇體差異，因此，攝片時足的鏇轉角度無法準確控製。目前，對于投射角度對踝關節評估的研究較少。目的：本研究通過不同鏇轉角度對踝關節進行透視，評估相關參數對下脛腓聯閤及三角韌帶損傷診斷的可靠性。方法：取8具新鮮下肢尸體標本，分彆在正常情況以及建立腓骨短縮和（或）三角韌帶損傷模型後，“C”型臂X線機以5°為間隔，從-30°至30°逐一測量內踝間隙、脛距上間隙、脛腓間隙及脛腓重疊的距離。結果：正常情況下，內踝間隙平均為（2.58±0.59）mm，脛距上間隙為（2.89±0.56）mm，脛腓間隙為（3.03±0.72）mm，脛腓重疊為（4.25±3.14）mm。建立腓骨短縮和（或）三角韌帶損傷模型後，內踝間隙及脛腓間隙變大，而脛距上間隙及脛腓重疊變小。所有參數值均隨X線投射角度的改變而髮生相應變化。結論：脛腓間隙受透照角度的影響較小，是判斷下脛腓聯閤損傷較為可靠的影像學參數。內踝間隙始終小于脛距上間隙，一旦內踝間隙超過脛距上間隙，則應懷疑三角韌帶損傷，或存在外踝短縮畸形的可能。脛腓重疊不會齣現負值，如果齣現負值，意味著下脛腓聯閤存在損傷。
배경：림상수술중통상용X선래학인과관절골절치료시적해부복위。단유우과관절적각삼수존재개체차이，인차，섭편시족적선전각도무법준학공제。목전，대우투사각도대과관절평고적연구교소。목적：본연구통과불동선전각도대과관절진행투시，평고상관삼수대하경비연합급삼각인대손상진단적가고성。방법：취8구신선하지시체표본，분별재정상정황이급건립비골단축화（혹）삼각인대손상모형후，“C”형비X선궤이5°위간격，종-30°지30°축일측량내과간극、경거상간극、경비간극급경비중첩적거리。결과：정상정황하，내과간극평균위（2.58±0.59）mm，경거상간극위（2.89±0.56）mm，경비간극위（3.03±0.72）mm，경비중첩위（4.25±3.14）mm。건립비골단축화（혹）삼각인대손상모형후，내과간극급경비간극변대，이경거상간극급경비중첩변소。소유삼수치균수X선투사각도적개변이발생상응변화。결론：경비간극수투조각도적영향교소，시판단하경비연합손상교위가고적영상학삼수。내과간극시종소우경거상간극，일단내과간극초과경거상간극，칙응부의삼각인대손상，혹존재외과단축기형적가능。경비중첩불회출현부치，여과출현부치，의미착하경비연합존재손상。
Background:X-ray is used to confirm intraoperative anatomic reduction of ankle fractures. However, because of individual differences in ankle-related parameters, the rotation angle of foot can not be accurately controlled. It makes radiologic as-sessment difficult, and few studies have been reported. Objective: To measure radiologic parameters of the ankle in different projective angles and to evaluate the reliability of these parameters in the diagnosis of distal tibiofibular syndesmosis and deltoid ligament disruption. Methods:Eight fresh lower limb specimens were collected in the study. The models of fibula shortening and deltoid liga-ment injury were constructed. The radiologic parameters, including medial clear space, superior clear space, tibiofibular clear space and tibiofibular overlap were measured in the normal specimen and the models of fibula shortening and deltoid ligament injury by"C"arm X-ray machine from-30° to 30° with an interval of 5°. Results:The average medial clear space, superior clear space, tibiofibular clear space and tibiofibular overlap were (2.58 ± 0.59) mm, (2.89±0.56) mm, (3.03±0.72) mm, and (4.25±3.14) mm, respectively, in the normal specimens. In shortened fibu-la and (or) deltoid ligament injury models, the medial clear space and tibiofibular clear space increased, while the superior clear space and tibiofibular overlap decreased. The values of all parameters changed with different projective angles of X-ray. Conclusions:There are few changes of tibiofibular clear space from different projective angles. So it is a reliable imaging parameters to judge distal tibiofibular syndesmosis. If medial clear space is bigger than superior clear space, the deltoid liga-ment may be disrupted or the length of fibula may be lost. The negative value of tibiofibular overlap means inferior tibiofib-ular joint injury.
