目的:本研究旨在使用磁共振成像(MRI)的形态学参数确定可能在距骨内侧骨软骨损伤(OLT)的病因中起作用的解剖学危险因素。
方法:这项回顾性研究包括124例内侧OLT患者以及年龄和性别匹配的124例对照。两名检查者对五个MRI参数进行了独立的OLT分类和测量:胫骨轴-内踝角(TMM),距骨的前开放角(AOT),距骨位置(TalPos),胫骨远端关节面与滑车距弧长度之比(TAS/TAL),腓骨切口深度(IncDep)。统计分析包括组内相关系数,独立t检验,接收机工作特性(ROC)分析,曲线下面积(AUC)计算,和逻辑回归分析。P值<0.05被认为是统计学上显著的。
结果:TTM,AOT,TalPos,和TAL值显著高于对照组,TAS/TAL比值显著低于对照组(p<0.001)。TMM的截止值和AUC值为15.15°(AUC0.763),AOT13.05°(AUC0.826),TalPos0.75mm(AUC0.887),TAL35.45mm(AUC0.642),和TAS/TAL比率0.82(AUC0.784),p<0.001。多因素logistic回归分析结果为TMM≥15.15°的比值比(OR)=6.1,对于AOT≥13.05°,OR=8.9,对于TalPos≥0.75mm,OR=36.1,对于TAS/TAL比值≤0.82,OR=6.7。
结论:踝关节形态可能对OLT发育有影响。距骨位置(TalPos)和距骨的前张开角(AOT)似乎是最强的诱发因素。
OBJECTIVE: This
study aimed to determine the anatomical risk factors that may play a role in the etiology of medial-sided osteochondral lesions of the talus (OLT) using morphological parameters in magnetic resonance imaging (MRI).
METHODS: One hundred twenty-four patients with medial-sided OLT and age- and sex-matched 124 controls were included in this retrospective
study. Two examiners conducted independent OLT classification and measurements of five MRI parameters: tibial axis-medial malleolus angle (TMM), the anterior opening angle of the talus (AOT), talus position (TalPos), the ratio of the distal tibial articular surface to the length of the trochlea tali arc (TAS/TAL), depth of the incisura fibularis (IncDep). Statistical analysis included intraclass correlation coefficients, independent t-tests, receiver-operating characteristic (ROC) analysis, area under the curve (AUC) calculation, and logistic regression analysis. A p-value < 0.05 was considered statistically significant.
RESULTS: TTM, AOT, TalPos, and TAL values were significantly higher and the TAS/TAL ratio was significantly lower in the case group than in the control group (p < 0.001). Cut-off and AUC values for TMM were 15.15° (AUC 0.763), AOT 13.05° (AUC 0.826), TalPos 0.75 mm (AUC 0.887), TAL 35.45 mm (AUC 0.642), and TAS/TAL ratio 0.82 (AUC 0.784), p < 0.001. Multivariate logistic regression analysis results were odds ratio (OR) = 6.1 for TMM ≥ 15.15°, OR = 8.9 for AOT ≥ 13.05°, OR = 36.1 for TalPos ≥ 0.75 mm, and OR = 6.7 for TAS/TAL ratio ≤ 0.82.
CONCLUSIONS: Ankle morphology might have an influence on OLT development. The talus position (TalPos) and anterior opening angle of the talus (AOT) seemed to be the strongest predisposing factors.