目的:本研究的目的是确定距骨内侧骨软骨损伤(OLT)发生的解剖学预测因素,通过分析从磁共振成像(MRI)获得的形态变量。
方法:在距骨圆顶内侧,年龄相等的非创伤性OLT患者中,共有430个脚踝,215个脚踝MRI,性别,在这项回顾性研究中分析了侧匹配的健康对照。测量的特定MRI参数包括距骨的前开口角(AOT),胫骨轴与内踝(TMM)之间的角度,胫骨平台与踝骨(PMA)的角度,距腓前韧带和后韧带之间的角度(ATFL-PTFL角度),滑车距骨弧的长度(TAL),胫骨远端关节面矢状长度(TAS),胫骨远端关节面矢状长度与滑车距弧长度之比(TAS/TAL),和腓骨切口的深度(IncDep)。
结果:AOT,IncDep,ATFL-PTFL角度,PMA,TMM,TAL,TAS/TAL在两组间均有显著性差异。确定的AOT截止值为13°(AUC0.875),IncDep为3.7mm(AUC0.565),ATFL-PTFL角度为78°(AUC0.729),PMA为14°(AUC0.581),TMM为15°(AUC0.907),TAL为34.3mm(AUC0.599),TAS/TAL为0.81(AUC0.719)。多因素logistic回归分析显示AOT>13°时的比值比(OR)=22.22,对于ATFL-PTFL角度>78°,OR=4.23,对于PMA≤14°,OR=1.99,对于TMM>15°,OR=31.598,对于TAS/TAL≤0.81,OR=3.79。
结论:这项研究强调了解剖参数的重要性,特别是TMM和AOT,作为OLT的关键预测因子。
OBJECTIVE: The aim of this study was to determine anatomical predictors for the occurrence of medial osteochondral lesions of the talus (OLT), by analyzing morphometric variables obtained from magnetic resonance imaging (MRI).
METHODS: A total of 430 ankles with 215 ankle MRIs from patients with nontraumatic OLTs on the medial side of the talar dome and an equal number of age, sex, and side-matched healthy controls were analyzed in this retrospective study. The specific MRI parameters that were measured include the anterior opening angle of the talus (AOT), the angle between the tibial axis and medial malleolus (TMM), the angle of the tibial plafond to the malleoli (PMA), the angle between the anterior and posterior talofibular ligaments (ATFL-PTFL angle), length of the trochlea tali arc (TAL), sagittal length of distal tibial articular surface (TAS), the ratio of the sagittal length of distal tibial articular surface to the length of the trochlea tali arc (TAS/TAL), and the depth of the incisura fibularis (IncDep).
RESULTS: AOT, IncDep, ATFL-PTFL angle, PMA, TMM, TAL, and TAS/TAL exhibited significant differences between the two groups. The established cut-off values were 13° (AUC 0.875) for AOT, 3.7 mm (AUC 0.565) for IncDep, 78° (AUC 0.729) for ATFL-PTFL angle, 14° (AUC 0.581) for PMA, 15° (AUC 0.907) for TMM, 34.3 mm (AUC 0.599) for TAL, and 0.81 (AUC 0.719) for TAS/TAL. Multivariate logistic regression analysis revealed Odds Ratio (OR) = 22.22 for AOT > 13°, OR = 4.23 for ATFL-PTFL angle > 78°, OR = 1.99 for PMA ≤ 14°, OR = 31.598 for TMM > 15°, OR = 3.79 for TAS/TAL ≤ 0.81.
CONCLUSIONS: This study highlights the significance of anatomical parameters, particularly the TMM and AOT, as key predictors of OLT.