目的:下胫腓骨远端韧带在高踝关节扭伤(HAS)发生中的作用已被广泛研究。但是以前的研究忽略了男性和女性之间的生理和解剖学差异,没有进一步细化性别。因此,腓骨切迹(FN)解剖形态对不同性别HAS的影响尚不清楚。本研究旨在探讨不同类型的FN对HAS严重程度的影响,并在排除性别造成的解剖学差异的情况下估计HAS患者的预后。
方法:本研究包括180例HAS患者作为实验组(即具有组)。根据性别和FN深度将他们进一步分为四组,深凹FN≥4mm,浅平FN<4mm。另设180例正常人作为对照组。FN形态学指标,胫腓距(TFD),测量踝关节指数,并与HAS组比较。组间采用独立t检验比较连续变量,使用组内相关系数(ICC)分析观察者内测量的可靠性,采用Pearson相关系数验证FN与HAS严重程度的相关性。
结果:在浅扁平型男性中,胫腓前距离(ATFD)的测量,胫腓中距离(mTFD),胫腓后距离(pTFD),前踝穴宽度(fAMW),中踝榫槽宽度(MAMW),后踝关节宽度(pAMW),HAS组踝关节深度(DOAM)明显大于正常组(p<0.05)。在深凹型男性患者中,ATFD的测量,mTFD,fAMW,mAMW,DOAM明显大于正常组(p<0.05)。在浅扁平型女性患者中,ATFD的测量,mTFD,pTFD,fAMW,mAMW,pAMW,发现DOAM明显大于正常组(p<0.05)。在深凹型女性患者中,mTFD的测量,pTFD,fAMW,mAMW,发现DOAM明显大于正常组(p<0.05)。FN深度与TFD呈负相关,治疗后浅平型患者的AOFAS评分明显低于深凹型患者(p<0.05)。
结论:在不同的性别群体中,与正常对照相比,HAS患者的TFD和部分踝关节指数存在显着差异。此外,FN深度与TFD呈负相关,浅平患者的AOFAS评分明显低于深凹患者。这些结果表明,浅扁平FN可能与更严重的远端胫腓骨韧带损伤和踝关节扩张有关。导致预后较差。在临床实践中应认真对待。
OBJECTIVE: The role of the distal tibiofibular ligament in the occurrence of high ankle sprain (HAS) has been widely studied. But previous studies have overlooked the physiological and anatomical differences between males and females and have not further refined gender. Therefore, the impact of the anatomical morphology of fibular notch (FN) on HAS in different genders is still unclear. This study aimed to explore the impact of different types of FN on the severity of HAS and to estimate the prognosis of patients with HAS while excluding anatomical differences caused by gender.
METHODS: One hundred and eighty patients with HAS were included in this study as the experimental group (i.e., HAS group). They were further divided into four groups according to gender and FN depth, with deep concave FN ≥ 4 mm and shallow flat FN < 4 mm. Another 180 normal individuals were set as the control group. The FN morphological indicators, tibiofibular distance (TFD), and ankle mortise indexes were measured and compared with those in HAS group. The independent t-test was used to compare continuous variables between groups, the intraclass correlation coefficient (ICC) was used to analyze the reliability of intra-observer measurement, and the Pearson correlation coefficient was used to verify the correlation between FN and the severity of HAS.
RESULTS: In males with shallow flat type, the measurements of anterior tibiofibular distance (aTFD), middle tibiofibular distance (mTFD), posterior tibiofibular distance (pTFD), front ankle mortise width (fAMW), middle ankle mortise width (mAMW), posterior ankle mortise width (pAMW), and depth of ankle mortise (DOAM) in HAS group were significantly larger than those in normal group (p < 0.05). In male patients with deep concave type, the measurements of aTFD, mTFD, fAMW, mAMW, and DOAM were significantly larger than those in normal group (p < 0.05). Among female patients with shallow flat type, the measurements of aTFD, mTFD, pTFD, fAMW, mAMW, pAMW, and DOAM were found to be significantly larger than those in normal group (p < 0.05). Among female patients with deep concave type, the measurements of mTFD, pTFD, fAMW, mAMW, and DOAM were found to be significantly larger than those of the normal group (p < 0.05). The depth of FN was negatively correlated with TFD, and the AOFAS score of patients with shallow flat type was significantly lower than that of patients with deep concave type after treatment (p < 0.05).
CONCLUSIONS: In different gender groups, compared with the normal controls, the TFD and partial ankle mortise indices were significantly different in HAS patients. Moreover, FN depth was negatively correlated with TFD, and the AOFAS score of shallow flat patients was significantly lower than that of deep concave patients. These suggested that shallow flat FN may be associated with more severe distal tibiofibular ligament injury and ankle mortise widening, leading to poorer prognosis. This should be taken seriously in clinical practice.