MRI评估慢性踝关节不稳患者轴位像距骨和腓骨位置

doi:10.3877/cma.j.issn.1674-134X.2025.03.008

目的

评估慢性踝关节不稳（CAI）患者踝关节磁共振成像（MRI）轴位像上距骨和腓骨的位置。

方法

2019年1月至2023年7月因CAI在三峡大学附属仁和医院骨科住院治疗的50例患者为实验组（纳入患者检查显示有距腓前韧带损伤，诊断为CAI；排除既往下肢关节手术史和下肢关节畸形），以及因其他疾病在三峡大学附属仁和医院就诊的50例患者为对照组（排除踝关节相关骨性及韧带结构损伤）。回顾性分析纳入患者的资料，使用影像归档与通信系统（PACS）内部测量工具测量轴向踝指数（AMI）、踝间指数（IMI）、踝距指数（MTI）、踝中心指数（CMI）、中点踝间指数（MIMI），同时在轴位像靠近关节的近端层面测量腓骨中心与远端胫骨轴线的距离d，并使用t检验和非参数秩和检验进行统计学分析。

结果

实验组与对照组的年龄、性别比、患侧比、身高、体重和身体质量指数（BMI）等差异无统计学意义（均为P>0.05）。两组的AMI（-10.8±4.8）°vs.（-10.4±5.5）°、IMI（-9.3±3.7）° vs.（-9.4±3.9）°、CMI（-15.8±6.5）° vs.（-13.9±5.8）°、MIMI（-8.4±3.7）° vs.（-8.3±3.6）°、MTI 86.00（84.00,88.00）°vs. 85.00（83.00,87.00）°，差异均无统计学意义（均为P>0.05）。实验组与对照组相比，腓骨中心相对于远端胫骨轴线的位置更靠后（Z=2.562，P<0.05）。

结论

CAI患者MRI轴位像上腓骨相对于胫骨的位置后移，而距骨的位置未见明显变化。

关键词: 踝关节, 距骨, 腓骨, 磁共振成像

Objective

To evaluate the position of the talus and fibula on axial magnetic resonance imaging (MRI) images of patients with chronic ankle instability (CAI).

Methods

Fifty patients who were hospitalized in the Department of Orthopedics of Renhe Hospital Affiliated to China Three Gorges University from January 2019 to July 2023 were enrolled as as the experimental group (the included patients were diagnosed with CAI with anterior talofibular ligament injury; patients with a history of previous lower limb joint surgery or deformity were excluded). The other 50 patients who visited this hospital for other diseases were enrolled as control group (excluded those with ankle joint-related bony or ligamentous injuries). A retrospective analysis was performed on the data of the enrolled patients. The axial malleolar index (AMI), inter malleolar index (IMI), malleolar talus index (MTI), central malleolar index (CMI), and midpoint inter malleolar index (MIMI) were measured using the measurement tools within the Picture Archiving and Communication System (PACS) of the hospital. The distance (d) between the center of the fibula and the axis line of the proximal tibia was measured at the level of the axial image layers near the joint; t test and Wilcoxon rank sum test were applied for statistical analysis.

Results

No statistically significant differences were found in age, gender ratio, affected side ratio, height, weight, or body mass index (BMI) between the experimental group and the control group. There were no significant differences in angular measurements between the two groups ( all P>0.05), the data were as follows: AMI (-10.8±4.8)°vs. (-10.4±5.5)°, IMI (-9.3±3.7)° vs. (-9.4±3.9)°, CMI (-15.8±6.5)° vs. (-13.9±5.8)°, MIMI (-8.4±3.7)° vs. (-8.3±3.6)°, MTI 86.00 (84.00, 88.00)°vs.85.00 (83.00, 87.00)°. The experimental group showed a more posterior position of the fibular center relative to the distal tibial axis compared to the control group (Z=2.562, P<0.05).

Conclusion

In CAI patients, the position of the fibula relative to the tibia is displaced posteriorly on MRI axial images, with no significant change in the position of the talus.

Key words: Ankle, Talus, Fibula, Magnetic resonance imaging

图1 距骨的中轴线M及内外踝关节面的切线

Figure 1 Axis of talus (line M) and the tangents to the articular surfaces of the medial and lateral malleolus

图2 AMI（轴向踝指数）与MTI（踝距指数）的测量方法

Figure 2 Measurement of AMI（axial malleolar index） and MTI（malleolar talus index）

图3 IMI（踝间指数）的测量方法

Figure 3 Measurement of IMI（inter malleolar index）

图4 胫腓骨中点的测量方法

Figure 4 Measurement of midpoints of fibula and tibia

图5 CMI（踝中心指数）的测量方法

Figure 5 Measurement of CMI（central malleolar index）

图6 MIMI（中点踝间指数）测量方法

Figure 6 Measurement of MIMI（midpoint inter malleolar index）

图7 腓骨中心与远端胫骨轴线距离d的测量方法

Figure 7 Measurement of distance d between the fibular center and the distal tibial axis

表1 观察者内部和观察者之间的ICC值

Table 1 The intra- and inter-observer ICC values

测量指标	AMI	IMI	MTI	CMI	MIMI	腓骨中心与远端胫骨轴线的距离d
内部ICC	0.893	0.878	0.872	0.896	0.878	0.897
组间ICC	0.879	0.865	0.857	0.888	0.864	0.894

表1 观察者内部和观察者之间的ICC值

Table 1 The intra- and inter-observer ICC values

测量指标	AMI	IMI	MTI	CMI	MIMI	腓骨中心与远端胫骨轴线的距离d
内部ICC	0.893	0.878	0.872	0.896	0.878	0.897
组间ICC	0.879	0.865	0.857	0.888	0.864	0.894

表2 两组研究对象的一般资料比较结果

Table 2 Comparison of general characteristics between the two groups

组别Groups	例数Number of cases	性别（男/女）Gender (male/female)	患侧（左/右）Side (left/right)	年龄[岁，（±s）]Age (year)	身高[cm，（±s）]Height	体重[kg，（±s）]Weight	BMI[kg/m²，（±s）]
实验组Experimental group	50	30/20	23/27	30.0±9.0	170.6±8.1	68.5±11.1	23.5±3.0
对照组Control group	50	29/21	21/29	33.0±7.0	170.6±7.6	69.3±9.9	23.7±2.3
统计值Statistical values		χ²=0.041	χ²=0.162	t=1.918	t=0	t=0.370	t=0.453
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表2 两组研究对象的一般资料比较结果

Table 2 Comparison of general characteristics between the two groups

组别Groups	例数Number of cases	性别（男/女）Gender (male/female)	患侧（左/右）Side (left/right)	年龄[岁，（±s）]Age (year)	身高[cm，（±s）]Height	体重[kg，（±s）]Weight	BMI[kg/m²，（±s）]
实验组Experimental group	50	30/20	23/27	30.0±9.0	170.6±8.1	68.5±11.1	23.5±3.0
对照组Control group	50	29/21	21/29	33.0±7.0	170.6±7.6	69.3±9.9	23.7±2.3
统计值Statistical values		χ²=0.041	χ²=0.162	t=1.918	t=0	t=0.370	t=0.453
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

图8 两组间腓骨中心与远端胫骨轴线的距离d的比较

Figure 8 Comparison of distance d between the fibular center and the distal tibial axis in the two groups

表3 实验组与对照组MRI轴位像距骨层面测量相关参数[°，（

±s）]

Table 3 Parameters measured on axial MRI images at the talar level of the two groups

组别Groups	例数Number of cases	AMI	IMI	CMI	MIMI
实验组Experimental group	50	-11±5	-9±4	-16±7	-8±4
对照组Control group	50	-10±5	-9±4	-14±6	-8±4
t值		0.444	0.132	1.542	0.222
P值		>0.05	>0.05	>0.05	>0.05

表3 实验组与对照组MRI轴位像距骨层面测量相关参数[°，（

±s）]

Table 3 Parameters measured on axial MRI images at the talar level of the two groups

组别Groups	例数Number of cases	AMI	IMI	CMI	MIMI
实验组Experimental group	50	-11±5	-9±4	-16±7	-8±4
对照组Control group	50	-10±5	-9±4	-14±6	-8±4
t值		0.444	0.132	1.542	0.222
P值		>0.05	>0.05	>0.05	>0.05

表4 实验组与对照组MTI和腓骨中心到远端胫骨轴线距离

Table 4 MTI and distance between the fibular center and the distal tibial axis in the two groups

组别Groups	例数Number of cases	MTI[°，M（P₂₅，P₇₅）]	距离d [mm，M（P₂₅，P₇₅）]Distance d
实验组Experimental group	50	86.00 （84.00，88.00）	-2.20 （-3.50，-1.60）
对照组Control group	50	85.00 （83.00，87.00）	-1.60 （-2.80，-0.20）
Z值		1.892	2.562
P值		>0.05	<0.05

表4 实验组与对照组MTI和腓骨中心到远端胫骨轴线距离

Table 4 MTI and distance between the fibular center and the distal tibial axis in the two groups

组别Groups	例数Number of cases	MTI[°，M（P₂₅，P₇₅）]	距离d [mm，M（P₂₅，P₇₅）]Distance d
实验组Experimental group	50	86.00 （84.00，88.00）	-2.20 （-3.50，-1.60）
对照组Control group	50	85.00 （83.00，87.00）	-1.60 （-2.80，-0.20）
Z值		1.892	2.562
P值		>0.05	<0.05

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MRI evaluation of fibula and talus positions in patients with chronic ankle instability

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MRI evaluation of fibula and talus positions in patients with chronic ankle instability