| Objective: In this study,ankle joint CT scan was performed on normal Chinese adults aged18-60 years old grouped by age,sex and height.The lower tibiofibular space was measured on horizontal CT scan and the ankle space on coronal CT scan.By studying the ratio of the lower tibiofibular space to the ankle space in normal anatomic state,it provides a new reference for the diagnosis and reduction evaluation of the lower tibiofibular injury.By measuring the Angle between the vertical bisecting line and the horizontal line of the fibula articular surface arc of the tibial and fibula articular notch of the lower tibiofibular joint,the ideal insertion Angle in the separation and reduction fixation of the Chinese patients with the lower tibiofibular joint was investigated,in order to provide clinical guidance for accurate reduction and screw implantation in the operation of the lower tibiofibular joint injury.Methods: From December 1,2020 to December 31,2020,100 men and 100 women with ankle injury in the outpatient and inpatient department of Tianshui First People’s Hospital were scanned by CT.The two groups were divided into 18-39 years old and 40-60 years old groups according to age,and women were divided into 150-159 cm and 160-170 cm groups according to height.Men were divided into two groups according to their height: 160-174 cm and175-185 cm.Exclusion criteria:(1)congenital foot deformities,hallux valgus and flatfoot;(2)Deformity of lower limb alignment,such as varus and valgus deformity of hip and knee;(3)Ankle joint disease.The ankle joint was placed in a neutral position at the level of the anterior tibial crest,and the second toe was straight up.The line between the calcaneal tubercle and the second toe belly was perpendicular to the horizontal plane and fixed.The scanning layer was measured,and five axial sections were selected for measurement in the coronal view,including the lower margin,middle margin,upper margin,1cm above the upper margin,and 2cm above the upper margin of the distal tibiofibular syndesmosis.The width of the space between the upper and lower tibiofibular syndesmosis on the vertical bisector line of the arc chord of the fibular joint surface,the Angle between the vertical bisector line and the horizontal line of the tibial fibular notch of the distal tibiofibular joint,and the width of the tibiotalar joint space on the middle line of the ankle point in the coronal image were measured.The ratio of the distal tibiofibular space width to the tibiotalar joint width and the Angle between the vertical bisector line and the horizontal line of the fibular joint surface corresponding to the tibiofibular incision of the upper and lower tibiofibular joint were statistically analyzed.SBSS software was used to analyze the results.Results: According to the measurement of the ratio of the tibiofibular space to the ankle space under normal anatomical conditions in each group,there was no significant difference in the ratio of the tibiofibular space to the ankle space in each group,and there was no significant difference in the width of the tibiofibular space at all levels and the width of the tibiofibular space and talar space on the medial line of the ankle point in the coronal image.For the Angle between the vertical bisection and horizontal line of the articular surface of the fibula and the tibial fibula incisor of the lower tibiofibular joint corresponding to the articular surface of the fibula,the Angle measured at the lower margin of the lower tibiofibular joint in each group was the smallest,and the Angle gradually increased down to the upper margin of the lower tibiofibular joint,while the Angle changed little from the upper margin of the lower tibiofibular joint to the upper margin of the lower tibiofibular joint 1cm and 2cm above the upper margin of the lower tibiofibular joint.In terms of age,the Angle between the vertical bisector and the horizontal line of the fibula articular surface arc of the fibula articular surface corresponds to the notch of the tibiofibula articular surface arc of the fibula articular surface corresponds to the Angle between the vertical bisector and the horizontal line of the fibula articular surface and has no statistical difference with gender,age and height.Therefore,it can be considered that the Angle between the vertical bisector and the horizontal line of the fibula articular surface corresponds to the notch of the tibiofibula articular surface at all levels corresponds to gender,age and height.Conclusions: The normal ankle joints of 200 healthy adults were scanned by CT and measured according to gender,age and height.The following conclusions were drawn: 1.The tibiofibular syndesmosis space at all levels of the normal ankle joint is not related to gender,age and height.2.There was no correlation between ankle joint space and gender,age and height.(3)The ratio of distal tibiofibular syndesmosis space to ankle space at each level of the normal ankle joint was not related to gender,age,and height,and the ratio interval was 0.97-1.36,that is,when the gap between the lower tibiofibular syndesmosis and ankle joint was not within this interval,it indicated that the distal tibiofibular syndesmosis was injured.However,whether it can be used as a new diagnostic criterion for distal tibiofibular syndesmosis separation needs more cases to be verified in clinical practice.4.The Angle between the vertical bisector line and the horizontal line of the fibular joint arc chord corresponding to the tibial fibular notch of the distal tibiofibular syndesmosis at each level of the normal ankle joint is not related to gender,age,and height.However,the placement of the distal tibiofibular syndesmosis screw is usually2 cm above the tibiotalar joint,so the best insertion Angle of the distal tibiofibular syndesmosis screw is 30.26°-32.08°. |
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