DOI QR코드

DOI QR Code

Comparison of Radiologic Parameters between Weight Bearing Affected Both Ankle and Single Ankle in Ankle Exam

체중부하 상태의 족관절 검사시 양측 족관절 동시 검사와 편측 족관절 검사의 방사선학적 비교

  • Cha, Sangyoung (Department of Radiological Science, Dongshin University) ;
  • Shin, Jaehan (Department of Radiology, Inha University Hospital) ;
  • Choi, Namgil (Department of Radiological Science, Dongshin University)
  • 차상영 (동신대학교 방사선학과) ;
  • 신재한 (인하대학병원 영상의학과) ;
  • 최남길 (동신대학교 방사선학과)
  • Received : 2016.11.17
  • Accepted : 2016.12.31
  • Published : 2016.12.31

Abstract

This study was performed to analyze the results of radiologic parameters compared both leg weight bearing position to single leg weight bearing position in ankle osteoarthritis. Between January 2016 and June 2016, 25 patients (50 ankles) who visited our Hospital to treat ankle pain. In radiographic assessment, We masured tibial anterior surface angle(TAS), tibial medial malleolar angle(TMM), talar tilting angle(TT), joint space width(JSW), tibiotalar joint space, fibulotalar joint space of ankle as radiologic parameters. On the right leg of the both leg weight bearing position, TAS was $87.24^{\circ}$, TT was $6.44^{\circ}$, TMM was $26.76^{\circ}$, fibulotalar joint space was 0.98mm. Right leg of the single leg weight bearing position, TAS was $88.93^{\circ}$, TT was $2.41^{\circ}$, TMM was $19.77^{\circ}$, fibulotalar joint space was 1.6mm. And then, on the left leg of the both leg weight bearing position, TAS was $87.25^{\circ}$, TT was $5.71^{\circ}$, TMM was $23.92^{\circ}$, fibulotalar joint space was 1.22 mm and left leg of the single weight bearing position, TAS was 88.75, TT was $3.19^{\circ}$, TMM $21.45^{\circ}$, fibulotalar joint space was 1.22 mm. There are unsimilarity between measure values of TAS and tibiotalar joint space. As the result of test of weight bearing ankle study, it would be more exact to examine to measure one side in the first time rather than both to conclude on accurate measurement.

체중부하 상태에서의 족관절 검사 시 양측 족관절을 동시 촬영 했을 때와 편측 족관절을 나누어 각각 촬영 했을 때, 족관절염의 평가에 해당되는 측정값들의 변화에 대해 알아보고자 한다. 양측을 동시촬영 할 때, 다리를 모아 촬영하게 됨으로 Tibia axis축이 기울게 되고, 족관절의 external rotation으로 인해 족관절의 각도와 joint space의 왜곡이 발생하게 된다. 양측 족관절 동시촬영과 편측 족관절을 나누어 촬영한 영상을 PACS system 이용하여 족관절 평가에 이용되는 TAS, TT, TMM, JSW, Tibiotalar joint, Fibulotalar joint의 측정값을 구한 후 통계 분석 하였다. 각도 측정에 있어, 체중부하 양측 족관절 동시 촬영한 검사의 오른쪽 족관절의 TAS, TT, TMM 측정값은 $87.24^{\circ}$, $6.44^{\circ}$, $26.67^{\circ}$ 이였으며 편측을 나누어 촬영한 오른쪽 족관절의 TAS, TT, TMM은 $88.93^{\circ}$, $2.41^{\circ}$, $19.77^{\circ}$ 였다. 양측 족관절 동시촬영의 왼쪽 족관절 TAS, TT, TMM의 측정값은 $87.25^{\circ}$, $5.71^{\circ}$, $23.92^{\circ}$ 였으며 편측을 나누어 촬영한 왼쪽 족관절의 TAS, TT, TMM은 $88.75^{\circ}$, $3.19^{\circ}$, $21.45^{\circ}$ 였다. 양측 족관절을 동시촬영한 검사와 편측을 나누어 촬영한 족관절과의 비교 시, 양측을 동시 촬영한 검사에서 족관절 평가의 중증도 비율이 높게 나타났으며, 자세로 인한 측정값의 왜곡을 확인할 수 있었다. 반면 너비 측정에서 JSW, Tibiotalar joint는 검사 자세로 인한 측정값들 간의 유의성은 없었지만, Fibulotalar joint 의 양측 족관절 동시 검사에서 오른쪽 0.98mm 왼쪽 1.22mm 로 나타났고, 한쪽씩 촬영한 오른쪽 족관절에서는 1.6mm 왼쪽 1.22mm로 측정 자세로 인한 측정값의 유의한 차이를 보였다. 따라서 족관절염 평가를 위한 체중부하 족관절 검사시 양측을 동시에 검사하기 보다는 각각의 족관절을 나누어 촬영하는 것이 족관절염 평가값에 왜곡을 최소화 하며, 측정값의 정확성을 높일 수 있다.

Keywords

References

  1. J. R. Kim, W. C. Lee, "Comparison of Radiologic Parameters between Weinht Bearing affected Single Ankle Anteroposterior View and both Ankle Anteroposterior View in Ankle Osteoarthritis," J Korean Foot Ankle Soc. Vol. 15, No. 3, pp. 159-164, 2011.
  2. W. C. Lee, Y. H. Kang, "Radiological Analysis of the Degenerative Arthritis of the Ankle," J Korean Foot Ankle Soc. Vol. 9, No. 2, pp. 135-139, 2005.
  3. Bruce W. Long, "Merrill's Atlas of Radiographic Positioning and Procedures." Volume 2, Edition 13.
  4. Buckland-Wright, "Radioraphic assessmenet of osteoarthritis: comparison between existing methodologies," Osteoartiritis Cartilage. 1999;7:430-3. https://doi.org/10.1053/joca.1998.0234
  5. Friberg O, Kujala UM, Aalto T, Kvist M, Osterman K, "Lower limb asymmetry and patellofemoral joint incongruence in the etiology of knee exertion injuries in athletes," Int J Sports Med. 1987;8:214-20. https://doi.org/10.1055/s-2008-1025658
  6. J. S. Park, S. T. Jeong, S. C. Hwang, D. H. Kim, J. Y. Gwak, H. K. Yoon, D. C. Nam, "Radiographic Analysis of Tibial-Articular Surface Angle According to the Selection of the Mechanical Axis," J Korean Foot Ankle Soc. Vol. 17, No. 3, pp. 189-195, 2013.
  7. D. Y. Lee, I. H. Sung, "Ankle Arthrodesis" J Korean Foot Ankle Soc. Vol. 15, No. 3, pp. 124-131, 2011.
  8. J. Y. Choi, H. J. Jeong, H. K. Shin, Eugene Kim, S. J. Park, D. S. Seo, "Surgical Treatment of Ankle Fractures in the Elderly," J Korean Foot Ankle Soc. Vol. 17, No. 1, pp. 23-27, 2013.
  9. B. S. Kim, W. J. Choi, Y. S. Kim, J. W. Lee, "Total ankle replacement in moderate to severe varus deformity of the ankle," The journal of bone and joint surgery. VOL. 91-B,No. 9, SEPTEMBER 2009.
  10. Takakura Y, Tanaka Y, Kumai T. Tamai S, "Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients," J Bone Joint Surg Br. 1995;77:50-4.
  11. J. S. Moon, J. C. Shim, J. S. Suh, W. C. Lee, "Radiographic predictability of cartilage damage in medial ankle osteoarthritis," Clin Orthop Relat Res. 2010;468:2188-97. https://doi.org/10.1007/s11999-010-1352-2
  12. W. C. Lee, J. S. Moon, K. Lee, W. J. Byun, S. H. Lee, "Indications for Supramalleolar Osteotomy in Patients with Ankle Osteoarthritis and Varus Deformity," 2011;93:1243-8 d doi: 10.2106/JBJS.J.00249.
  13. Karlsson J, Lansinger O, "lateral instability of the ankle joint," Clin Orthop relat Res. 1992;2276 :253-61.
  14. Thomas H. Berquist FACR, "Imaging of the Foot and Ankle," ISBN-13: 978-1605475721, September 16, 2010. p.252-253.
  15. Cushnaghan J, Dieppe P, "Study of 500 patients with limb joint osteoarthritis. I. Analysis by age, sex, and distribution of symptomatic joint sites," Ann Rheum Dis. 1991;50:8-13. https://doi.org/10.1136/ard.50.1.8
  16. Huch K, Kuettner KE, Dieppe P, "Osteoarthritis in ankle and knee joints," Semin Arthritis Rheum. 1997;26:667-74. https://doi.org/10.1016/S0049-0172(97)80002-9
  17. Saltzman CL, Salamon ML, Blanchard GM, et al, "Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center," Iowa Orthop J. 2005;25: 44-6.
  18. W. C. Lee, J. S. Moon, K. Lee, H. J. Choi, "Relationship between Radiographic Classification and Articular Cartilage Lesions in Medial Degenerative Arthritis of the Ankle," J Korean Foot Ankle Soc. Vol. 11, No. 2, pp.130-134, 2007.