摘要: 目的：本研究旨在通过定量测量踝关节磁共振(MRI)图像的解剖结构，明确距骨内侧骨软骨损伤(Osteochondral lesions of the talus, OLT)与踝关节解剖结构的相关性。方法：回顾性搜集青岛大学附属医院2025年6月至2026年3月因踝关节疼痛就诊的病人，所有病人行踝关节常规MRI检查，46例OLT者纳入病例组，42例距骨正常者纳入对照组。踝关节MRI图像测量的解剖参数包括：胫骨轴–内踝角(TMM)、距骨前开角(AOT)、距骨位置(TalPos)、胫骨远端关节面与距骨滑车弧长度比值(TAS/TAL)及腓骨切迹深度(IncDep)。应用SPSSAU对测量数据进行统计学分析，包括数据汇总分析及绘制核密度图，绘制受试者工作特征曲线(Receiver operator characteristic curve，ROC曲线)并计算曲线下面积(Area under the curve, AUC)、标准误、p值及95%置信区间(Confidence Interval, CI)，多变量逻辑回归分析等，并评估各测量值与OLT的相关性；计算约登指数以确定踝关节各测量值预测OLT的最佳截断值。结果：分类汇总分析显示：病例组TMM平均值(18.887)明显高于对照组(15.887)，两组数据接近正态分布且组间差异显著，病例组数据离散程度较对照组略大；病例组的AOT平均值(18.021)明显高于对照组(15.325)，两组数据接近正态分布，两组数据组间差异显著，对照组的数据离散程度较病例组大；病例组TalPos平均值(−0.332)显著高于对照组(−1.511)，两组数据呈正态分布，两组数据组间差异显著，病例组数据离散程度小于对照组；TAS/TAL病例组平均值(0.808)低于对照组(0.877)，两组数据呈正态分布，两组数据组间差异显著，两组数据离散程度相近；IncDep病例组平均值(5.048)略低于对照组(5.418)，两组数据间差异不显著，对照组数据较病例组数据离散程度大。核密度图显示：病例组和对照组TMM、AOT、TalPos及TAS/TAL数值有良好的组间区分特征，病例组与对照组的IncDep数值无良好的组间区分特征。ROC曲线分析显示：TMM (AUC: 0.821, 95% CI: 71.75%~92.52%)、AOT (AUC: 0.736, 95% CI: 60.96%~86.28%)、TalPos (AUC: 0.788, 95% CI: 66.98%~90.70%)及TAS/TAL (AUC: 0.805, 95% CI: 70.01%~91.01%)与OLT显著相关，其中TMM的相关性最显著；IncDep (AUC: 0.584)与OLT无明显相关性。结论：距骨内侧骨软骨损伤(OLT)与踝关节的解剖结构特征显著相关。TMM、AOT、TalPos及TAS/TAL与OLT显著相关，其中TMM的相关性最显著。IncDep与OLT无明显相关性。
Abstract: Objective: This study aimed to clarify the correlation between osteochondral lesions of the talus (OLT) and ankle joint anatomy by quantitatively measuring anatomical structures on ankle MRI images. Methods: We retrospectively collected patients who visited Qingdao University Affiliated Hospital for ankle pain from June 2025 to March 2026. All patients underwent routine ankle MRI. A total of 46 patients with OLT were included in the case group, and 42 patients with normal talus were included in the control group. Anatomical parameters measured on ankle MRI images included tibial axis-medial malleolus angle (TMM), anterior opening angle of talus (AOT), talus position (TalPos), ratio of distal tibial articular surface to talar trochlea arc length (TAS/TAL), and fibular notch depth (IncDep). SPSSAU was used for statistical analysis of the measured data, including summary analysis, kernel density plots, ROC curves, calculation of area under the curve (AUC), standard error, p value, 95% confidence interval (CI), multivariate logistic regression analysis, and assessment of correlations between each measurement and OLT. The Youden index was calculated to determine the optimal cutoff values for predicting OLT using ankle measurements. Results: Summary analysis showed that the mean TMM in the case group (18.887) was significantly higher than in the control group (15.887), with both groups approximately normally distributed and a significant difference between groups. The case group had slightly higher data dispersion. The mean AOT in the case group (18.021) was significantly higher than the control group (15.325), both approximately normally distributed, with a significant difference; the control group had higher dispersion. The mean TalPos in the case group (−0.332) was significantly higher than the control group (−1.511), both normally distributed, with a significant difference, and the case group showed less dispersion. TAS/TAL mean in the case group (0.808) was lower than the control group (0.877), both normally distributed, with a significant difference, and similar dispersion. IncDep mean in the case group (5.048) was slightly lower than the control group (5.418), with no significant difference between groups; the control group showed greater dispersion. Kernel density plots showed good separation between case and control groups for TMM, AOT, TalPos, and TAS/TAL, while IncDep did not show good separation. ROC analysis showed significant correlations of TMM (AUC: 0.821, 95% CI: 71.75%~92.52%), AOT (AUC: 0.736, 95% CI: 60.96%~86.28%), TalPos (AUC: 0.788, 95% CI: 66.98%~90.70%), and TAS/TAL (AUC: 0.805, 95% CI: 70.01%~91.01%) with OLT, with TMM being the most significant, while IncDep (AUC: 0.584) showed no obvious correlation. Conclusion: Osteochondral lesions of the talus (OLT) are significantly associated with specific anatomical features of the ankle joint. TMM, AOT, TalPos, and TAS/TAL are significantly related to OLT, with TMM showing the strongest correlation. IncDep shows no obvious correlation with OLT.