单髁置换术前判断前交叉韧带功能完整的准确性研究  

Evaluation of Anterior Cruciate Ligament Integrity in Patients before Unicompartmental Knee Arthroplasty

作　　者：马童[1] 涂意辉[1] 薛华明[1] 文涛[1] 蔡珉巍[1] 

机构地区：[1]同济大学附属杨浦医院关节外科,上海200090

出　　处：《实用骨科杂志》2016年第1期18-20,32,共4页Journal of Practical Orthopaedics

基　　金：上海市卫生局重大科研项目(2013040);上海市科委引导类项目(134119b1400)

摘　　要：目的探讨各种术前检查判断符合单髁置换标准前交叉韧带功能完整的准确性。方法回顾性分析2007年1月至2014年12月,418例(529膝)拟行单髁置换术治疗膝骨关节炎患者,所有患者术前进行Lachman试验、轴移试验和X线检查,405例膝关节行MRI检查,判断前交叉韧带是否符合单髁置换标准。观察各项检查敏感度、特异度、准确性和似然比,采用Kruskal-Wallis法进行统计学检验。结果术中检查前交叉韧带功能完整451膝,功能失完整78膝。Lachman试验准确性90.9%,阳性似然比(positive likelihood ratios,+LR)30.54,阴性似然比(negative likelihood ratios,-LR)0.53;轴移试验准确性89.2%,+LR 17.92,-LR 0.62;X线检查准确性92.8%,+LR 14.04,-LR0.14;修正X线检查准确性97.4%,+LR 153.47,-LR 0.28;MRI检查准确性32.4%,+LR 1.23,-LR 0.16;修正MRI检查准确性82.5%,+LR 4.13,-LR 0.60。经检验,各项检查准确性差异有统计学意义(P<0.01)。结论侧位X线检查是目前判断骨关节炎中ACL功能完整性最准确的检查,而Lachman试验和轴移试验有较高的特异性,MRI有较高的敏感性。Objective To evaluate the diagnostic accuracy of tests for the diagnosis of ACL deficiency before UKA. Methods Between January 2007 and December 2014,418 patients（ 529 knees） with unicompartmental knee osteoarthritis were prepared to treat with Oxford UKA. All cases were tested by Lachman＇ s test,pivot shift test and X-rays,405 cases received MRI test. Sensitivity,specificity,accuracy and likelihood ratios were evaluated. Results At surgery,451 ACLs were found to be intact and 78 ACLs were deficiency. The accuracy of Lachman＇s test was 90. 9%,positive likelihood ratios（ ＋ LR） was 30. 54,negative likelihood ratios（- LR） was 0. 53. The accuracy of pivot shift test was 89. 2%,＋ LR was 17. 92,- LR was 0. 62.The accuracy of X-rays was 92. 8%,＋ LR is 14. 04,- LR was 0. 14. The accuracy of modified X-rays was 97. 4%,＋ LR was153. 47,- LR was 0. 28. The accuracy of MRI was 32. 4%,＋ LR was 1. 23,- LR was 0. 16. The accuracy of modified MRI was 82. 5%,＋ LR was 4. 13,- LR was 0. 16. There was significant difference in accuracy（ P〈 0. 01）. Conclusion The modified X-rays is the most accurate test to judge ACL. Lachman＇s test and pivot shift test are better in specificity. MRI is better in sensitivity.

关 键 词：前交叉韧带 骨关节炎 关节置换术 单间室 检查 

分 类 号：R684[医药卫生—骨科学]