丝攻应力试验在术中诊断急性三角韧带损伤的价值  

The value of tap test for intraoperative diagnosis of the acute deltoid ligament injury

作　　者：伍凯[1] 林健[1] 黄建华[1] 王秋根[1] 

机构地区：[1]上海交通大学附属第一人民医院创伤骨科,201620

出　　处：《中华骨科杂志》2016年第21期1367-1373,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨丝攻应力试验在术中评估三角韧带完整性的价值。方法2013年3月至2015年8月，对62例踝关节骨折且疑似三角韧带损伤患者进行重力应力试验及丝攻应力试验，男38例，女24例；年龄19-62岁，平均39．4岁；Lauge-Hansen分型：旋后外旋型32例，旋前外旋型28例，旋前外展型2例。首先在术前作重力应力试验，分别由3位医生单独进行评估，当2名及以上医生获得相同诊断结果时，即作为重力应力试验的诊断结果。随后对腓骨及后踝骨折进行切开复位内固定，再由3位医生单独进行丝攻应力试验，评估三角韧带是否损伤。随后切开内侧踝穴探查三角韧带的完整性，并以此作为参照，评估重力应力试验和丝攻应力试验的敏感性、特异性，计算两种试验的阳性预测值、阴性预测值、误诊率及漏诊率。使用Kappa系数判定观察者之间的一致性。结果术前重力应力试验，62例患者中提示有47例患者（75．8％）阳性；术中的丝攻应力试验，提示52例患者（83．9％）阳性；最终手术探查发现48例（77．4％）存在三角韧带损伤。丝攻应力试验的敏感性为100％（48／48），特异性为71．4％（10／14），阳性预测值为92，3％（48／52），阴性预测值为100％（10／10），误诊率为28．6％（4／14），漏诊率为0（0／48）；重力试验的敏感性为95．8％（46／48），特异性为92．9％（13／14），阳性预测值为97．9％（46／47），阴性预测值为86．7％（13／15），误诊率7．1％（1／14），漏诊率为4．2％（2／48）。丝攻应力试验和重力试验结果，各观察者间的一致性比例均〉90％，Kappa系数均〉0．75。结论丝攻应力试验和重力应力试验均具有良好的观察者间一致性。丝攻应力试验具有敏感性高，操作简单，放射线暴露少的特点，尽管其误诊率稍高于重力应力试验，但在术中评估急性三角韧Objective To explore the value of the tap test for intraoperative assessment of the integrity of deltoid ligament. Methods Sixty-two consecutive patients who were suspected to have a combined deltoid ligament injury between March 2013 and August 2015 were enrolled in this prospective study. Gravity stress test was performed on those 62 cases preoperatively by three independent doctors. The diagnosis that at least two doctors agreed with was defined as a final result. After open reduction and internal fixation of fibular and posterior malleolus fracture, tap test was performed to evaluate the integrity of deltoid ligament intraoperatively. The sensitivity, specificity, positive predict value, negative predict value, false positive rate and false negative rate were calculated. The Kappa coefficient was used to determine inter-rater reliability. Results Among the 62 cases, gravity stress test before the surgery demonstrated that 47 （75.8%） of the 62 patients had a positive result, while tap test showed 52 （83.9%） cases got a positive result. Finally 48 （77.4%） cases were proved to be combined with deltoid ligament rupture by surgical exploration. Tap test had a sensitivity of 100%（48/48）, a specificity of 71.4%（10/14）, a positive predict value of 92.3%（48/52）, a negative predict value of 100%（10/10）, a false positive rate of 28.6%（4/14） and a false negative rate of zero（0/48）, while gravity stress test had a sensitivity of 95.8%（46/48）, a specificity of 92.9%（13/14）, a positive predict value of 97.9%（46/47）, a negative predict value of 86.7%（13/15）, a false positive rate of 7.1%（1/14） and a false negative rate of 4.2%（2/48）. The consistency between the observers and kappa coefficient of both tests were above 90% and 0.75. Conclusion Both tap test and gravity stress test had excellent inter-rater reliability. Tap test is sensitive and easy to manipulate, and allows us to reduce radiation exposure. Although its false positive rate is relatively higher than gr

关 键 词：韧带 创伤和损伤 治疗结果 

分 类 号：R658.3[医药卫生—外科学]