杠杆征在前交叉韧带损伤查体中的应用研究  

Application of lever sign in clinical diagnosis of anterior cruciate ligament injury

作　　者：范德超 杨国夫[1] 王焕[1] 

机构地区：[1]哈尔滨医科大学附属第一医院骨科,黑龙江哈尔滨150007

出　　处：《中国骨与关节损伤杂志》2018年第2期141-144,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨杠杆征在前交叉韧带(ACL)损伤临床查体中的敏感度和准确性。方法纳入本院自2014-07—2017-03行关节镜治疗的200例ACL损伤,根据损伤类型及损伤时间分为4组:A组(急性损伤期,ACL完全损伤),B组(慢性损伤期,ACL完全损伤),C组(急性损伤期,ACL部分损伤),D组(慢性损伤期,ACL部分损伤)。比较4组杠杆征、Lachman试验、前抽屉试验、轴移试验的阳性率。结果麻醉前后A、C、D组4种诊断方法的阳性率差异有统计学意义(P<0.05),而B组(慢性完全损伤)4种诊断方法的阳性率差异无统计学意义(P>0.05)。进一步两两比较,无论是在麻醉前还是麻醉后,A、C、D组中杠杆征阳性率均高于其他3种方法,差异有统计学意义(P<0.05)。麻醉后A、C、D组杠杆征阳性率均高于麻醉前,差异有统计学意义(P<0.05)。结论杠杆征在ACL损伤查体时的敏感度较Lachman试验、前抽屉试验、轴移试验更高,受损伤类型与损伤时间的影响较小,并且麻醉状态下杠杆征查体可以获得更准确的阳性率。Objective To explore the sensitivity and accuracy of the lever sign in the anterior cruciate ligament （ACL） injury. Methods Two hundred cases of ACL injury under arthroscopic treatment were selected in our hospital from July 2014 to March 2017. According to the type and time of the injury, all cases were divided into four groups： group A （acute injury, completed ACL injury）, group B （chronic injury, completed ACL injury）, group C （acute injury, partial ACL injury）, group D （chronic injury, partial ACL injury）. The positive rate of the 4 manual tests： lever sign, Lachman test, anterior drawer test and pivot shift test were compared. Results In group A, C and D, the differences in positive rate of the 4 manual tests were statistically significant before and after anesthesia （P 〈0.05）. The difference in positive rate of the four manual tests in the group B had no statistical significance （P 〉0.05）. Furthermore, the positive rates of the lever sign in the group A, C and D were higher than that in the other three tests before and after anesthesia, and the difference was statistically significant （P 〈 0.05）. After anesthesia, the positive rate of the lever sign was higher than before anesthesia in the group A, C and D, and the difference was statistically significant （P 〈0.05）. Conclusion The sensitivity of the lever sign is higher than that of Laehman test, anterior drawer test and pivot shift test in diagnosing ACL injury, and it is less affected by the injury＇s type and time. In addition, under anesthesia, a more accurate positive rate could be obtained.

关 键 词：前交叉韧带损伤 杠杆征 Lachman试验 前抽屉试验 轴移试验 阳性率 

分 类 号：R686.5[医药卫生—骨科学]