超声评估踝关节骨折患者距腓前韧带及下胫腓前韧带远侧束损伤的价值  

Diagnostic value of ultrasonography for injury of anterior talofibular ligament and anterior inferior tibiofibular ligament distal fascicle in patients with ankle fractures

作　　者：吕盼盼[1] 刘超[2] 李世岩[1] LYU Panpan;LIU Chao;LI Shiyan(Department of Ultrasound,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;Department of Orthopedics,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院超声科,浙江杭州310016 [2]浙江大学医学院附属邵逸夫医院骨科,浙江杭州310016

出　　处：《浙江大学学报（医学版）》2024年第4期411-418,共8页Journal of Zhejiang University(Medical Sciences)

摘　　要：目的:探讨超声在评估踝关节骨折患者距腓前韧带(ATFL)及下胫腓前韧带远侧束(ATiFL-DF)损伤中的应用价值。方法:收集2019年4月至2023年3月在浙江大学医学院附属邵逸夫医院因踝关节骨折就诊,临床怀疑韧带损伤,术前行踝关节超声检查,并予以踝关节镜探查的患者。以踝关节镜下检查结果为诊断金标准,评估韧带损伤分级,统计分析超声诊断ATFL及ATiFL-DF损伤的敏感度、特异度、阳性预测值和阴性预测值,并行Kappa一致性检验。结果:共收集病例51例。超声诊断ATFL损伤的敏感度和特异度分别为100.0%和92.3%,阳性预测值为92.6%,阴性预测值为100.0%,超声与踝关节镜检查结果一致性佳(kappa=0.849)。超声诊断ATiFL-DF损伤的敏感度和特异度分别为86.7%和33.3%,阳性预测值为90.7%,阴性预测值为25.0%,超声与踝关节镜检查结果一致性差(kappa=0.168)。结论:超声检查是评价踝关节骨折患者ATFL损伤的可靠的检查方式,但对ATiFL-DF损伤的评估特异性较差,因此ATiFL-DF损伤超声检查阴性的踝关节骨折患者仍有必要行踝关节镜检查。Objective:To explore the diagnostic value of ultrasonography for injuries of anterior talofibular ligament(ATFL)and anterior inferior tibiofibular ligament distal fascicle(ATiFL-DF)in patients with ankle fractures.Methods:Clinical data of 51 patients with ankle fractures who were clinically suspected of ligament injuries and underwent ankle ultrasonography examination and arthroscopy in Sir Run Run Shaw Hospital,Zhejiang University School of Medicine from April 2019 to March 2023 were retrospectively analyzed.Using arthroscopic results as the gold standard,the sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)of ultrasonography in diagnosing ATFL and ATiFL-DF injuries were evaluated,and Kappa consistency test was performed.Results:The sensitivity and specificity of ultrasonography in diagnosis of ATFL injury were 100.0%and 92.3%,with the PPV of 92.6%and NPV of 100.0%.Ultrasonography findings exhibited excellent concordance with arthroscopic results(kappa=0.849).The sensitivity and specificity of ultrasonography in diagnosis of ATiFL-DF injury was 86.7%and 33.3%,with the PPV of 90.7%and NPV of 25.0%.However,the consistency between ultrasonography and arthroscopic results was poor(kappa=0.168).Conclusions:Ultrasonography is reliable in assessing injuries of ATFL in patients with ankle fractures,but its specificity in diagnosing ATiFL-DF is poor.Therefore,ankle arthroscopy remains necessary for ankle fracture patients with negative findings of ATiFL-DF in ultrasonography.

关 键 词：距腓前韧带 下胫腓前韧带远侧束 超声检查 关节镜检查 诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R648[医药卫生—诊断学]