摘要
[目的]探讨CT扫描在下胫腓联合损伤中的诊断价值,为下胫腓联合损伤的早期诊断提供最佳诊断方法。[方法]2009年1月～2012年9月72例踝部闭合性骨折的患者,均符合手术指征并愿意接受手术,男40例,女32例,年龄20～65岁,平均39.2岁。所有手术采用切开复位及内固定,术中行常规探查以明确是否存在下胫腓联合损伤,术中探查下胫腓联合是否损伤作为诊断的金标准。术前均常规行踝关节CT扫描和X线片以评价下胫腓联合是否损伤,再将影像学评价结果与手术探查结果进行统计学比较分析。[结果]术中探查发现49例存在下胫腓联合损伤,23例无下胫腓联合损伤。影像学检查与术中探查结果相比较,术前X线诊断为下胫腓联合损伤的真阳性、真阴性、假阳性、假阴性分别是26、14、9、23例,敏感性50.06%、特异性60.87%、准确度55.56%。术前CT扫描诊断下胫腓联合损伤的真阳性、真阴性、假阳性、假阴性分别是44、21、2、5例,敏感性89.80%、特异性91.30%、准确度90.28%,CT扫描与X线片相比,在诊断下胫腓联合损伤中有明显差异(P<0.01)。[结论]单纯依靠X线片诊断下胫腓联合损伤是不可靠的,CT扫描与X线相比,可以减少误诊和漏诊,提高诊断的真实性、可靠性,能够提供重要的临床参考价值。
[ Objective ] To evaluate the application of computed tomographic （CT） scanning in diagnosing distal tibiofibular syndesmosis injury and provide an effective method for early clinical diagnosis. [ Method ] From January 2009 to September 2012,72 patients with closed ankle fractures ,who were indicated for operative stabilization ,were treated by using open reduction and internal fixation. There were 40 male patients and 32 female patients with a mean age of 39.2 years（ range,20-65 years）. The tibiofibular syndesmosis was intraoperatively explored by using the conventional method, and the results were used as the gold standard to evaluate the diagnostic value of radiography and CT scanning in the present study. Radiography and CT scans were performed on all patients preoperatively, and the condition of the distal tibiofibular syndesmosis was evaluated independent-ly. The evaluation results of radiographsand CT scan images were compared with the corresponding results of surgical explora- tion. The results of each diagnostic test were also evaluated and statistically analyzed. [ Result] After surgical exploration of the distal tibiofibular syndesmosis,49 patients were diagnosed with an injury, whereas 23 patients did not have any injury. The find- ings of distal tibiofibular syndesmosis injury on plain radiographs were positive in 26 cases, negative in 14 cases ,falsely positive in 9 cases, and falsely negative in 23 cases. In addition, the findings of distal tibiofibular syndesmosis injury on CT scanning were positive in 44 cases, negative in 21 cases, falsely positive in 2 cases, and falsely negative in 5 cases. When compared with surgi-cal exploration, radiography had a sensitivity of 50.06% , specificity of 60.87 %, and accuracy of 55.56%, whereas CT scanning had a sensitivity of 89.80% ,specificity of 91.30% ,and accuracy of 90.28% ,in the diagnosis of distal tibiofibular syndesmosis injury,these values were significantly different between the methods（P 〈0.01 ）. [ Conclusion] Conventional radiography is not a reliable method for assessing distal tibiofibular syndesmosis injury. However, CT scan is a more reliable and valid method, and it provides an important reference point.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2013年第20期2015-2018,共4页
Orthopedic Journal of China
关键词
下胫腓联合损伤
X线片
CT扫描
踝部骨折
distal tibiofibular syndesmosis injury, radiographs, CT scan, ankle fractures
