三种特殊物理检查诊断前交叉韧带完全断裂价值评价

The Diagnostic Value of Three Special Physical Tests for Anterior Cruciate Ligament Rupture

目的：比较并评价三种特殊物理检查在前交叉韧带完全断裂诊断中的价值。方法：回顾性分析2005年8月～2006年4月因单侧膝关节外伤、初诊怀疑为单纯膝关节韧带断裂或伴有半月板损伤而需入院手术的患者115例，入院时分别行三种特殊物理检查：前抽屉试验、Lachman试验、轴移试验。并于3日内对所有患者行关节镜检查。以关节镜检查结果为金标准，通过临床流行病学方法对三种物理检查诊断前交叉韧带完全断裂的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、准确度进行比较和评价。结果：经关节镜检查证实，115例患者中确诊为前交叉韧带完全断裂的41例；前抽屉试验、Lachman试验、轴移试验三种物理检查的灵敏度分别为43．9％、90．2％、70．7％，特异度分别为90．5％、90．5％、95．9％，阳性预测值分别为72．0％、84．1％、90．6％，阴性预测值分别为74．4％、94．4％、85．5％，准确度分别为73．9％、90．4％、87．0％，阳性似然比分别为4．62、9．49、17．24，阴性似然比分别为0．62、0．11、0．31。结论：总体看，Lachman试验对诊断前交叉韧带完全断裂具有更高的诊断价值。从单方面看，轴移试验确定前交叉韧带完全断裂最有效，Lachman试验排除前交叉韧带完全断裂最有效。

Objective To compare and evaluate the diagnostic value of three special physical tests for complete rupture of anterior cruciate ligament （ACL）. Methods Retrospective review was performed in 115 cases, which were diagnosed as ligament or menisci injury in unilateral knee and admitted for surgery from Aug. 2005 to Apr. 2006. Before surgery, all injured knee laxity was examined by the anterior drawer test （ADT）, the Lachman test and the pivot shift test （PST）. Within 3 days after hospitalization, arthroscopic surgery was performed in all cases. Result of arthroscopy was used as a gold standard for defining ACL complete rupture. The sensitivity （Se）, specificity （Sp）,positive predictive value （PPV）, negative predictive value （NPV）, accuracy（n）, positive likelihood among the three tests were evaluated and compared. Results There were 41 cases with ACL complete rupture in 115 cases determined by arthroscopy. The Se, Sp, PPV, NPV, positive likelihood ratio （PLR）, and negative likelihood ratio （NLR） of the three tests were 43.9%, 90.2% and 70.7%, respectively; 90.5%, 90.5% and 95.9%, respectively; 72.0%, 84.1% and 90.6%, respectively; 74.4%, 94.4% and 85.5%, respectively; 73.9%, 90.4% and 87.0%, respectively; 4.62, 9.49 and 17. 24, respectively; and 0.62, 0.11 and 0.31, respectively. Conclusion For the diagnosis of ACL complete rupture, the Lachman test revealed a higher value. At the same time, positive pivot shift test was the effective test for determining complete rupture of ACL, and negative Lachman test was the effective test for ruling out complete rupture of ACL.