高频超声诊断下胫腓联合损伤的应用价值

High frequency ultrasound in diagnosis of distal tibiofibular syndesmosis injury

目的通过对比X线、高频超声、MRI及手术探查对诊断下胫腓联合损伤的差异,探讨高频超声诊断下胫腓联合损伤的应用价值。方法本试验为诊断性试验,共纳入61例采取切开复位钢板螺钉内固定术治疗闭合性有移位的踝关节骨折患者,术中常规对下胫腓联合进行探查。术前均常规做踝关节正侧位X线、高频超声及MRI扫描,共有三名医生分别评价下胫腓联合损伤情况,第四名医生进行手术探查,并将探查结果与前三名医生的评价结果进行统计学分析。结果本研究中高频超声与X线相比,在诊断下胫腓联合损伤时,敏感性、特异性、准确度都优于X线(P<0.05),与MRI比较,敏感性、特异性、准确度差异都无统计学意义(P>0.05)。X线的Kappa指数为0.412,说明与手术探查结果相比有中度一致性。高频超声的Kappa指数为0.621,说明与手术探查结果相比有较高一致性;MRI扫描的Kappa指数为0.714,与手术探查结果相比一致性较高。结论高频超声与MRI对诊断下胫腓联合损伤同样有着较高的真实性和可靠性,能够提供重要的临床参考价值,同时高频超声具有费用低廉、便于操作、快捷优势,成为诊断下胫腓联合损伤值得推广的方法。

Objective To explore the application value of high frequency ultrasound in diagnosis of distal tibiofibular syndesmosis injury by comparing the examination results among X-ray,high frequency ultrasound,MRI and operative exploration. Methods This test is a diagnostic test.Sixty-one patients with closed displaced ankle fracture received open reduction with plate and screw internal fixation,routine exploration of inferior tibiofibular joint was performed during operation.Preoperative routine ankle lateral X-ray,high frequency ultrasound and MRI scanning were performed,three doctors evaluated syndesmosis injuries separately,the fourth doctor carried out operation exploration,and the evaluation of operative exploration results were compared with the three doctors assessment and statistical analysis was performed. Results In this study,compared high frequency ultrasound with X-ray in diagnosing distal tibiofibular syndesmosis injury,the sensitivity,specificity,accuracy was superior to X-ray plain film（P〈0.05）;the comparison of sensitivity,specificity and accuracy between high frequency ultrasound with MRI yielded no statistically significant differences（P〉0.05）.X-ray Kappa index was 0.412,which had moderate consistency with operation results.High frequency ultrasound Kappa index was 0.621,which had high consistency with operation results;MRI scan of the Kappa index was 0.714,which had high consistency with the operation results. ConclusionThe results showed that high frequency ultrasound has the same facticity and reliability as MRI in diagnosis of distal tibiofibular syndesmosis injury,which can provide important clinical references for physicians.High frequency ultrasound is worthy of popularization in diagnosis of distal tibiofibular syndesmosis for its low cost,convenient operation and fast results.