快速诊断规则在诊断青年踝关节扭伤是否合并骨折的临床价值探讨

The clinical application value of Ottawa ankle rules in diagnosis of the existence of fracture in young patients with ankle sprain

目的探讨快速诊断规则（Ottawa ankle rules,OAR）在诊断青年踝关节扭伤合并骨折中的准确性,并评估其对隐匿性骨折的临床实用价值。方法选择2010年6月~2014年12月就诊的足踝扭伤患者93例,其中男性78例,女性15例;年龄19~26岁,平均23.4岁。所有患者首先采用OAR检查,均接受足踝X线检查,结果阴性症状较重者行CT检测。结果 93例患者中OAR阳性者38例,影像学结果显示36例患者伴有骨折（X线确诊34例,CT确诊2例）,4例OAR阴性而疼痛持续,X线确诊伴有骨折。总体敏感性、特异性、阳性诊断率和阴性诊断率分别为85.7%、100.0%、89.5%、92.7%。结论 OAR规则在急性踝关节损伤相关的骨折诊断中敏感性和特异性均较高,且可能检测X线不可见的隐匿性骨折。

Objective To explore the accuracy of Ottawa ankle rules （ OAR） in the diagnosis of fracture in young patients with ankle sprain , and evaluate its clinical significance in occult fracture .Methods Ninety-three patients with ankle sprain were selected from Affiliated Hospital of Traditional Chinese Medicine of Southwest Medi -cal University between Jun .2010 and Dec.2014.There were 78 males and 15 females,with age ranging from 19 to 26 years（mean,23.4 years）.All patients were detected with OAR and ankle X-ray,and patients with severe nega-tive symptoms by X-ray received CT scan.Results Among the 93 patients,38 cases were positive for OAR,and imaging results showed that 36 cases were accompanied with fracture （34 cases diagnosed by X-ray and 2 cases by CT）,4 cases with negative symptoms and continuous pain were diagnosed as fracture by X-ray.The overall sensitivi-ty,specificity,positive diagnostic rate and negative diagnostic rate were 85.7%,100.0%,89.5%,92.7%,respec-tively. Conclusion OAR shows a high sensitivity and specificity in the diagnosis of acute ankle joint injury-relat-ed fracture,and they may detect occult fracture which is invisible by X-ray.