4种物理检查方法在前交叉韧带完全断裂诊断中的应用价值

Evaluation of four physical examinations in diagnosis of complete rupture of anterior cruciate ligament

目的·探讨4种物理检查方法在前交叉韧带完全断裂诊断中的应用价值。方法·对2016年7月11日—2017年6月10日100例因单侧膝关节外伤初诊怀疑膝关节韧带或半月板损伤而接受手术治疗患者的资料进行回顾性分析。患者均接受以下物理检查:Lachman试验、前抽屉试验、杠杆试验和轴移试验。以术中关节镜检查结果为金标准,对4种物理检查对于前交叉韧带完全断裂诊断的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、准确度等进行综合性分析。结果·经关节镜检查证实,100例患者中确诊为前交叉韧带完全断裂81例;对于前交叉韧带完全断裂的患者,前抽屉试验、杠杆试验、轴移试验、Lachman试验的灵敏度分别为87.7%、100.0%、97.5%、96.3%,特异度分别为84.2%、78.9%、73.7%、63.2%,阳性预测值分别为95.9%、95.3%、94.0%、91.8%,阴性预测值分别为61.5%、100.0%、87.5%、80.0%,准确度分别为87%、96%、93%、90%,阳性似然比分别为5.6、4.7、3.7、2.6,阴性似然比分别为0.1、0、0、0.1。结论·前抽屉试验确定前交叉韧带完全断裂最有效;杠杆试验排除前交叉韧带完全断裂最有效,且敏感性强,易于操作,对于新鲜、急性损伤及患肢肿胀肥胖患者更为适宜,其诊断价值较高。

Objective · To estimate the value of four physical examination methods in the diagnosis of anterior cruciate ligament complete rupture. Methods · A retrospective study was conducted on 100 patients who underwent surgical treatment for knee joint injury from July 11, 2016 to June 10, 2017. They received four physical examinations including Lachman test, anterior drawer test, lever sign test and pivot shift test. The results of the arthroscopy inspections were used as gold standard. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, accuracy and other parameter of four physical examinations were comprehensively discussed. Results · Arthroscopic examination confirmed that 81 patients had complete rupture of anterior cruciate ligament. The sensitivities of anterior drawer test, lever test, pivot shift test and Lachman test were 87.7%, 100.0%, 97.5% and 96.3%, and the specificities were 84.2%, 78.9%, 73.7% and 63.2%, respectively. The positive predictive values were 95.9%, 95.3%, 94.0% and 91.8%, while the negative predictive values were 61.5%, 100.0%, 87.5% and 80.0%, respectively. The accuracies were 87%, 96%, 93% and 90%, respectively. The positive likelihood ratios were 5.6, 4.7, 3.7 and 2.6, while the negative ones were 0.1, 0, 0 and 0.1, respectively. Conclusion · Anterior drawer test is the most effective in diagnosing the complete rupture of the anterior cruciate ligament, while lever sign test is the most effective in excluding one. Lever sign test is the most sensitive and easy to operate, especially for fresh bruise, acute injury, limb swelling and obesity, with high diagnostic value.