Ottawa足踝准则在急性足踝损伤X线检查中的临床意义

Clinical significance of Ottawa Ankle Rules in the X-ray examination for patients suffering acute foot and ankle injuries

目的分析OAR指导急性足踝损伤患者接受X线检查的敏感性、特异性。方法 734例急性足踝损伤患者(足355例,踝379例),根据OAR判断患者是否需行X线检查,根据X线检查结果验证OAR敏感性、特异性。结果经X线检查后骨折患者99例,其中踝部骨折56例,占14.8%,足部骨折43例,占12.1%。734例患者中经OAR评估阳性行X片检查者424例(踝241例、足183例),减少临床阴性摄片率42.2%。OAR在踝部损伤组中敏感性100%,特异性42.7%,阳性预测值23.2%,准确率51.2%。OAR在足损伤检查中的敏感性100%,特异性55.1%,阳性预测值23.4%,准确率60.6%。结论科学使用OAR降低阴性摄片率,降低医疗成本,减少非必要的X线暴露。

Objective To evaluate the sensitivity and specificity of the OAR in the guidance of X-ray determination for patients suffering acute ankle and foot injuries. Methods The OAR was applied to 734 cases,including 379 injuries of ankle,355 of foot. The outcomes of OAR,x-ray diagnosis were collected for evaluations.From these data the sensitivity,specificity,positive and negative likelihood ratios,and positives and negative predictive values were calculated.Results There were 99 cases of fracture after X-ray examination,of which 56 cases of ankle fracture,accounting for 14. 8%,43 of foot fracture,accounting for 12. 1%. Of the 734 patients,424 were examined by X-ray examination after OAR guidance（ ankle 241,foot 183）,reduced clinical negative film rate by 42. 2%. The sensitivity,specificity and positive predictive value of clinical negative radiographs in ankle injury were 100%,42.7%,and 23.2%,accuracy rate was 51.2%. The sensitivity,specificity,positive predictive value and accuracy were 100%,55.1%,23.4% and 60.6% in foot injuries,respectively.Conclusions Scientific use of OAR can reduce negative radiography rates,reduce medical costs,and reduce non-essential X-ray exposures