MRI在踝关节骨折伴发韧带损伤诊断中的应用价值

Value of MRI in Diagnosis of Ankle Fracture Associated with Ligament Injury

目的探讨磁共振成像(MRI)在踝关节骨折伴发韧带损伤诊断中的应用价值。方法收集南昌大学第三附属医院2015年1月至2018年1月收治的踝关节骨折患者138例,按Ashurst和Bromer分型分为内收型32例、外展型47例、外旋型33例和垂直型26例。所有病例均行MRI检查,分析踝关节韧带、关节软骨损伤情况及关节腔积液积血发生情况,并与术中或关节镜下探查结果进行比较。结果138例踝关节骨折患者,MRI诊断韧带损伤83例,术中或关节镜下探查韧带损伤69例,MRI诊断准确率为83.13%(69/83),其中内收型、外展型、外旋型、垂直型韧带损伤MRI诊断准确率分别为83.33%(15/18)、83.33%(20/24)、85.71%(18/21)、80.00%(16/20);韧带损伤部位MRI诊断准确率为74.95%(74/99),其中内侧三角韧带损伤、外侧副韧带损伤、下胫腓联合韧带损伤准确率分别为71.88%(23/32)、85.37%(35/41)、61.54%(16/26)。83例手术患者,MRI预测术后创伤性关节炎发生率为10.84%(9/83),与随访12个月后的实际发生率13.25%(11/83)相比,差异无统计学意义(χ^2=0.802,P=0.350)。结论MRI能明确显示踝关节骨折韧带、关节软骨受损情况,指导临床制定完善的治疗计划,对术后关节修复的评估及预测严重并发症的发生有重要价值。

Objective To investigate the value of magnetic resonance imaging(MRI) in the diagnosis of ankle fracture associated with ligament injury. Methods According to the Ashurst and Bromer classification,138 patients treated in our hospital for ankle fracture between January 2015 and January 2018 were divided into four groups: adduction(32 cases),abduction(47 cases),extorsion(33 cases),and vertical(26 cases).MRI was performed to analyze the occurrence of articular ligament and cartilage injury and articular effusion.In addition,MRI findings were compared with intraoperative or arthroscopic results. Results Among the 138 patients,ligament injury was diagnosed by MRI in 83,and by intraoperative or arthroscopic exploration in 69.The total diagnostic accuracy of MRI was 83.13%(69/83).Furthermore,the diagnostic accuracy of MRI was 83.33%(15/18) for adduction type,83.33%(20/24) for abduction type,85.71%(18/21) for extorsion type,and 80.00%(16/20) for vertical type.The accuracy of MRI for diagnosing injured site was 74.95%(74/99).Moreover,the diagnostic accuracy of MRI was 71.88%(23/32) for medial triangular ligament injury,85.37%(35/41) for lateral collateral ligament injury,and 61.54%(16/26) for distal tibiofibular syndesmosis ligament injury.The incidence of postoperative traumatic arthritis predicted by MRI was 10.84%(9/83),which was not significantly different from the actual incidence measured after 12 months of follow-up(13.25%,11/83)(χ^2 =0.802, P =0.350). Conclusion MRI can clearly show the damage of ligament and cartilage in patients with ankle fracture.Therefore,it provides a useful guide for developing clinical treatment plan,and has important value in evaluating postoperative joint repair and predicting the occurrence of serious complications.