大骨节病踝关节距骨损伤特点及ROC曲线分析

Characteristics and ROC curve analysis of ankle injury in Kashin-Beck disease

目的探讨大骨节病患者踝关节距骨CT测量特点及其诊断的有效性指标。方法根据纳入和排除标准选择40例来自大骨节病病区踝关节疼痛患者,CT测量冠状位距骨内上-外下、外上-内下距离,矢状位距骨后上-前下、前上-后下距离,将差异具有统计学意义的径线纳入ROC曲线分析。结果踝关节距骨CT测量结果显示,大骨节病组踝关节距骨外上-内下距离、前上-后下距离分别低于骨性关节炎组[(3.76±0.34)cm vs.(4.26±0.34)cm、(4.98±0.36)cm vs.(5.40±0.37)cm],差异具有统计学意义(t=-3.599、4.646,P=0.001)。ROC曲线面积分析显示,中距骨外上-内下距离cut-off值为4.055时,灵敏度70%,特异度90%;前上-后下cut-off值为5.41时,灵敏度65%,特异度95%。结论大骨节病踝关节距骨冠状位外上-内下(cut-off值为4.055 cm)、矢状位前上-后下距离(cut-off值为5.41 cm)可作为成人大骨节病踝关节损害的特异度诊断指标。

Objective To investigate the characteristics of ankle talus by CT scanning in patients with Kashin-Beck disease.Methods We included 40 patients with ankle pain for this study.CT examination was carried out to measure talus diameter,i.e.,from the upper at inside to the lower at outside and from the upper at outside to the lower at inside in coronal direction;from the upper at front to the lower at behind,from upper at front to the upper at behind in sagittal direction.The statistically significant indexes were included in the ROC curve analysis.Results CT measurement of the talus in ankle joints showed that the distance of the talus in ankle joints from the upper at outside to the lower at inside(3.76±0.34)cm,the upper at front to the lower at behind(4.98±0.36)cm in KBD group were significantly lower than those in OA group(4.26±0.34)cm and(5.40±0.37)cm,which was significantly difference(t=-3.599,4.646,P=0.00).ROC curve analysis showed that there was significant difference between KBD group and OA group,and the cut-off value of the distance from the upper at outside to the lower at inside was 4.055cm,with sensitivity of 70%and specificity of 90%.When the cut-off value of the distance from the upper at front to the lower at behind was 5.41cm,the sensitivity was 65%and the specificity was 95%.Conclusion The distance of the talus of KBD ankle joints from the upper at outside to the lower at inside(cut-off value of 4.055 cm)in coronal direction and the upper at front to the lower at behind(cut-off value was 5.41 cm)in sagittal direction can be used as specific diagnostic indicators of ankle joint damage for KBD in adults.