MRI在下胫腓联合损伤术前诊断及胫腓联合复位内固定术后疗效评估中的应用价值观察

Application Value of MRI in Preoperative Diagnosis of Distal Tibiofibular Syndesmosis Injuries and Evaluation of Curative Effect after Reduction and Internal Fixation of the Tibiofibular Syndesmosis

目的探讨MRI在下胫腓联合损伤术前诊断及胫腓联合复位内固定术后疗效评估中的应用价值。方法选取2018年1月至2019年4月我院收治的闭合性踝关节骨折患者62例,术前均接受X线和MRI检查诊断有无合并下胫腓联合损伤,分析其影像学特征。进行切开复位内固定手术,并以手术探查结果作为诊断“金标准”。术后6个月复查X线和MRI评估患者预后。结果62例患者经手术探查,其中44例患者存在下胫腓联合损伤。X线诊断的灵敏度为59.09%,特异度为66.67%,准确度为61.29%,Kappa值为0.215,与手术探查的一致性较差。MRI诊断的灵敏度为100.00%,特异度为88.89%,准确度为96.77%,Kappa值为0.919,与手术探查具有高度一致性。MRI诊断下胫腓联合损伤的准确度明显高于X线(P<0.05)。MRI影像学特征表现为下胫腓联合韧带撕裂,T2W1序列、脂肪抑制图像均表现为片状高信号。术后6个月复查MRI,均呈低信号。预后优20例,良24例,治疗后踝关节评分(90.22±6.35)明显高于治疗前的(75.36±9.15)分(P<0.05)。结论MRI诊断下胫腓联合损伤的准确度高,在术前诊断及术后疗效评估中具有重要价值。

Objective To investigate the application value of MRI in the preoperative diagnosis of distal tibiofibular syndesmosis injuries and the evaluation of curative effect after reduction and internal fixation of the tibiofibular syndesmosis.Methods 62 patients with closed ankle fractures admitted to the hospital between January 2018 and April 2019 were selected.All the subjects were examined with X-ray and MRI before surgery to diagnose whether there were distal tibiofibular syndesmosis injuries,and the imaging features were analyzed.The subjects were treated with open reduction and internal fixation.With the result of surgical exploration as the diagnostic golden standard,the value of X-ray and MRI in the evaluation of the prognosis 6 months after surgery was assessed.Results 62 patients underwent surgical exploration,and 44 of them had distal tibiofibular syndesmosis injuries.The sensitivity,specificity,accuracy,and Kappa value of X-ray diagnosis were 59.09%,66.67%,61.29%,and 0.215,with poor inconsistency with surgical exploration.The sensitivity,specificity,accuracy,and Kappa value of MRI diagnosis were 100.00%,88.89%,96.77%,and 0.919,with high consistency with surgical exploration.The accuracy of MRI was significantly higher than that of X-ray for diagnosis of distal tibiofibular syndesmosis injuries(P<0.05).MRI findings showed torn ligament of the distal tibiofibular syndesmosis.T2W1 sequence and fat suppression images all showed a patchy high signal.MRI reexamination at 6 months after surgery showed a low signal.The prognosis was excellent in 20 cases and good in 24 cases.The ankle joint score after treatment(90.22±6.35)was significantly higher than that before treatment(75.36±9.15)(P<0.05).Conclusion The accuracy of MRI in the diagnosis of distal tibiofibular syndesmosis injuries is higher,and it is of great value in preoperative diagnosis and postoperative evaluation of curative effect.