高频超声与实时剪切波弹性成像诊断急性距腓前韧带损伤的临床价值

Clinical Value of High Frequency Ultrasound and Real Time Shear Wave Elastography in Diagnosis of Acute Anterior Talofibular Ligament Injury

目的:通过比较高频超声与实时剪切波弹性成像(SWE)在急性距腓前韧带损伤诊断中的诊断效能,探讨临床诊断该病的优势诊察手段。方法:收集2021年3月至2023年4月期间疑似踝关节急性距腓前韧带损伤患者80例,术前均给予高频超声及SWE超声弹性检查,将关节镜检查结果作为诊断的金标准,对比高频超声及SWE在急性距腓前韧带损伤中的诊断价值,采用受试者工作特征(ROC)曲线分析高频超声及SWE对急性距腓前韧带损伤的诊断效能。并对关节腔积液、距骨骨软骨损伤、肌腱损伤、骨折的检出率进行对比。结果:①80例患者经关节镜证实均有损伤,其中42例完全撕裂,35例部分撕裂,3例为韧带损伤;高频超声检查中47例完全撕裂,30例部分撕裂,3例韧带损伤。高频超声联合SWE检查中43例完全撕裂,35例部分撕裂,2例韧带损伤。②将关节镜检查结果作为金标准,借助SPSS软件进行一致性分析,一致性检验结果显示高频超声与关节镜诊断之间的一致性系数Kappa=0.644(P<0.001),且两者之间在Ⅰ级损伤(χ^(2)=0.000,P=1.000)、Ⅱ级损伤(χ^(2)=0.648,P=0.421)、Ⅲ级损伤(χ^(2)=0.633,P=0.426)中均无统计学差异。高频超声联合SWE与关节镜诊断之间的一致性系数Kappa=0.857(P<0.001),且两者之间在Ⅰ级损伤(χ^(2)=0.206,P=1.000)、Ⅱ级损伤(χ^(2)=0.000,P=1.000)、Ⅲ级损伤(χ^(2)=0.025,P=0.874)中均无统计学差异。③高频超声Ⅰ级损伤的曲线下面积(AUC)为0.827,高频超声联合SWEⅠ级损伤AUC为0.833,差异无统计学意义(P>0.05);高频超声Ⅱ级损伤AUC为0.802,高频超声联合SWEⅡ级损伤AUC为0.938,差异有统计学意义(P<0.05);高频超声Ⅲ级损伤AUC为0.831,高频超声联合SWEⅢ级损伤AUC为0.949,差异有统计学意义(P<0.05)。④高频超声与高频超声联合SWE在关节腔积液、距骨骨软骨损伤、肌腱损伤中的检出率无统计学差异(P>0.05);在骨折中的检出率有统计学差异(P<0.05)。结论:高频超声联合SWE在急性距腓前韧带损伤诊断中具有较高的临床价值,且对于损伤分级具有较高的判断力,也可用于判断踝关节合并性损伤。

Objective:To compare the diagnostic efficacy of high-frequency ultrasound(HFUS)and real-time shear wave elastography(SWE)in diagnosing acute anterior talofibular ligament(ATFL)injury and to explore the advantages of diagnostic methods for clinical diagnosis of the disease.Methods:A total of 80 patients with suspected acute ATFL injury of the ankle joint were collected from March 2021 to April 2023.All patients underwent HFUS and SWE ultrasound elastography examination before surgery.The arthroscopy examination results were used as the gold standard for diagnosis.The diagnostic value of HFUS and SWE in a-cute ATFL injury was compared,and the receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of HFUS and SWE for acute ATFL injury.The detection rates of joint effusion,talar cartilage injury,tendon injury,and fracture were also compared.Results:①All 80 patients were confirmed to have injuries by arthroscopy,including 42 cases of complete tear,35 cases of partial tear,and 3 cases of liga-ment injury.In the HFUS examination,there were 47 cases of complete tear,30 cases of partial tear,and 3 cases of ligament injury.In the HFUS combined with SWE examination,there were 43 cases of complete tear,35 cases of partial tear,and 2 cases of ligament injury.②Taking the arthroscopy examination results as the gold standard,the consistency analysis was performed using SPSS software.The consistency test results showed that the kappa coefficient of consistency between HFUS and arthroscopy diagnosis was 0.644(P<0.001),and there was no statistical difference between the two in I degree injury(χ^(2)=0.000,P=1.000),II degree injury(χ^(2)=0.648,P=0.421),and III degree injury(χ^(2)=0.633,P=0.426).The Kappa coefficient of consistency between HFUS combined with SWE and arthroscopy diagnosis was 0.857(P<0.001),and there was no statistical difference between the two in I degree injury(χ^(2)=0.206,P=1.000),II degree injury(χ^(2)=0.000,P=1.000),and III degree injury(χ^(2)=0.025,P=0.874).③The area under the curve(AUC)of HFUS for I degree injury was 0.827,and the AUC of HFUS combined with SWE for I degree injury was 0.833,with no statistical difference(P>0.05);the AUC of HFUS for II degree inju-ry was 0.802,and the AUC of HFUS combined with SWE for II degree injury was 0.938,with statistical difference(P<0.05);the AUC of HFUS for III degree injury was 0.831,and the AUC of HFUS combined with SWE for III degree injury was 0.949,with statistical difference(P<0.05).④There was no statistical difference in the detection rates of joint effusion,talar cartilage injury,and tendon injury between HFUS and HFUS combined with SWE(P>0.05);the detection rate of fracture was statistically different(P<0.05).Conclusion:HFUS combined with SWE has high clinical value in diagnosing acute ATFL injury,and it has high judgment ability for injury grading,and it can also be used to judge the combined injury of the ankle joint.