CAJ | 학술논문

目的：通过对比 X 线、高频超声、MRI 及手术探查对诊断下胫腓联合损伤的差异，探讨高频超声诊断下胫腓联合损伤的应用价值。方法本试验为诊断性试验，共纳入61例采取切开复位钢板螺钉内固定术治疗闭合性有移位的踝关节骨折患者，术中常规对下胫腓联合进行探查。术前均常规做踝关节正侧位 X 线、高频超声及 MRI 扫描，共有三名医生分别评价下胫腓联合损伤情况，第四名医生进行手术探查，并将探查结果与前三名医生的评价结果进行统计学分析。结果本研究中高频超声与 X 线相比，在诊断下胫腓联合损伤时，敏感性、特异性、准确度都优于 X 线（P ＜0．05），与MRI 比较，敏感性、特异性、准确度差异都无统计学意义（P ＞0．05）。X 线的 Kappa 指数为0．412，说明与手术探查结果相比有中度一致性。高频超声的 Kappa 指数为0．621，说明与手术探查结果相比有较高一致性；MRI 扫描的 Kappa 指数为0．714，与手术探查结果相比一致性较高。结论高频超声与 MRI 对诊断下胫腓联合损伤同样有着较高的真实性和可靠性，能够提供重要的临床参考价值，同时高频超声具有费用低廉、便于操作、快捷优势，成为诊断下胫腓联合损伤值得推广的方法。
목적：통과대비 X 선、고빈초성、MRI 급수술탐사대진단하경비연합손상적차이，탐토고빈초성진단하경비연합손상적응용개치。방법본시험위진단성시험，공납입61례채취절개복위강판라정내고정술치료폐합성유이위적과관절골절환자，술중상규대하경비연합진행탐사。술전균상규주과관절정측위 X 선、고빈초성급 MRI 소묘，공유삼명의생분별평개하경비연합손상정황，제사명의생진행수술탐사，병장탐사결과여전삼명의생적평개결과진행통계학분석。결과본연구중고빈초성여 X 선상비，재진단하경비연합손상시，민감성、특이성、준학도도우우 X 선（P ＜0．05），여MRI 비교，민감성、특이성、준학도차이도무통계학의의（P ＞0．05）。X 선적 Kappa 지수위0．412，설명여수술탐사결과상비유중도일치성。고빈초성적 Kappa 지수위0．621，설명여수술탐사결과상비유교고일치성；MRI 소묘적 Kappa 지수위0．714，여수술탐사결과상비일치성교고。결론고빈초성여 MRI 대진단하경비연합손상동양유착교고적진실성화가고성，능구제공중요적림상삼고개치，동시고빈초성구유비용저렴、편우조작、쾌첩우세，성위진단하경비연합손상치득추엄적방법。
Objective To explore the application value of high frequency ultrasound in diagnosis of distal tibiofibular syndesmosis injury by comparing the examination results among X- ray,high frequency ultra-sound,MRI and operative exploration. Methods This test is a diagnostic test.Sixty- one patients with closed displaced ankle fracture received open reduction with plate and screw internal fixation,routine explora-tion of inferior tibiofibular joint was performed during operation.Preoperative routine ankle lateral X- ray, high frequency ultrasound and MRI scanning were performed,three doctors evaluated syndesmosis injuries sep-arately,the fourth doctor carried out operation exploration,and the evaluation of operative exploration results were compared with the three doctors assessment and statistical analysis was performed. Results In this study,compared high frequency ultrasound with X-ray in diagnosing distal tibiofibular syndesmosis injury, the sensitivity,specificity,accuracy was superior to X-ray plain film (P <0.05);the comparison of sensitivi-ty,specificity and accuracy between high frequency ultrasound with MRI yielded no statistically significant differences (P >0.05).X-ray Kappa index was 0.412,which had moderate consistency with operation re-sults.High frequency ultrasound Kappa index was 0.621,which had high consistency with operation results;MRI scan of the Kappa index was 0.714,which had high consistency with the operation results. Conclusion The results showed that high frequency ultrasound has the same facticity and reliability as MRI in diagnosis of distal tibiofibular syndesmosis injury,which can provide important clinical references for physicians.High fre-quency ultrasound is worthy of popularization in diagnosis of distal tibiofibular syndesmosis for its low cost, convenient operation and fast results.