| 摘要: |
| 目的 探讨应用肌骨超声在诊断空降兵急性距腓前韧带损伤及评估其预后的临床应用价值。方法 选取2021年1月-2023年1月在中部战区总医院就诊的120例因空降军事训练所致的疑似急性距腓前韧带损伤患者,均行肌骨超声及核磁共振(MRI)踝关节检查。以MRI为参照标准,利用Kappa分析肌骨超声与参照标准的一致性。所有患者均于治疗前后行肌骨超声及MRI测量距腓前韧带(ATFL)厚度,随访6~8周,采用美国足与踝关节协会(AOFA)评分进行预后评估,分析ATFL厚度与预后的关系,并采用ROC曲线分析肌骨超声及MRI对预后的评估价值。结果 MRI确诊114例急性距腓前韧带损伤,其中Ⅰ级36例,Ⅱ级32例(轻度12例,重度20例),Ⅲ级46例。手术证实66例(重Ⅱ级20例、Ⅲ级46例)。肌骨超声诊断急性距腓前韧带损伤112例,确诊Ⅰ级36例,Ⅱ级30例(轻度10例,重度20例),Ⅲ级46例。灵敏度为98.25%,特异度为83.33%,准确度为97.50%,kappa值为0.756。肌骨超声病情分级诊断结果与参照标准比较无差异(P>0.05)。据AOFA评分评估,纳入预后优良组92例,预后不佳组22例。治疗前,两组ATFL厚度比较无统计学差异(P>0.05),治疗后,预后优良组ATFL厚度均低于预后不佳组(P<0.05)。肌骨超声和MRI检测ATFL厚度对评估距腓前韧带损伤预后均具有较好的临床应用价值,且两者AUC比较无差异(P>0.05)。结论 空降兵在空降军事训练中所致的距腓前韧带损伤以Ⅲ级为主,肌骨超声对距腓前韧带损伤诊断与MRI及术中探查的一致性较好,测量ATFL厚度对评估患者预后具有一定的临床应用价值。 |
| 关键词: 空降 急性 预后 距腓前韧带损伤 肌骨超声 |
| DOI： |
| 投稿时间：2023-10-16修订日期：2023-11-22 |
| 基金项目: |
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| Clinical manifestation, diagnosis and prognosis evaluation of high-frequency musculoskeletal ultrasound in airborne troops with lateral collateral ligament injury of ankle joint |
| lianghao,durui,mufeng,yangli |
| () |
| Abstract: |
| Objective To observe the clinical manifestations of airborne troops with lateral collateral ligament injury of ankle joint, and to explore the diagnosis and prognosis evaluation value of high-frequency musculoskeletal ultrasound. Methods A total of 120 patients with suspected lateral collateral ligament injury of ankle joint caused by airborne training in General Hospital of PLA Central Theater were enrolled between January 2021 and January 2023. The clinical manifestations of patients were observed, and all completed examinations of high-frequency musculoskeletal ultrasound and magnetic resonance imaging (MRI). Taking MRI or intraoperative exploration as reference standards, the consistency between high-frequency ultrasound and the reference standards was analyzed by Kappa consistency test. All patients were followed up for 6-8 weeks. The prognosis was evaluated by scores of American Foot and Ankle Association (AOFA). The relationship between measurement parameter [anterior talofibular ligament (ATFL) thickness] and prognosis was analyzed. Results It was confirmed by MRI or intraoperative exploration that there were 114 cases with lateral collateral ligament injury of ankle joint, including 36 cases at grade I, 32 cases at grade II (12 mild cases, 20 severe cases) and 46 cases at grade III. The sensitivity, specificity, accuracy and kappa value of high-frequency ultrasound in the diagnosis of lateral collateral ligament injury of ankle joint were 98.25%, 83.33%, 97.50% and 0.756, respectively. There was no significant difference in diagnosis results of disease severity grading between high-frequency ultrasound and the reference standards (P>0.05). According to AOFA scores, there were 92 cases in good prognosis group and 22 cases in poor prognosis group. After treatment, ATFL thickness in good prognosis group was thinner than that in poor prognosis group (P<0.05). ATFL thickness measured by high-frequency ultrasound and MRI was of good prognostic value in lateral collateral ligament injury of ankle joint, but there was no significant difference in AUC between the two methods (P>0.05). Conclusion The main grading of lateral collateral ligament of ankle joint caused by airborne training is grade III in airborne troops. The consistency between high-frequency ultrasound and intraoperative exploration is good in the diagnosis of lateral collateral ligament injury of ankle joint, and which has certain prognostic value. |
| Key words: Military training Lateral collateral ligament injury of ankle joint High-frequency musculoskeletal ultrasound Diagnosis Prognosis evaluation Clinical value |
