Fagan D J, Davies S
Department of Radiology, Royal Glamorgan Hospital, Ynys Maerdy, UK.
Injury. 2000 Nov;31(9):723-7. doi: 10.1016/s0020-1383(00)00075-9.
to assess the key symptoms and physical signs in the acutely injured knee that are significantly associated with fracture and utilise these to develop an algorithm for the use of radiography in acute knee trauma.
retrospective review of all acute knee injuries presenting to the accident and emergency unit at a District General Hospital over a 6-month period in 1998 (over 500 cases). After exclusions, a study group of 370 eligible adults was obtained. These patients were reviewed for the key symptoms and physical signs, and radiological evidence of fracture.
the X-ray films were interpreted by a consultant radiologist. Of those patients on whom radiographs were not performed, follow up was assessed by a review of any re-attendance to the A&E department.
there was a statistically significant correlation, using chi-square (Mantel-Haentzel) and linear regression analysis, between the presence of a fracture and each of the following variables: age, non-weightbearing in the department (p<0.05), haemarthrosis, point bony tenderness, effusion (p<0.001).
these key symptoms and physical signs may form the basis of an algorithm for examining knees radiologically, with acceptable positive and negative predictive values. (This is currently being tested prospectively).
评估急性膝关节损伤中与骨折显著相关的关键症状和体征，并利用这些来制定急性膝关节创伤时使用X线摄影的算法。
回顾性分析1998年某地区综合医院急诊室6个月内收治的所有急性膝关节损伤病例（超过500例）。排除相关病例后，得到一个由370名符合条件的成年人组成的研究组。对这些患者进行关键症状、体征及骨折的影像学证据检查。
X线片由放射科会诊医师解读。对于未进行X线检查的患者，通过复查其再次到急诊科就诊的情况来评估随访结果。
采用卡方（曼特尔-亨泽尔）检验和线性回归分析，结果显示骨折的存在与以下各变量之间存在统计学显著相关性：年龄、在科室不能负重（p<0.05）、关节积血、骨压痛、关节积液（p<0.001）。
这些关键症状和体征可为膝关节X线检查算法提供依据，其阳性和阴性预测值均可接受。（目前正在进行前瞻性测试）
