Springer B A, Arciero R A, Tenuta J J, Taylor D C
Department of Physical Therapy and Orthopaedics, Keller Army Community Hospital, West Point, New York USA.
Am J Sports Med. 2000 Nov-Dec;28(6):864-8. doi: 10.1177/03635465000280061501.
To determine the necessity of ankle and foot radiographs, we used modified Ottawa Ankle Rules to evaluate all cadets seen with an acute ankle or midfoot injury at the United States Military Academy. This scoring system determines the need for radiographs. Each patient was independently examined and the decision rules were applied by a physical therapist and an orthopaedic surgeon. Ankle and foot radiographs were obtained for all subjects. Sensitivity, specificity, and the positive predictive value were calculated in 153 patients. There were six clinically significant ankle fractures and three midfoot fractures, for a total incidence of 5.8%. For physical therapists, the sensitivity was 100%, the specificity for ankle injuries was 40%, and the specificity for foot injuries was 79%. For orthopaedic surgeons, the sensitivity was also 100%, the specificity for ankle injuries was 46%, and the specificity for foot injuries was 79%. Interobserver agreement between the orthopaedic surgeons and physical therapists regarding the overall decision to obtain radiographs was high, with a kappa coefficient value of 0.82 for ankle injuries and 0.88 for foot injuries. There were no false-negative results. Use of the modified Ottawa Ankle Rules would have reduced the necessity for ankle and foot radiographs by 46% and 79%, respectively.
为了确定踝关节和足部X线片检查的必要性，我们采用改良渥太华踝关节规则，对美国军事学院所有因急性踝关节或中足损伤前来就诊的学员进行评估。该评分系统可确定是否需要进行X线片检查。每位患者均由物理治疗师和骨科医生独立进行检查并应用决策规则。所有受试者均拍摄了踝关节和足部X线片。对153例患者计算了敏感度、特异度和阳性预测值。共有6例具有临床意义的踝关节骨折和3例中足骨折，总发生率为5.8%。对于物理治疗师，敏感度为100%，踝关节损伤的特异度为40%，足部损伤的特异度为79%。对于骨科医生，敏感度同样为100%，踝关节损伤的特异度为46%，足部损伤的特异度为79%。骨科医生和物理治疗师在是否进行X线片检查的总体决策上观察者间一致性较高，踝关节损伤的kappa系数值为0.82，足部损伤的kappa系数值为0.88。无假阴性结果。采用改良渥太华踝关节规则分别可将踝关节和足部X线片检查的必要性降低46%和79%。
