Pliefke Jenny, Stengel Dirk, Rademacher Grit, Mutze Sven, Ekkernkamp Axel, Eisenschenk Andreas
Department of Hand Surgery, Replantation Surgery, and Microsurgery, Unfallkrankenhaus Berlin, Warener Strasse 7, 12683 Berlin, Germany.
Skeletal Radiol. 2008 Feb;37(2):139-45. doi: 10.1007/s00256-007-0410-7. Epub 2007 Nov 16.
Missed tears of the scapholunate ligament (SLL) and scapholunate dissociation (SLD) after wrist injuries pose a high risk of post-traumatic osteoarthritis of the carpus. Plain X-rays and dynamic radiographic studies are frequently used for initial diagnostic work-up. Given the limited evidence of their accuracy, we retrospectively compared the radiographic findings of patients with suspected traumatic SLD with wrist arthroscopy as the accepted reference standard.
During a 6-year period, plain radiographs and DSA cineradiography scans were obtained from 198 patients who had sustained a hyperextension injury to their hand. Of those, 102 (72 men, 30 women, mean age of 42+/-12 years) subsequently underwent diagnostic arthroscopy. Digital images were reevaluated by experienced radiologists unaware of the arthroscopic findings for the presence or absence of SLD. We calculated the sensitivity (SN) and specificity (SP) with 95% confidence intervals (CI), and computed areas under the receiver operating characteristic curves (AUC/ROC).
Arthroscopy revealed 42 SLL ruptures, 13, 10, and 19 of which were classified as grade I (partial), II (complete with dynamic instability), or III (complete with static instability) respectively. Plain radiographs correctly identified 24 injuries (SN 57.1%, 95% CI 41.0-72.3%), and produced 1 false-positive result (SP 98.3%, 95% CI 91.1-100.0%). The scapholunate distance and the SL angle contributed independently to the diagnostic variance, with an AUC/ROC of 85.7% (95% CI 76.8-92.2%). Cineradiography had a sensitivity of 36 out of 42 (85.7%, 95% CI 71.5-94.6%), and a specificity of 57 out of 60 (95.0%, 95% CI 86.1-99.0%).
Pathological results on plain radiographs and cineradiography reliably indicate the presence of SLD after wrist trauma. Although non-conclusive, a negative dynamic study markedly reduces the pre-test probability of disease. Both methods remain key elements of primary diagnostic strategies for suspected traumatic SLD, and may facilitate the selection of additional tests.
腕部损伤后舟月韧带（SLL）撕裂及舟月关节分离（SLD）漏诊会导致腕关节创伤性骨关节炎的高风险。普通X线片和动态放射学检查常用于初步诊断评估。鉴于其准确性证据有限，我们回顾性比较了疑似创伤性SLD患者的放射学检查结果与被视为参考标准的腕关节镜检查结果。
在6年期间，对198例手部过伸伤患者进行了普通X线片和数字减影血管造影（DSA）动态造影扫描。其中102例（72例男性，30例女性，平均年龄42±12岁）随后接受了诊断性关节镜检查。由不了解关节镜检查结果的经验丰富的放射科医生对数字图像进行重新评估，以确定是否存在SLD。我们计算了敏感度（SN）和特异度（SP）及其95%置信区间（CI），并计算了受试者工作特征曲线下面积（AUC/ROC）。
关节镜检查发现42例SLL断裂，其中13例、10例和19例分别被分类为I级（部分断裂）、II级（完全断裂伴动态不稳定）或III级（完全断裂伴静态不稳定）。普通X线片正确识别了24例损伤（SN 57.1%，95%CI 41.0 - 72.3%），并产生1例假阳性结果（SP 98.3%，95%CI 91.1 - 100.0%）。舟月间距和SL角对诊断差异有独立贡献，AUC/ROC为85.7%（95%CI 76.8 - 92.2%）。动态造影检查42例中有36例敏感度为85.7%（95%CI 71.5 - 94.6%），60例中有57例特异度为95.0%（95%CI 86.1 - 99.0%）。
普通X线片和动态造影的病理结果可靠地表明腕部创伤后SLD的存在。尽管结果不具有决定性，但动态检查结果为阴性可显著降低疾病的预检概率。这两种方法仍然是疑似创伤性SLD初步诊断策略的关键要素，并可能有助于选择其他检查。
