Katharinenhospital Stuttgart, Klinik für Unfallchirurgie und Orthopädie, Stuttgart, Germany.
Foot Ankle Int. 2012 Dec;33(12):1063-8. doi: 10.3113/FAI.2012.1063.
To our knowledge, there are only a few prospective studies on the use of magnetic resonance imaging (MRI) to diagnose injuries associated with ankle sprains in children. We hypothesized that MRI examinations of acute ankle sprains in growing children would show relevant injuries that may have been overlooked by conventional clinical, radiological, and ultrasound examinations.
Thirty children with acute inversion injury of the ankle were subjected to an MRI examination of the ankle joint, in addition to conventional radiographic procedures. All data were recorded prospectively. Depending on the severity of the clinical symptoms, the children were divided into three different groups. Children with little soft-tissue swelling and who were still able to walk were assigned to Group I (n = 10), Group II consisted of children who were only partially able to walk and had moderate soft-tissue swelling (n = 12), while Group III consisted of the children who were not able to walk and had pronounced soft-tissue swelling (n = 8). Regular followup examinations were carried out. At the final followup examination, on average 8 months after injury, the children in Groups II and III were again examined by MRI. The clinical results were compared and correlated with the results of the MRI examinations.
Altogether, torn ligaments could be verified in 23 out of 30 of the cases; bony avulsions were found in 10% of these. Three of 30 patients had a Salter I injury. Bone bruising was found in 18 out of 30 (60%). Bone bruising was most commonly found near the medial talus. MRI examination of the patients in Group I showed no more ruptures than the clinical examination; here, only four patients were found to have partial ruptures of the ATL. In Group II, torn ligaments were found in six out of 12 (50%) of the cases; similarly, Salter I injuries were found in three out of 12 cases. The patients in Group III also showed serious injuries on the MRI examination. Bone bruising, torn ligaments, or bony avulsions were found in eight out of eight (100%) cases. The recorded clinical results showed only weak correlation to the injury patterns diagnosed using MRI. Only the bone bruises correlated with clinical results. Children with more pronounced swelling and less ability to walk were more commonly diagnosed with bone bruises. No differences were found between groups with regard to pain, instability, or limitations of mobility in the followup examinations or the final MRI examination 8 months after injury.
The injury patterns diagnosed through MRI examination did not correlate with clinical findings. With adequate progressive rehabilitation, the pathological changes diagnosed with MRI healed without further complications. MRI examinations of acute ankle distortion injuries in children did not result in any additional therapeutic value. Therefore, we believe conventional clinical, radiological, and ultrasound diagnostic methods are sufficient for the primary diagnosis of ankle fractures and ankle ligament injuries in children.
据我们所知，仅有少数几项前瞻性研究使用磁共振成像（MRI）来诊断儿童踝关节扭伤相关的损伤。我们假设，对生长中的儿童急性踝关节扭伤进行 MRI 检查，将显示出可能被传统临床、放射学和超声检查所忽视的相关损伤。
30 例儿童急性内翻性踝关节扭伤患者除进行常规放射学检查外，还接受了踝关节 MRI 检查。所有数据均进行前瞻性记录。根据临床症状的严重程度，将患儿分为三组。肿胀程度轻且仍能行走的患儿归入 I 组（n=10）；仅部分能行走且软组织肿胀中度的患儿归入 II 组（n=12）；不能行走且软组织肿胀明显的患儿归入 III 组（n=8）。进行定期随访检查。在受伤后平均 8 个月的最终随访时，II 组和 III 组患儿再次接受 MRI 检查。比较临床结果，并与 MRI 检查结果相关联。
总共 30 例患者中有 23 例证实有韧带撕裂；10%的患者有骨撕脱。30 例患者中有 3 例为 Salter I 型损伤。30 例患者中有 18 例（60%）有骨挫伤。骨挫伤最常见于内踝附近。I 组患者的 MRI 检查并未发现比临床检查更多的撕裂；这里只有 4 例患者发现 ATL 部分撕裂。II 组中，12 例中有 6 例（50%）发现有韧带撕裂；同样，12 例中有 3 例为 Salter I 型损伤。III 组患者的 MRI 检查也显示出严重的损伤。8 例患者（100%）均发现骨挫伤、韧带撕裂或骨撕脱。记录的临床结果与 MRI 诊断的损伤模式仅存在弱相关性。只有骨挫伤与临床结果相关。肿胀更明显、行走能力更差的患儿更常被诊断为骨挫伤。在随访检查或受伤后 8 个月的最终 MRI 检查中，各组之间在疼痛、不稳定或活动受限方面均无差异。
MRI 检查诊断的损伤模式与临床发现不相关。通过适当的逐步康复治疗，MRI 诊断的病理性改变无需进一步治疗即可愈合。对儿童急性踝关节扭伤进行 MRI 检查并未带来任何额外的治疗价值。因此，我们认为，对于儿童踝关节骨折和踝关节韧带损伤的初步诊断，传统的临床、放射学和超声诊断方法已足够。
