Lee Sun Hwa, Yun Seong Jong
Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Seoul, Nowon-gu 139-707, Republic of Korea.
Department of Radiology, Aerospace Medical Center, Republic of Korea Air Force, PO Box 335-21, 635 Danjae-ro, Namil-myeon, Cheongwon-gun, Chungcheongbuk-do 363-849, Republic of Korea.
Injury. 2017 Oct;48(10):2323-2328. doi: 10.1016/j.injury.2017.07.015. Epub 2017 Jul 13.
To evaluate the feasibility of point-of-care ankle ultrasound compared with magnetic resonance imaging (MRI) for diagnosing major ligaments and Achilles tendon injuries in patients with recurrent ankle sprain and chronic instability, and to evaluate inter-observer reliability between an emergency physician and a musculoskeletal radiology fellow.
A prospective cross-sectional study was conducted in an emergency department. Patients with recurrent ankle sprain and chronic instability were recruited. An emergency physician and a musculoskeletal radiology fellow independently evaluated the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), distal anterior tibiofibular ligament (ATiFL), deltoid ligament, and Achilles tendon using point-of-care ankle ultrasound. Findings were classified normal, partial tear, and complete tear. MRI was used as the reference standard. We calculated diagnostic values for point-of-care ankle ultrasound for both reviewers and compared them using DeLong's test. Intra-class correlation coefficients (ICCs) were calculated for agreement between each reviewer and the reference standard, and between the two reviewers.
Eighty-five patients were enrolled. Point-of-care ankle ultrasound showed acceptable sensitivity (96.4-100%), specificity (95.0-100%), and accuracy (96.5-100%); these performance markers did not differ significantly between reviewers. Agreement between each reviewer and the reference standard was excellent (emergency physician, ICC=0.846-1.000; musculoskeletal radiology fellow, ICC=0.930-1.000), as was inter-observer agreement (ICC=0.873-1.000).
Point-of-care ankle ultrasound is as precise as MRI for detecting major ankle ligament and Achilles tendon injuries; it could be used for immediate diagnosis and further pre-operative imaging. Moreover, it may reduce the interval from emergency department admission to admission for surgical intervention, and may save costs.
评估即时护理踝关节超声与磁共振成像（MRI）在诊断复发性踝关节扭伤和慢性不稳定患者主要韧带及跟腱损伤方面的可行性，并评估急诊医生与肌肉骨骼放射科住院医师之间的观察者间可靠性。
在急诊科进行一项前瞻性横断面研究。招募复发性踝关节扭伤和慢性不稳定患者。一名急诊医生和一名肌肉骨骼放射科住院医师使用即时护理踝关节超声独立评估距腓前韧带（ATFL）、跟腓韧带（CFL）、胫腓前韧带远端（ATiFL）、三角韧带和跟腱。检查结果分为正常、部分撕裂和完全撕裂。MRI用作参考标准。我们计算了两位评估者即时护理踝关节超声的诊断价值，并使用德龙检验进行比较。计算了每位评估者与参考标准之间以及两位评估者之间的组内相关系数（ICC）。
共纳入85例患者。即时护理踝关节超声显示出可接受的敏感性（96.4 - 100%）、特异性（95.0 - 100%）和准确性（96.5 - 100%）；这些性能指标在评估者之间无显著差异。每位评估者与参考标准之间的一致性极佳（急诊医生，ICC = 0.846 - 1.000；肌肉骨骼放射科住院医师，ICC = 0.930 - 1.000），观察者间一致性也极佳（ICC = 0.873 - 1.000）。
即时护理踝关节超声在检测主要踝关节韧带和跟腱损伤方面与MRI一样精确；它可用于即时诊断和进一步的术前成像。此外，它可能会缩短从急诊科入院到手术干预入院的间隔时间，并可能节省成本。
