Li N, Liu Y S, Xin J Y, Ma X L, Mei X L, Shi Z Q, Li G, Sun Z H
Department of Orthopaedics, Tianjin Hospital, Tianjin 300211, China.
Zhonghua Yi Xue Za Zhi. 2017 Sep 19;97(35):2742-2745. doi: 10.3760/cma.j.issn.0376-2491.2017.35.006.
To evaluate the efficiency of modified Ottawa Ankle Rules (OAR) for the differential diagnosis of fractures in acute foot and ankle injuries. From October 2016 to December 2016, 272cases (135 males and 137 females) of foot and ankle injury in emergency department of Tianjin Hospital were prospective enrolled in the study.The median age was 27.5 years (7-87); left limb 155, right 117 cases; injury time ranged from 0.3 to 24 h (median 4 h). Conventional and modified OAR was applied on physical examination, subsequently radiography performed to determine the occurrence of fractures.The efficiency of the two methods were compared and analyzed. Fractures were found in 100 cases (36.8%), 49 cases of ankle and 51 cases of foot fractures.With the imaging results as the standard, the sensitivity for conventional and modified OAR were 93.0% and 100%, specificity were 9.9% and 8.7%, the positive predictive value were 37.5% and 38.9%, the negative predictive value were 70.8% and 100%, the accuracy were 40.4% and 42.3%, missed diagnosis rate were 7% and 0% respectively.The sensitivity, positive likelihood ratio, positive predictive value, negative predictive value, accuracy, negative likelihood ratio and missed diagnosis ratio were better than in modified OAR compared with Conventional OAR, while the specificity was slightly lower compared to Conventional OAR.The Kappa value of modified OAR was 0.065 (>0.05), which is better than conventional OAR.Conventional OAR can reduce 6.3% (17/272) X-ray and modified OAR decline 5.5% (15/272). Modified OAR significantly reduces the rate of missed diagnosis of foot fractures, but its specificity is poor. Ultrasound can be assisted to improve the specificity and reduce the number of unnecessary X-rays.
评估改良渥太华踝关节规则（OAR）对急性足踝部损伤骨折鉴别诊断的效能。2016年10月至2016年12月，前瞻性纳入天津市天津医院急诊科272例足踝部损伤患者（男135例，女137例）。年龄中位数为27.5岁（7 - 87岁）；左侧肢体155例，右侧117例；受伤时间为0.3至24小时（中位数4小时）。体格检查时应用传统及改良OAR，随后行X线检查以确定骨折的发生情况。对两种方法的效能进行比较分析。共发现100例骨折（36.8%），其中踝关节骨折49例，足部骨折51例。以影像学结果为标准，传统OAR的敏感度为93.0%，改良OAR为100%；特异度分别为9.9%和8.7%；阳性预测值分别为37.5%和38.9%；阴性预测值分别为70.8%和100%；准确度分别为40.4%和42.3%；漏诊率分别为7%和0%。与传统OAR相比，改良OAR的敏感度、阳性似然比、阳性预测值、阴性预测值、准确度、阴性似然比及漏诊率均更优，而特异度略低于传统OAR。改良OAR的Kappa值为0.065（>0.05），优于传统OAR。传统OAR可减少6.3%（17/272）的X线检查，改良OAR可减少5.5%（15/272）。改良OAR显著降低了足部骨折的漏诊率，但其特异度较差。可辅助超声检查以提高特异度并减少不必要的X线检查次数。
