术前MRI在慢性外侧踝关节不稳手术决策中的可靠性和有效性
Reliability and validity of preoperative MRI for surgical decision making in chronic lateral ankle instability.
作者信息
Morvan Antoine, Klouche Shahnaz, Thes André, Hardy Philippe, Bauer Thomas
机构信息
Hôpitaux Universitaires Paris Ile-de-France Ouest, Assistance Publique-Hôpitaux de Paris, 92100, Boulogne-Billancourt, France.
UFR des Sciences de la Santé, Université de Versailles Saint-Quentin-en-Yvelines, 78180, Montigny-Le-Bretonneux, France.
出版信息
Eur J Orthop Surg Traumatol. 2018 May;28(4):713-719. doi: 10.1007/s00590-017-2116-4. Epub 2018 Jan 3.
PURPOSE
To evaluate the value of analyzing the anterior talofibular ligament (ATFL) on preoperative MRI as a decision-making tool to determine the surgical technique in patients undergoing surgery for chronic lateral ankle instability.
METHODS
A retrospective study of prospective data was performed. All patients who underwent surgery between 2013 and 2016 for arthroscopic stabilization of the ankle were included. The ATFL was evaluated on preoperative MRI including axial T2-weighted images by two readers who were blinded to arthroscopic results. The arthroscopic evaluation, which was considered to be the reference examination, was performed by one senior surgeon. The main judgment criteria were two features of the ATFL: (1) absent or thin (< 1 mm thick) and (2) detached or thickened (> 3.2 mm in diameter) with or without a high intensity intraligamentous signal. Inter- and intraobserver reproducibility was evaluated by the kappa coefficient (k), and parameters of the diagnostic accuracy of preoperative MRI were analyzed.
RESULTS
Twenty-two patients were included, 15 men/7 women mean age 30.3 ± 9.5 years. Fourteen patients (63.6%) underwent arthroscopic repair of the ATFL (Broström-Gould technique) and 8 patients (36.4%) an arthroscopic anatomical reconstruction of the ATFL. Intraobserver reproducibility of MRI findings was substantial (k = 0.68) and interobserver reproducibility moderate (k = 0.55) to nearly perfect (k = 0.87). Agreement between MRI and arthroscopic findings was substantial (k = 0.70). Diagnostic parameters of preoperative MRI were good for both observers: Se = 85.7-87.5%, Sp = 86.7-92.9%, PPV = 75-87.5%, NPV = 92.9%, and classification of patients was good = 86.4-90.9%.
CONCLUSION
Preoperative MRI of the ATFL is a reliable and valid decisional tool to choose the surgical technique for stabilization of chronic lateral ankle instability.
LEVEL OF EVIDENCE
Level II; Diagnostic study-development of diagnostic criteria on the basis of consecutive patients.
目的
评估术前磁共振成像（MRI）分析距腓前韧带（ATFL）作为一种决策工具，以确定慢性踝关节外侧不稳定患者手术技术的价值。
方法
对前瞻性数据进行回顾性研究。纳入2013年至2016年间接受踝关节镜稳定手术的所有患者。两位对关节镜检查结果不知情的阅片者在术前MRI上评估ATFL，包括轴位T2加权像。由一位资深外科医生进行关节镜评估，将其视为参考检查。主要判断标准为ATFL的两个特征：（1）缺如或变薄（厚度<1mm）；（2）断裂或增厚（直径>3.2mm），伴或不伴有韧带内高信号。通过kappa系数（k）评估观察者间和观察者内的可重复性，并分析术前MRI诊断准确性的参数。
结果
纳入22例患者，15例男性/7例女性，平均年龄30.3±9.5岁。14例患者（63.6%）接受了ATFL的关节镜修复（布罗斯特伦-古尔德技术），8例患者（36.4%）接受了ATFL的关节镜解剖重建。MRI检查结果的观察者内可重复性良好（k=0.68），观察者间可重复性中等（k=0.55）至几乎完美（k=0.87）。MRI与关节镜检查结果之间的一致性良好（k=0.70）。两位观察者术前MRI的诊断参数均良好：敏感性（Se）=85.7-87.5%，特异性（Sp）=86.7-92.9%，阳性预测值（PPV）=75-87.5%，阴性预测值（NPV）=92.9%，患者分类良好率=86.4-90.9%。
结论
ATFL的术前MRI是选择慢性踝关节外侧不稳定稳定手术技术的可靠且有效的决策工具。
证据水平
II级；诊断性研究——基于连续患者制定诊断标准。
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