Simon R R, Hoffman J R, Smith M
Am J Emerg Med. 1986 Sep;4(5):387-9. doi: 10.1016/0735-6757(86)90183-x.
A literature search failed to demonstrate any investigations of the plain films of the ankle to determine whether there were any measurable differences in the ankle mortise, which would differentiate between a second and a third degree ankle sprain, thus obviating the need for stress views. In this study, the authors independently measured the distances between the talus and tibia at eight predetermined sites on the lateral and mortise views. This was done blindly so that neither author knew which cases were second- or third-degree ankle sprains. Only definite third-degree ankle sprains, as defined by a positive anterior drawer sign and/or a positive inversion stress test result on clinical evaluation, were included. The authors found there was severe interobserver variability. The authors thus feel that there is no clinically significant measurement on plain films of the ankle that can be used to differentiate accurately between second and third degree ankle sprains, and current reliance on clinical findings and subsequent stress x-ray films is appropriate and must remain the non-operative standard for evaluation of this problem.
文献检索未能找到任何关于踝关节X线平片的研究，以确定踝关节榫眼是否存在可测量的差异，从而区分二度和三度踝关节扭伤，进而无需进行应力位片检查。在本研究中，作者在侧位片和榫眼位片上的八个预定部位独立测量了距骨和胫骨之间的距离。测量过程是在不知情的情况下进行的，这样两位作者都不知道哪些病例是二度或三度踝关节扭伤。仅纳入临床评估时前抽屉试验阳性和/或内翻应力试验结果阳性所定义的明确三度踝关节扭伤。作者发现观察者间存在严重的变异性。因此，作者认为踝关节X线平片上没有可用于准确区分二度和三度踝关节扭伤的具有临床意义的测量方法，目前依赖临床检查结果及后续应力位X线片是合适的，并且必须仍然是评估该问题的非手术标准。
