Dunlop M G, Beattie T F, White G K, Raab G M, Doull R I
Br Med J (Clin Res Ed). 1986 Sep 6;293(6547):603-5. doi: 10.1136/bmj.293.6547.603.
A prospective study was performed to establish definitive guidelines for selective use of radiography in the assessment of inversion ankle injuries. Five hundred patients were included, representing 3.2% of the workload of the department during the study period. There were 379 soft tissue injuries, 56 malleolar fractures, 40 avulsion fractures, 21 fractures at the base of the fifth metatarsal, and four calcaneal fractures. Multiple logistic regression identified distal fibular tenderness, age, and ability to bear weight as the most important clinical variables in predicting important fractures (p less than 0.001). A policy of requesting x ray examination of only those patients with distal fibular tenderness or inability to bear weight or aged over 60, with a further proviso that no foot radiographs should be obtained, would produce a 60% reduction in ankle radiography in this centre without detriment to patient care.
进行了一项前瞻性研究，以制定在评估踝关节内翻损伤时选择性使用放射照相的明确指南。纳入了500名患者，占研究期间该科室工作量的3.2%。其中有379例软组织损伤、56例踝关节骨折、40例撕脱性骨折、21例第五跖骨基底骨折和4例跟骨骨折。多因素逻辑回归分析确定，腓骨远端压痛、年龄和负重能力是预测重要骨折的最重要临床变量（p<0.001）。仅对那些有腓骨远端压痛或无法负重或年龄超过60岁的患者进行X光检查的政策，进一步规定不应进行足部X光检查，这将使该中心的踝关节放射照相减少60%，而不会损害患者的治疗。
