附加重力应力X线片在孤立性B型腓骨远端骨折治疗决策中的价值
The Value of Additional Gravity Stress Radiographs for Decision Making in the Treatment of Isolated Type B Distal Fibular Fractures.
作者信息
van Leeuwen Claar A T, van Dorst Roderick W J J, Krijnen Pieta, Schipper Inger B, Hoogendoorn Jochem M
机构信息
Department of Surgery, Haaglanden Medical Centre, the Hague, the Netherlands.
Department of Trauma Surgery, Leiden University Medical Centre, Leiden, the Netherlands.
出版信息
Foot Ankle Int. 2021 Aug;42(8):1031-1039. doi: 10.1177/10711007211001037. Epub 2021 Apr 14.
BACKGROUND
Prior to treatment decisions concerning isolated Weber type B ankle fractures, assessment of the stability of the ankle joint is mandatory. The gravity stress (GS) radiograph is a radiographic tool to determine stability. We hypothesized that this additional GS radiograph would lead to fewer operative treatments by applying the criterion of operative treatment when medial clear space (MCS) > superior clear space (SCS) + 2 mm on the GS radiograph, compared with the nonstressed mortise view criteria of advising operative treatment in case of MCS > SCS + 1 mm.
METHODS
This retrospective comparative cohort study analyzed 343 patients aged between 18 and 70 years with an isolated Weber type B ankle fracture diagnosed at the emergency department between January 2014 and December 2019. The cohort was divided into 2 groups based on whether an additional GS radiograph was performed. Group I consisted of 151 patients in whom a regular mortise and lateral radiograph were performed. Group II comprised 192 patients, with an additional GS radiograph. Primary outcome was type of treatment (conservative vs operative). Secondary outcomes were patient-reported functional outcomes and pain.
RESULTS
Baseline characteristics of both groups did not differ. In group I, surgery was performed in 60 patients (39.7%) compared with 108 patients (56.3%) in group II ( = .002). In the operatively treated patients, the mean MCS on regular mortise view was significantly smaller in patients in whom an additional GS radiograph was performed compared to patients without an additional GS radiograph (4.1 mm vs 5.2 mm, < .001). Mean Olerud-Molander Ankle Score and mean visual analog scale (VAS) for pain did not differ significantly between groups I and II.
CONCLUSIONS
Contrary to what was hypothesized, the introduction of an additional gravity stress radiograph, by which operative treatment was indicated if the MCS was wider than the SCS + 2 mm, did not result in reduced operative treatment of Weber type B ankle fractures when operative treatment was indicated for MCS > SCS + 1 mm on non-gravity stress radiographs.
LEVEL OF EVIDENCE
Level III: retrospective comparative study.
背景
在针对单纯Weber B型踝关节骨折做出治疗决策之前，评估踝关节的稳定性是必不可少的。重力应力（GS）X线片是一种用于确定稳定性的影像学工具。我们假设，与在非应力位踝关节正位片上内侧间隙（MCS）> superior clear space（SCS）+ 1 mm时建议手术治疗的标准相比，当GS X线片上MCS > SCS + 2 mm时应用手术治疗标准，这种额外的GS X线片将导致手术治疗的病例减少。
方法
这项回顾性比较队列研究分析了2014年1月至2019年12月期间在急诊科诊断为单纯Weber B型踝关节骨折的343例年龄在18至70岁之间的患者。根据是否进行额外的GS X线片检查，将队列分为两组。第一组由151例患者组成，这些患者进行了常规的踝关节正位和侧位X线片检查。第二组包括192例患者，他们还进行了额外的GS X线片检查。主要结局是治疗类型（保守治疗与手术治疗）。次要结局是患者报告的功能结局和疼痛情况。
结果
两组的基线特征没有差异。在第一组中，60例患者（39.7%）接受了手术治疗，而在第二组中这一比例为108例患者（56.3%）（P = 0.002）。在接受手术治疗的患者中，与未进行额外GS X线片检查的患者相比，进行了额外GS X线片检查的患者在常规踝关节正位片上的平均MCS明显更小（4.1 mm对5.2 mm，P < 0.001）。第一组和第二组之间的平均Olerud-Molander踝关节评分和平均视觉模拟量表（VAS）疼痛评分没有显著差异。
结论
与假设相反，当在非重力应力X线片上MCS > SCS + 1 mm时建议进行手术治疗，而在GS X线片上MCS大于SCS + 2 mm时进行手术治疗的情况下，引入额外的重力应力X线片并没有减少Weber B型踝关节骨折的手术治疗。
证据水平
III级：回顾性比较研究。
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