Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité Berlin, University Hospital, Berlin, Germany.
Jacksonville Orthopaedic Institute, 1325 San Marco Blvd., Jacksonville, FL, 32207, USA.
Arch Orthop Trauma Surg. 2023 Nov;143(11):6631-6639. doi: 10.1007/s00402-023-04985-w. Epub 2023 Jul 21.
Acute isolated syndesmotic injuries (AISIs) have a high potential to be misdiagnosed or underdiagnosed at initial presentation to the hospital. Although magnetic resonance imaging (MRI) is the gold standard in noninvasive diagnostics, it is not always available immediately and is much more expensive than other imaging modalities. This study identifies improvements in conventional radiography and computed tomography (CT) to diagnose AISI and aims to reduce the number of MRI scans needed to verify the diagnosis.
A retrospective case match control study was conducted by searching our trauma database between 2008 and 2022. A study group of patients with AISI (n = 64) and a control group of patients without AISI (n = 76) were formed to generate an equal number of images from both groups (62 radiographs and 22 CT scans). A total of 16 parameters that quantify the distal tibiofibular relation in injured and uninjured ankles were analyzed. For statistical analysis, a two-sided t-test was applied to calculate significant differences (p < 0.05). In a further step, a receiver operating characteristic curve (ROC) was used to determine cut-off values for the most significant parameters.
The most significant measurement (p < 0.001) on axial CT scans was the syndesmotic area (SA). The ROC curve revealed an area under the curve (AUC) of 0.94 (95% CI 0.86-1.0) and a cut-off value of 71.68 mm that shows a sensitivity and specificity of 95.5% and 81.8%, respectively.
This study suggests that radiographic imaging could represent an equally accurate alternative to MRI. These methods might generate the correct diagnosis faster due to their availability and inexpensiveness. By applying our new cut-off values in a clinical setting, the number of underdiagnosed and untreated unstable syndesmotic injuries could be reduced.
III, retrospective comparative study.
急性孤立性下胫腓联合损伤（AISI）在初次就诊于医院时，很容易被误诊或漏诊。尽管磁共振成像（MRI）是非侵入性诊断的金标准，但它并不总是立即可用，而且比其他成像方式昂贵得多。本研究旨在通过常规 X 线和计算机断层扫描（CT）来提高 AISI 的诊断水平，并减少验证诊断所需的 MRI 扫描数量。
通过检索 2008 年至 2022 年期间的创伤数据库，进行了回顾性病例匹配对照研究。形成了 AISI 患者的研究组（n=64）和无 AISI 患者的对照组（n=76），以从两组中生成相同数量的图像（62 张 X 线片和 22 张 CT 扫描）。分析了 16 个定量评估受伤和未受伤踝关节下胫腓联合关系的参数。采用双侧 t 检验进行统计分析，计算显著差异（p<0.05）。在进一步的步骤中，使用接收者操作特征曲线（ROC）确定最重要参数的截断值。
轴向 CT 扫描最显著的测量值（p<0.001）是下胫腓联合面积（SA）。ROC 曲线显示曲线下面积（AUC）为 0.94（95%CI 0.86-1.0），截断值为 71.68mm，其灵敏度和特异性分别为 95.5%和 81.8%。
本研究表明，影像学检查可能是 MRI 的一种同样准确的替代方法。由于这些方法的可用性和经济性，它们可能更快地做出正确诊断。通过在临床实践中应用我们的新截断值，可以减少未确诊和未治疗的不稳定下胫腓联合损伤的数量。
III，回顾性比较研究。
