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[踝关节韧带损伤:放射影像学检查程序的重要性]

[Ligamentous injuries of the ankle joint : Importance of radiological imaging procedures].

作者信息

Volmer Erik, Mittlmeier Thomas, Weber Marc-André

机构信息

Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.

Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Rostock, Deutschland.

出版信息

Orthopadie (Heidelb). 2023 Sep;52(9):773-783. doi: 10.1007/s00132-023-04436-9. Epub 2023 Aug 29.

Abstract

Injuries of the ankle joint show lesions of the lateral ligamentous apparatus with an incidence of 1 in 1000 cases. With a range of 0.3-0.7 in 1000 cases, injuries of the medial ligamentous apparatus occur more frequently than previously thought and are often overlooked. Correct imaging diagnostics of the ankle ligaments are mandatory for the prognosis and treatment planning. In cases of clinically strong suspicion of ligamentous injury or osteochondral lesions of the ankle joint, after primary radiographic evaluation magnetic resonance imaging (MRI) is primarily recommended for a more precise assessment. Additionally, the sensitivity for assessment of the ligaments with ultrasonography is good (91% vs. 97% with MRI) but its specificity is inferior compared to MRI (63% vs. 93% with MRI). Supination trauma is the most common ankle injury and attention should be paid to the anterior tibiofibular ligament and calcaneofibular ligament. In approximately 50%, injuries to the superficial layer of the medial collateral ligament complex are associated with lesions of the posterior tibiotalar ligament.

摘要

踝关节损伤表现为外侧韧带结构损伤,发病率为千分之一。内侧韧带结构损伤的发病率在千分之0.3至0.7之间,比之前认为的更为常见,且常被忽视。对踝关节韧带进行正确的影像诊断对于预后和治疗规划至关重要。在临床上高度怀疑踝关节韧带损伤或骨软骨损伤的情况下,在初次X线评估后,主要推荐进行磁共振成像(MRI)以进行更精确的评估。此外,超声检查评估韧带的敏感性良好(与MRI相比为91%对97%),但其特异性低于MRI(与MRI相比为63%对93%)。旋后创伤是最常见的踝关节损伤,应注意胫腓前韧带和跟腓韧带。在大约50%的病例中,内侧副韧带复合体浅层损伤与胫距后韧带损伤相关。

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