Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, 290 Jermjompol, Si Racha, Chonburi, 20110, Thailand.
Department of Radiology, Queen Savang Vadhana Memorial Hospital, Si Racha, Chonburi, 20110, Thailand.
Eur J Orthop Surg Traumatol. 2024 Nov 23;35(1):19. doi: 10.1007/s00590-024-04156-6.
Currently, traumatic arthrotomy of the knee could be diagnosed by saline loading test and computed tomography (CT) which reported excellent sensitivity and specificity. However, there are drawbacks associated with CT, such as cost and radiation hazards. This study aims to evaluate a new diagnostic tool using knee arthrography for individuals with suspected open knee injury and reported sensitivity and specificity using CT scan as the gold standard.
A prospective diagnostic study, involving 43 patients who sustained laceration wounds over the knee, was conducted. The physical examination and conventional radiographic imaging were inconclusive in determining the presence of open joint injury. The established protocol involved directing the patients to undergo a CT scan, which is considered the gold standard for detecting open knee injuries. Subsequently, arthrography of the affected knee was performed. The diagnostic value was subsequently determined based on the outcomes derived from these procedures.
There were 5/43 cases (11.6%) that diagnosed open knee injuries as determined by CT scans. The calculated diagnostic parameters of arthrography derived from these findings are as follows: The sensitivity was 83.3%, the specificity was 96.5%, the negative predictive value was 96.5%, the positive predictive value was 83.3%, the accuracy is 94.3%, the false positive rate is 16.7%, and the false negative rate was 3.4%. Interobserver reliability was substantial (Kappa 0.617). No complication was observed during the arthrography procedure.
Knee arthrography demonstrated high sensitivity, specificity and accuracy for diagnosing open knee injuries, offering a viable alternative to CT scans in certain situations, such as when minimizing radiation exposure is a priority and cost considerations are paramount. Ultimately, careful clinical judgement should guide the choice of diagnostic modality based on individual patient circumstances.
目前，膝关节创伤性关节切开术可通过生理盐水负荷试验和计算机断层扫描（CT）诊断，其报道的敏感性和特异性均较高。然而，CT 存在成本和辐射危害等缺点。本研究旨在评估一种新的诊断工具，即膝关节造影术，用于疑似开放性膝关节损伤的患者，并使用 CT 扫描作为金标准报告其敏感性和特异性。
对 43 例膝关节有撕裂伤的患者进行前瞻性诊断研究。体格检查和常规 X 线摄影检查对确定是否存在开放性关节损伤的结果不确定。既定方案包括指导患者进行 CT 扫描，CT 扫描被认为是检测开放性膝关节损伤的金标准。随后对受影响的膝关节进行关节造影术。随后根据这些程序的结果确定诊断价值。
有 5/43 例（11.6%）通过 CT 扫描诊断为开放性膝关节损伤。从这些发现中得出的关节造影术的诊断参数如下：敏感性为 83.3%，特异性为 96.5%，阴性预测值为 96.5%，阳性预测值为 83.3%，准确率为 94.3%，假阳性率为 16.7%，假阴性率为 3.4%。观察者间可靠性较高（Kappa 值为 0.617）。关节造影术过程中未观察到并发症。
膝关节造影术对诊断开放性膝关节损伤具有较高的敏感性、特异性和准确性，在某些情况下（例如当优先考虑最小化辐射暴露且成本考虑至关重要时），可替代 CT 扫描。最终，应根据患者个体情况，谨慎进行临床判断，选择诊断方式。
