D'Erme M
Istituto Chirurgico Ortopedico Traumatologico (I.C.O.T.), Latina.
Radiol Med. 1996 Jun;91(6):705-9.
Acute sprains are one of the most frequent ankle conditions; the lateral collateral ligaments are often involved. Currently, plain radiography and clinical examination are the methods of choice in the management of these injuries. This study was aimed at describing the MR findings of acute ankle sprains, to assess which ligaments are involved, to study the repair process during conservative treatment and, finally, to compare MR and US findings in acute and chronic injuries. We divided our study into a prospective and a retrospective parts. In the prospective study, MRI was performed in 20 consecutive patients with acute ankle sprain diagnosed at the emergency care unit of our institute and treated conservatively with braces. The patients with fractures were excluded. Follow-up was based on a series of MR exams performed every 30 days for 6 months. We diagnosed 18 injuries of the lateral collateral ligaments, 5 of the anterior talofibular ligament (ATFL) (2 partial and 3 complete tears) and 13 of both the ATFL and the calcaneofibular (CFL) (6 partial and 7 complete tears). The follow-up showed complete edema resorption at 30 days in 2 patients with no ligament injuries; the persistence of a medium-large amount of fluid in partial tears at 30 days and its complete resorption at 60 days; and, finally, the persistence of a medium-large amount of fluid at 180 days in 2 complete tears. No scar could be identified in all the patients with ligament injuries. The retrospective study was based on the comparison of MR (gold standard) and US findings in 78 patients with ankle sprain, 28 in the acute and 50 in the chronic phase. In the first group we found 9 ATFL injuries (6 partial and 3 complete tears), 5 ATFL and CFL injuries (3 partial and 2 complete tears), 2 complete tears of lateral collateral ligaments, 3 deltoid ligament (DL) injuries, 2 ATFL and DL injuries and 2 injuries of both lateral and medial collateral ligaments. US was in agreement with MRI in 85% of ATFL, 67% of CFL and 28% of DL injuries; US also yielded 2 false positives in PAA. In the second group of 50 patients, MRI showed 11 ATFL and 8 ATFL and CFL injuries, 3 injuries of lateral collateral ligaments, 6 DL and 8 ATFL, CFL and DL injuries and 5 complete tears of both internal and external collateral ligaments; 10 exams were negative. US had 58% agreement with MRI in ATFL, 46% in CFL and 21% in DL injuries. In this series, US yielded 3 false positives in PAA injuries.
急性扭伤是最常见的踝关节病症之一；外侧副韧带常受累。目前，X线平片和临床检查是这些损伤治疗中的首选方法。本研究旨在描述急性踝关节扭伤的磁共振成像（MR）表现，评估哪些韧带受累，研究保守治疗期间的修复过程，最后比较急性和慢性损伤中MR与超声（US）的表现。我们将研究分为前瞻性和回顾性两部分。在前瞻性研究中，对我院急诊科诊断为急性踝关节扭伤并采用支具保守治疗的20例连续患者进行了MRI检查。排除骨折患者。随访基于每30天进行一次、持续6个月的一系列MR检查。我们诊断出18例外侧副韧带损伤，5例距腓前韧带（ATFL）损伤（2例部分撕裂和3例完全撕裂），以及13例ATFL和跟腓韧带（CFL）联合损伤（6例部分撕裂和7例完全撕裂）。随访显示，2例无韧带损伤的患者在30天时完全水肿吸收；部分撕裂患者在30天时仍有中大量积液，60天时完全吸收；最后，2例完全撕裂患者在180天时仍有中大量积液。所有韧带损伤患者均未发现瘢痕。回顾性研究基于对78例踝关节扭伤患者（28例急性和50例慢性）的MR（金标准）和US表现进行比较。在第一组中，我们发现9例ATFL损伤（6例部分撕裂和3例完全撕裂），5例ATFL和CFL联合损伤（3例部分撕裂和2例完全撕裂），2例外侧副韧带完全撕裂，3例三角韧带（DL）损伤，2例ATFL和DL联合损伤，以及2例内外侧副韧带联合损伤。US与MRI在85%的ATFL损伤、67%的CFL损伤和28%的DL损伤中结果一致；US在距骨前沟（PAA）还出现了2例假阳性。在第二组50例患者中，MRI显示11例ATFL损伤、8例ATFL和CFL联合损伤、3例外侧副韧带损伤、6例DL损伤、8例ATFL、CFL和DL联合损伤以及5例内外侧副韧带完全撕裂；10例检查结果为阴性。US与MRI在ATFL损伤中的一致性为58%，在CFL损伤中为46%，在DL损伤中为21%。在本系列中，US在PAA损伤中出现了3例假阳性。
