van Dijk C N, Molenaar A H, Cohen R H, Tol J L, Bossuyt P M, Marti R K
Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Skeletal Radiol. 1998 May;27(5):256-61. doi: 10.1007/s002560050377.
To investigate the merits of arthrography after supination trauma of the ankle.
In a group of 160 consecutive patients operative exploration was performed in cases where arthrography and/or a delayed physical examination showed positive findings. In all patients arthrography was performed within 48 h after trauma. To determine interobserver agreement, all arthrograms were independently evaluated by two radiologists, both ignorant of the first assessment.
The prevalence of an ankle ligament lesion was found to be 76%. Of the 122 patients with a rupture of one or more ankle ligaments, 52% had an isolated anterior talofibular ligament lesion, 3% had an isolated calcaneofibular ligament lesion, and 45% had combined lesions. The site of the lesion was predominantly intraligamentous. In the determination of the presence or absence of an ankle ligament lesion, the specificity and sensitivity of the ankle arthrogram were 71% and 96% respectively. Interobserver agreement on the arthrogram was very good (kappa 0.9). In 1% of patients a clear diagnosis was not possible by means of arthrography.
Arthrography provides information of high diagnostic quality with excellent interobserver agreement and therefore remains the gold standard for early diagnosis (within 48 h) of a lateral ankle ligament rupture.
探讨踝关节旋后损伤后关节造影的优点。
在一组连续的160例患者中，对关节造影和/或延迟体格检查显示阳性结果的患者进行手术探查。所有患者均在创伤后48小时内进行关节造影。为确定观察者间的一致性，两位放射科医生在不知道首次评估结果的情况下独立评估所有关节造影片。
发现踝关节韧带损伤的患病率为76%。在122例一条或多条踝关节韧带断裂的患者中，52%为单纯前距腓韧带损伤，3%为单纯跟腓韧带损伤，45%为联合损伤。损伤部位主要在韧带内。在确定踝关节韧带损伤的有无时，踝关节造影的特异性和敏感性分别为71%和96%。观察者间对关节造影片的一致性非常好（kappa值为0.9）。1%的患者通过关节造影无法明确诊断。
关节造影提供了高质量的诊断信息，观察者间一致性良好，因此仍然是外侧踝关节韧带断裂早期诊断（48小时内）的金标准。
