摘要目的 对照关节镜与MRI对外侧韧带复合体(lateral ligament complex,LLC)急性损伤严重程度的诊断一致性和诊断效能,探寻早期精确诊断急性LLC损伤的有效手段.方法 收集2015年2月至2016年12月踝关节LLC急性损伤37例患者资料,男27例,女10例;年龄18～42岁,平均(28.6±6.2)岁;损伤至关节镜诊治时间0.3～8 d,平均(4.6±3.3)d.对所有患者行MRI和踝关节镜探查,并对照LLC损伤的检查结果,分析两种结果间的一致性,评价二者对LLC急性损伤的诊断效能.结果 两种检查方法 对LCC不同部位的诊断结果 一致性存在差异,距腓前韧带起点部分撕裂、完全撕裂和跟腓韧带起点完全撕裂方面的一致性一般(kappa值分别为0.641,0.624和0.680),LLC其他部位损伤的一致性均较差(kappa＜0.4).相对于关节镜,MRI对距腓前韧带部分撕裂的诊断准确率为62％(23/37),完全撕裂的诊断准确率为62％(23/37);跟腓韧带完全撕裂的诊断准确率为78％(29/37).结论 MRI不能准确反映急性LLC损伤的真实情况,存在诊断效能不足的缺陷,关节镜探查对急性踝关节LLC损伤具较高的诊断价值.

abstractsObjective To compare the diagnostic consistency and efficacy of arthroscopy and MRI on the severity of acute lateral ligament complex (LLC) injury,and to find an effective method to diagnose acute LLC injury accurately in early stage.Methods Data of 37 patients (27 males,10 females),with acute lateral ligament complex injury who were treated from February 2015 to December 2016 were retrospectively analyzed.The average age was 28.6±6.2 years (range,18-42 years) and duration from injury to operation was 4.6±3.3 days (range,0.3-8 days).The results of MRI and ankle arthroscopy for detecting LLC injury were compared,and the consistency between the two examination results was analyzed.Results Different consistencies were found between the two examination methods according to different parts of LCC injuries.The consistency of injuries (partial tear,complete tear) at the starting point of anterior talofibular ligament and complete tear at the starting point of calcaneofibularligament was ordinary (kappa=0.641,0.624,0.680),while the consistency of damage in other parts of LLC was poor (kappa＜ 0.4).Compared with arthroscopy,MRI has a diagnostic accuracy of 62％ (23/37) for partial tear of anterior talofibular ligament,and 62％ (23/37) for complete tear.And that of the calcaneofibularligament complete tear was 78％ (29/37).Conclusion MRI had low capability in detecting the severity of acute LLC injury accurately and the diagnosing efficacy was insufficient,while arthroscopic exploration had a high diagnostic value for acute ankle joint injuries.