Significance of X-ray, CT and MRI combined with Weber classification in the differential diagnosis of injury degree of patients with tibiofibular syndesmosis
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摘要:
目的研究X线、CT与MRI检查联合Weber分型在下胫腓联合损伤患者损伤程度鉴别中的意义。 方法选择2017年10月~2018年10月在我院就诊的75例下胫腓联合损伤患者作为研究对象。Weber分型：A型患者31例，B型患者25例，C型患者19例。右踝骨折患者39例，左踝骨折患者36例，患者的功能损伤情况：Lauge-Hansen分型：旋前外展Ⅰ、Ⅱ、Ⅲ型患者分别为9、5、8例，旋前外旋Ⅰ、Ⅱ、Ⅲ、Ⅳ患者分别为6、7、9、5例，旋后外旋Ⅰ、Ⅱ、Ⅲ、Ⅳ患者分别为9、4、2、3例，旋后内收Ⅰ、Ⅱ患者分别为3、5例。分别对患者开展X线、CT、MRI检查，以MRI检查结果作为金标准，分析X线、CT与MRI检查结果的一致性，分析联合诊断与单独诊断灵敏度之间的差异。 结果通过MRI检查，共发现前韧带损伤患者39例，深韧带损伤患者36例。以此作为金标准，CT诊断结合Weber分型发现浅韧带损伤41例，其中与MRI一致的有35例；发现深韧带损伤34例，与MRI结果一致的有30例。CT诊断结合Weber分型与MRI诊断的一致性较强（P < 0.05）；X线结合Weber分型与核磁共振诊断的一致性较强（P < 0.05）；通过对患者的不同严重程度的下胫腓联合损伤患者的CT、X线结合Weber分型的联合诊断，其灵敏度高于单独检测，差异有统计学意义（P < 0.05）。 结论X线、CT与MRI检查联合Weber分型在下胫腓联合损伤患者损伤程度的诊断灵敏度显著提升，同时与MRI检查的一致性较高，建议临床推广。 Abstract:ObjectiveTo explore the significance of X-ray, CT and MRI combined with Weber typing in the differential diagnosis of injury degree of patients with tibiofibular syndesmosis. MethodsSeventy-five patients with tibiofibular syndesmosis injury were treated in our hospital from October 2017 to October 2018. Weber classification: 31 patients of type A, 25 patients of type B and 19 patients of type C. There were 39 cases of right ankle fracture and 36 cases of left ankle fracture. According to Lauge-Hansen classification, there were 9, 5 and 8 cases of pronation and abduction type Ⅰ, Ⅱ, and Ⅲ respectively; 6, 7, 9 and 5 cases of pronation and external rotation Ⅰ, Ⅱ, Ⅲ and Ⅳ respectively; 9, 4, 2 and 3 cases of supination and external rotation Ⅰ, Ⅱ, Ⅲ and Ⅳ respectively. There were 3 cases of supinational adduction type Ⅰ and 5 cases of supinational adduction type Ⅱ. X-ray, CT and MRI examination were carried out for the patients respectively. The results of MRI examination were taken as the gold standard. The consistency of X- ray, CT and MRI examination results and the difference between the sensitivity of combined diagnosis and single diagnosis were analyzed. ResultsThirty-nine patients with anterior ligament injury and 36 patients with deep ligament injury were found by MRI. As a gold standard, 41 patients with shallow ligament injury were found by CT diagnosis combined with Weber classification, 35 of which were consistent with MRI, 34 of which were consistent with MRI. The consistency of CT diagnosis combined with Weber typing and MRI diagnosis was stronger (P < 0.05). The consistency of X-ray combined with Weber typing and MRI diagnosis was stronger (P < 0.05). The sensitivity of combined CT and X-ray combined with Weber typing was significantly higher than that of single detection (P < 0.05). ConclusionThe sensitivity of X-ray, CT, examination combined with Weber classification in the diagnosis of the injury degree of tibiofibular syndesmosis is improved. The consistency with MRI is high, so it is recommended to promote the clinical application. -
Key words:
- injury of tibiofibular syndesmosis /
- MRI /
- X-ray /
- CT diagnosis /
- joint diagnosis
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图 1 CT诊断结合Weber分型在下胫腓联合损伤患者中的诊断
A, B:下胫腓联合损伤侧位及正位片; C:下胫腓联合损伤CT横断面; D:下胫腓联合损伤冠状位CT; E, F:下胫腓联合韧带损伤MRI不同矢状位截面
Figure 1. CT diagnosis combined with Weber typing in patients with lower tibiofibular syndesmosis injury
表 1 联合诊断效能分析
Table 1. Effectiveness analysis of joint diagnosis
诊断方法 真阳（n） 假阳（n） 真阴（n） 假阴（n） 准确率（%） 灵敏度（%） 特异度（%） 阳性预测值（%） 阴性预测值（%） 标准误 AUC 95%CI P 浅韧带（n=39） CT 12 6 5 16 43.59 70.59 23.81 42.86 45.45 11.231 0.775 0.520-0.872 0.017 MRI 19 5 11 4 76.92 63.33 73.33 82.61 68.75 9.252 0.603 0.600-0.746 0.000 联合检测 14 11 7 7 53.85 66.67 50.00 66.67 38.89 3.222 0.892 0.607-0.816 0.000 深韧带（n=36） CT 9 5 4 18 36.11 69.23 18.18 33.33 44.44 0.027 0.778 0.762-0.869 0.000 MRI 11 6 7 12 50.00 61.11 36.84 47.83 53.85 1.027 0.792 0.762-0.870 0.000 联合检测 15 7 10 4 69.44 60.00 71.43 78.95 58.82 2.027 0.832 0.760-0.871 0.000 
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