4种物理检查方法在前交叉韧带完全断裂诊断中的应用价值

发布时间：2018-10-09 17:40

【摘要】：目的·探讨4种物理检查方法在前交叉韧带完全断裂诊断中的应用价值。方法·对2016年7月11日—2017年6月10日100例因单侧膝关节外伤初诊怀疑膝关节韧带或半月板损伤而接受手术治疗患者的资料进行回顾性分析。患者均接受以下物理检查:Lachman试验、前抽屉试验、杠杆试验和轴移试验。以术中关节镜检查结果为金标准,对4种物理检查对于前交叉韧带完全断裂诊断的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、准确度等进行综合性分析。结果·经关节镜检查证实,100例患者中确诊为前交叉韧带完全断裂81例;对于前交叉韧带完全断裂的患者,前抽屉试验、杠杆试验、轴移试验、Lachman试验的灵敏度分别为87.7%、100.0%、97.5%、96.3%,特异度分别为84.2%、78.9%、73.7%、63.2%,阳性预测值分别为95.9%、95.3%、94.0%、91.8%,阴性预测值分别为61.5%、100.0%、87.5%、80.0%,准确度分别为87%、96%、93%、90%,阳性似然比分别为5.6、4.7、3.7、2.6,阴性似然比分别为0.1、0、0、0.1。结论·前抽屉试验确定前交叉韧带完全断裂最有效;杠杆试验排除前交叉韧带完全断裂最有效,且敏感性强,易于操作,对于新鲜、急性损伤及患肢肿胀肥胖患者更为适宜,其诊断价值较高。
[Abstract]:Objective to explore the value of four physical examination methods in the diagnosis of complete rupture of anterior cruciate ligament (ACL). Methods from July 11, 2016 to June 10, 2017, 100 patients who received surgical treatment for unilateral knee joint trauma due to suspected ligament or meniscus injury were retrospectively analyzed. The patients underwent the following physical tests: the: Lachman test, the front drawer test, the lever test, and the shaft shift test. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio of the four physical examinations for the diagnosis of complete rupture of anterior cruciate ligament were taken as gold standard. The accuracy is analyzed comprehensively. Results among the 100 cases confirmed by arthroscopy, 81 cases were diagnosed as complete rupture of anterior cruciate ligament, and 81 cases were diagnosed as complete rupture of anterior cruciate ligament, and the anterior drawer test and lever test were performed on the patients with complete rupture of anterior cruciate ligament. The sensitivity of the Lachman test was 87.70.100.00.The sensitivity of the Lachman test was 87.70.00.The sensitivity was 84.28.9 and the specificity was 84.28.78.73.70.The positive predictive value was 95.8, the negative predictive value was 61.5100.087.50.The accuracy was 874.9696 / 93390,the positive likelihood ratio was 5.64.73.73.72.6and the negative likelihood ratio was 0.100.087.50.The positive likelihood ratio was 5.64.73.73.72.6and the negative likelihood ratio was 0.100.087.50.The positive likelihood ratio was 5.64.73.73.72.60.The negative predictive value was 87.57.50.The accuracy was 874.9696 / 93900.The positive likelihood ratio was 5.64.73.73.72.6. Conclusion anterior drawer test is the most effective method to determine the complete rupture of anterior cruciate ligament (ACL), the lever test is the most effective, sensitive and easy to operate, and is more suitable for fresh, acute injury and swollen obesity patients. Its diagnostic value is high.
【作者单位】：广东省中山市中医院骨科;上海交通大学医学院附属第九人民医院骨科上海市骨科内植物重点实验室;
【基金】：国家重大科学研究计划(2011CB013300) 上海市卫生系统重要疾病联合攻关项目(2013ZYJB0501) 上海市教育委员会高峰高原学科建设计划(20152224) 上海市卫生系统重要薄弱学科建设项目(2015ZB04904) 上海申康医院发展中心促进市级医院临床技能与临床创新三年行动计划(16CR3088B) 中山市新型研发机构产业化项目(2016F2FC0019)~~
【分类号】：R687

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