高频超声诊断急性跟腓韧带损伤的临床价值

目的探讨高频超声诊断急性跟腓韧带损伤的临床价值。方法对临床单纯或合并有踝关节内翻扭伤者,使用高频线阵探头扫查踝关节外侧副韧带,重点观察跟腓韧带是否损伤。结果48例超声诊断为跟腓韧带损伤患者中,Ⅰ型30例,Ⅱ型12例,Ⅲ型6例,将跟腓韧带损伤各型的超声诊断例数与手术符合例数相比较,两者问差异无统计学意义（P〉0．05）。结论对于早期诊断跟腓韧带的损伤,高频超声是一种分辨力高、价廉、操作简便、用时短的影像学检查方法,值得临床推广运用。     

高频超声诊断踝关节外侧副韧带损伤的临床价值

目的探讨高频超声对踝关节外侧副韧带不同损伤类型分层诊断的价值。方法回顾性分析自2016-01—2018-02诊治的80例踝关节外侧副韧带损伤,以MRI检查与术中所见结果为标准,观察高频超声诊断踝关节外侧副韧带损伤类型准确性和敏感性。结果 MRI检查与术中结果一致,证实踝关节外侧副韧带未断裂16例(Ⅰ型),部分断裂39例(Ⅱ型),完全断裂25例(Ⅲ型)。高频超声诊断踝关节外侧副韧带损伤结果:Ⅰ型16例,Ⅱ型40例,Ⅲ型24例。以术中确定或MRI检查结果为标准,高频超声诊断踝关节外侧副韧带损伤的正确率为88.75%,且一致性较高(Kappa=0.702,P <0.001)。ROC分析结果显示,高频超声鉴别Ⅰ型与Ⅱ、Ⅲ型踝关节外侧副韧带损伤的曲线下面积为0.951(95%CI为0.895~1.000,P <0.001),灵敏度为96.0%,特异度为98.18%。结论高频超声分层诊断踝关节外侧副韧带损伤类型具有较高的准确性和敏感性,可以为临床治疗提供准确的信息。     

踝关节韧带损伤的治疗

踝关节韧带损伤 ,一般Ｘ线片上往往不能显示 ,不给予足够重视 ,处理不当 ,同样可以造成踝关节功能障碍。1　临床资料　　自 1996年元月至 1999年元月共治疗踝关节韧带损伤5 6例 ,男 35例 ,女 2 1例。其中距腓前韧带损伤 45例 ,平均年龄 43岁 ;距腓前韧带损伤伴跟腓韧带损伤 7例 ,平均年龄 36岁 ;胫腓下关节前后韧带损伤 4例 ,平均 46岁。诊断标准 :对踝关节急性损伤的患者 ,凡怀疑有韧带损伤 ,全部在局麻或跟骨阻滞麻醉下摄踝关节正侧应力位片。距腓前韧带损伤 :外踝前下方局部肿胀压痛Ｘ线片示距骨轻度倾斜并向前移位。距腓前韧带损伤伴跟…     

经高频超声分析跟骰关节周围韧带损伤的流行病学特点

目的通过高频超声技术探讨跟骰关节周围韧带损伤的流行病学及特点。方法分析2018年1月至2019年1月期间在我院经高频超声诊断跟骰关节周围韧带损伤的患者,并对跟骰关节周围韧带损伤患者的基本资料及合并损伤进行分析。结果经高频超声诊断的539例(跟骰关节周围韧带损伤和/或踝关节外侧韧带损伤)患者中,149例(27.6%)为跟骰关节周围韧带损伤,390例(72.4%)为单纯踝关节外侧韧带损伤。149例患者中52例为单纯跟骰关节周围韧带损伤,97例为跟骰关节周围韧带合并有踝关节外侧韧带损伤;男45例,女104例;左足73例(49%),右足76例(51%);年龄26~55岁的106例(71.1%)。分歧韧带跟骰部Ⅰ、Ⅱ、Ⅲ级损伤患者数分别为25.0%、15.6%、59.4%,跟骰背外侧韧带Ⅰ、Ⅱ、Ⅲ级损伤患者数分别为60.5%、23.7%、15.8%。结论在足踝部外侧韧带损伤的患者中,跟骰关节周围韧带损伤多见,且常合并踝关节外侧韧带损伤,女性损伤患者绝对数量多于男性,左右侧构成比接近,26~55岁为发病高峰。分歧韧带跟骰部损伤以Ⅲ级损伤多见,跟骰背外侧韧带损伤以Ⅰ级损伤多见。对于诊断跟骰关节周围韧带损伤,高频超声是一种不可或缺的诊断工具。     

高频超声对踝关节外侧副韧带不同损伤类型分层诊断的价值

目的对踝关节外侧副韧带进行高频超声检查,分析其对不同损伤类型分层诊断的价值。方法选取2019年6月至2020年6月于本院诊治的踝关节外侧副韧带损伤的患者192例,术前对所有患者均进行了高频超声检查。研究以MRI检查联合手术结果作为金标准,对高频超声诊断不同损伤类型的情况进行观察分析。结果经MRI检查,结果和手术结果一致,其中38例患者为损伤Ⅰ型,94例患者为损伤Ⅱ型,60例患者为损伤Ⅲ型。经高频超声诊断,结果 163例患者诊断为踝关节外侧副韧带损伤,其中30例为Ⅰ型,80例为Ⅱ型,53例为Ⅲ型。采用高频超声进行诊断的准确率为84.9%,其中Ⅱ型损伤的准确率为85.1%,Ⅲ型损伤准确率为88.3%。与MRI诊断相比,高频超声诊断准确率比较差异无显著性(P0.05)。结论对踝关节韧带损伤患者实施高频超声诊断具有较高的应用价值,该方式能够对损伤程度、类型等进行清晰显示,利于临床做出及时治疗方案。     

手术治疗踝关节外侧副韧带陈旧损伤26例

1995～ 1999年我们采用部分腓骨短肌腱重建韧带术治疗踝关节外侧副韧带陈旧损伤患者 2 6例 ,效果较好　材料与方法1.1　病例资料　本组 2 6例 ,男 2 2例 ,女 4例 ,年龄 19～ 45岁。前距腓韧带损伤 4例 ,跟腓韧带损伤 15例 ,后距腓韧带损伤 1例 ,前距腓韧带并跟腓韧带损伤 6例。并发创伤性关节炎 14例。病史最长 12年 ,最短 2年。检查 :向前应力踝关节侧位Ｘ线片示距骨内前半脱位 ,踝关节间隙增宽 >3ｍｍ ;踝关节前抽屉试验阳性 ;在健侧作对比下内翻应力踝关节正位Ｘ线片示距骨倾斜 10°～ 15°。1.2　治疗方法1.2 .1　前距腓韧带、跟腓韧带…     

X线片检查阴性踝关节外侧副韧带损伤的MRI分析

目的探讨MRI检查对X线片阴性踝关节外侧副韧带损伤的诊断价值。方法纳入自2015-06—2017-01因踝关节外伤就诊,踝关节X线片无阳性表现,伤后1~5 d经MRI检查确诊的39例踝关节外侧副韧带损伤。结果 39例MRI检查显示外侧副韧带损伤,主要表现为韧带形态和信号异常,在T2序列上表现为高信号。单条韧带损伤32例,其中距腓前韧带损伤29例(Ⅰ级10例,Ⅱ级15例,Ⅲ级4例),距腓后韧带1例(Ⅱ级),跟腓韧带损伤2例(Ⅰ级1例,Ⅱ级1例)。2条或2条以上复合韧带损伤7例,分别为距腓前韧带+距腓后韧带损伤1例(Ⅲ级),距腓前韧带+跟腓韧带损伤6例(Ⅱ级2例,Ⅲ级4例)。结论踝关节损伤X线片检查阴性时不能完全排除韧带损伤,特别是当患者疼痛严重、查体配合欠佳时行MRI进一步检查是必要的,可减少由于韧带损伤导致的踝关节不稳及并发骨性关节病。     

取腓骨短肌前部治疗距腓韧带及跟腓韧带陈旧性损伤的疗效分析

目的观察采用腓骨短肌前部治疗距腓韧带及跟腓韧带陈旧性损伤的临床疗效,寻找行之有效的踝关节外侧副韧带的重建方法。方法取腓骨短肌前部解剖重建距腓韧带及跟腓韧带,手术前后按踝关节系统评分(详见表1)。结果 27例患者术后平均随访12个月(5~24个月),在随访期间脚踝恢复情况良好,并且无明显复发情况。美国足踝外科(AOFAS)踝-后足功能评分由术前(51.3+3.5)分提高至术后(84.5±6.2)分,随访期间未发现踝关节不稳复发及其他并发症。结论腓骨短肌前部治疗距腓韧带及跟腓韧带陈旧性损伤,能有效恢复踝关节外侧不稳定,达到满意的疗效。     

高频肌骨超声诊断踝关节外侧副韧带损伤及其评估预后的价值

目的 对踝关节外侧副韧带进行高频超声检查，分析其诊断价值及其评估预后的价值。方法 选取2020年9月至2023年1月本院收治的踝关节外侧副韧带损伤患者64例，术前实施高频超声检查。依据MRI检查与手术情况为金标准，分析高频超声诊断价值。治疗后，采用高频肌骨超声与AOFAS评分评估患者踝关节恢复情况，依据AOFAS评分情况分为优良组与对照组，分析优良组与对照组高频肌骨超声评估预后结果。结果 MRI检查结果及手术结果显示，Ⅰ型损伤15例，Ⅱ型损伤37例，Ⅲ型损伤12例。经高频超声检查结果显示15例为Ⅰ型，38例为Ⅱ型，11例为Ⅲ型。以MRI检查结果 及手术结果 作为标准，高频超声诊断的正确率为0.835，且具有较高的一致性（P<0.05）；经ROC分析结果显示，高频超声诊断AUC值为0.942(95%CI:0.893～1.000)，灵敏度为0.915，特异度为0.967。与MRI检查与术中诊断结果相比，高频肌骨超声诊断并发损伤结果一致，差异无显著性（P>0.05）；对AOFAS评分的优良组与对照组进行高频肌骨超声诊断，结果两组间比较差异具有显著性（P<0.05）。高频肌骨...     

自体半腱肌腱重建距腓前韧带和跟腓韧带治疗踝关节外侧不稳

目的探讨自体半腱肌腱重建距腓前韧带和跟腓韧带治疗踝关节外侧不稳的临床效果及安全性。方法对16例踝关节外侧不稳患者行自体半腱肌腱重建距腓前韧带和跟腓韧带手术,观察踝关节功能情况。结果患者均获得随访,时间1~3年。术后6、12个月摄踝关节内翻应力位X线片未见距骨倾斜,均未发生复发踝关节外侧不稳。术后AOFAS评分为83.52分±7.26分,明显高于术前的50.45分±4.58分。踝关节功能评定:优8例,良7例,可1例。结论自体半腱肌腱重建距腓前韧带和跟腓韧带治疗踝关节外侧不稳疗效确切,安全性高,是一种较为理想的术式。     

Comparative results of conservative treatments for isolated anterior talofibular ligament (ATFL) injury and injury to both the ATFL and calcaneofibular ligament of the ankle as assessed by subtalar arthrography

Background There have been no reports describing the results of conservative treatment of acute lateral ligament injury of the ankle in detail in terms of the severity of the injury, and the results of conservative treatment for injury with severe instability are still controversial. The purpose of this study was to assess the results of nonoperative treatment of acute lateral ligament injury according to its severity. Methods Fifty-five consecutive acute lateral ankle ligament injuries in 54 patients who were treated nonoperatively were followed up as a prospective study. Twenty-seven were male patients and 27 were female patients; the average age was 23.9 years (12–55 years). The patients were divided into two groups according to the extent of the ligament injury: patients with an isolated injury of the anterior talofibular ligament and those with combined injuries of the anterior talofibular ligament and the calcaneofibular ligament. In addition to the routine examinations for inversion ankle sprain, subtalar arthrography was mainly used to assess the condition of the calcaneofibular ligament. The arthrography was performed an average of 3.5 days after the injury (0–5 days). Results Fifty-five ankles of patients who were treated nonoperatively according to the same protocol were included in this study, and were followed up for an average of 5.0 years (37–86 months). At the time of the final follow-up, 22 of 25 (88%) ankles with an isolated injury to the anterior talofibular ligament were asymptomatic; in contrast, only 9 of 30 (30%) ankles with combined injuries of the anterior talofibular and calcaneofibular ligament were asymptomatic. The average American Orthopaedic Foot and Ankle Society score of the isolated injuries was 97.8 points, in contrast to 92.4 points for the combined injuries. Conclusions The results of nonoperative treatment with 1 week immobilization followed by a functional brace were excellent in patients with an isolated injury of the anterior talofibular ligament, but were unsatisfactory in those with combined injuries of the anterior talofibular and calcaneofibular ligaments.     

A Rare Pattern of Ligamentous Injury of the Ankle: A Case Report and Review of the Literature

Ankle sprains are the most frequent sport related injuries with involvement of the lateral collateral ligament complex occurring in 85% of cases. Isolated anterior talofibular ligament injury is by far the commonest followed by combined anterior talofibular and calcaneofibular ligament strain. The posterior talofibular ligament is the strongest component of the lateral collateral ligament complex and is injured in severe ankle injury along with the other lateral collateral ligaments. While isolated calcaneofibular ligament strain has been reported, calcaneofibular ligament and posterior talofibular ligament strains with an intact anterior talofibular ligament are rare and reported in cadaveric studies. We present a case of radiologically diagnosed calcaneofibular ligament and posterior talofibular ligament injury and will discuss the anatomy, stress radiography, and magnetic resonance image findings and the mechanism of this particular injury.     

Diagnostic Value of Ultrasound in Ankle Sprain

The present study aimed to evaluate the sensitivity and specificity of clinical tests and ultrasonography in detecting ankle ligament injuries. In this cross-sectional study, 105 patients with a history of ankle sprain were included. Ankle ligaments, including syndesmosis of ankle, as well as deltoid, calcaneofibular, anterior talofibular, and posterior talofibular ligaments were evaluated by clinical tests, ultrasonography, and magnetic resonance imaging. The sensitivity and specificity of ultrasound and clinical tests were assessed in normal, sprain, partial tear, and complete tear groups. The inter-observer reliability (Cohen's Kappa score) of the evaluated techniques with magnetic resonance imaging was assessed. Anterior drawer test showed a sensitivity and specificity of 81 and 80% in the detection of anterior talofibular ligament injuries, respectively. Ultrasonography showed 100% sensitivity and specificity in distinguishing normal anterior talofibular ligament from the torn or sprained ligament with a kappa value of 1. The sensitivity of ultrasonography in detecting normal calcaneofibular ligament and deltoid ligament was 93% and 90%, respectively. Ultrasonography was highly specific in detecting calcaneofibular ligament tear but it was not sensitive in this regard. Ultrasonography was proved reliable in determining the normal anterior talofibular ligament and calcaneofibular ligament from the torn or sprained ligament. Ultrasonography is an effective complementary tool for primary evaluation of ankle injuries, which leads to early diagnosis and efficient quality of care. Clinical tests are not reliable to rule out the ankle ligaments injury and the results should be interpreted with caution.     

Ruptures of the Lateral Ligaments of the Ankle: Clinical Diagnosis

During the 11-month period 1 October 1977 to 31 August 1978 a total of 44 patients with acute supination trauma of the ankle were examined. The clinical findings were compared with the results of arthrography. This revealed that direct and indirect tenderness of the anterior talofibular ligament and calcaneofibular ligament respectively, combined with a ≧ 4 cm swelling anteriorly and over the lateral malleolus, indicated a ligament injury with great likelihood. If some of the diagnostic signs are absent, most emphasis should be laid on the swelling over the lateral malleolus and on the direct and indirect tenderness of the calcaneofibular ligament. The talar-tilt test and examination for the drawer sign were of limited diagnostic value.     

Acute and chronic lateral ankle instability in the athlete

Ankle sprain injuries are the most common injury sustained during sporting activities. Three-quarters of ankle injuries involve the lateral ligamentous complex, comprised of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). The most common mechanism of injury in lateral ankle sprains occurs with forced plantar flexion and inversion of the ankle as the body's center of gravity rolls over the ankle. The ATFL followed by the CFL are the most commonly injured ligaments. Eighty percent of acute ankle sprains make a full recovery with conservative management, while 20% of acute ankle sprains develop mechanical or functional instability, resulting in chronic ankle instability. Treatment of acute ankle sprains generally can be successfully managed with a short period of immobilization that is followed by functional rehabilitation. Patients with chronic ankle instability who fail functional rehabilitation are best treated with a Brostrom-Gould anatomic repair or, in those patients with poor tissue quality or undergoing revision surgery, an anatomic reconstruction.     

Subtalar arthrography in recurrent instability of the ankle.

Subtalar arthrography was done in 37 feet of 35 patients in whom recurrent instability of the ankle was diagnosed. There were 16 male and 19 female patients, with a mean age of 29.1 years (range, 11-56 years). The mean interval between the injury and arthrography was 4 years 3 months (range, 6 months-22 years). Anteroposterior, lateral, and oblique radiographs were obtained for all patients. Any leakage during arthrography into the ankle, tendon sheaths, or sinus tarsi was recorded. An oblique view of the microrecess along the interosseous ligament and an anteroposterior view of the lateral recess just under the end of the fibula were examined. At surgery, 13 feet had combined injuries of the anterior talofibular and calcaneofibular ligaments, and 24 feet had isolated injury of the anterior talofibular ligament. The findings of the two groups were significantly different when examined for leakage into the ankle, leakage into the peroneal tendon sheath, and the presence of the lateral recess. Presence of contrast medium in at least two of these three positive arthrographic findings showed 92.3% sensitivity and 87.5% specificity in making the diagnosis of calcaneofibular ligament injury. Subtalar arthrography is valuable in making the diagnosis of calcaneofibular ligament injury in recurrent instability of the ankle.     

踝关节周围韧带损伤对距骨稳定性影响的有限元分析

目的有限元法分析踝关节周围韧带损伤对距骨生物力学稳定性的影响,为临床踝关节周围韧带损伤的治疗提供理论依据。方法基于正常男性的足踝部螺旋CT扫描数据,运用三维重建软件,建立足踝部三维几何模型,最后导入Abaqus 6.9软件中,模拟人体踝关节内旋、外旋的受力状况,分析踝关节周围韧带损伤后距骨各关节面的接触压力及VonMises应力分布。结果建立包括骨、软骨、韧带在内的正常人体足踝部三维有限元模型,踝关节周围韧带在踝关节内旋、外旋时对距骨的生物力学影响不同。结论在外旋作用力下胫距后韧带对踝关节的稳定性具有重要作用,而在内旋作用力下跟腓韧带对踝关节的稳定性具有重要作用。     

自体腓骨短肌腱重建距腓前韧带和跟腓韧带治疗慢性踝关节外侧不稳定

目的:探讨自体腓骨短肌腱重建距腓前韧带和跟腓韧带治疗慢性踝关节外侧不稳定的临床疗效.方法:回顾性分析2016年7月至2019年7月采用自体腓骨短肌腱解剖重建距腓前韧带和跟腓韧带治疗的42例慢性踝关节外侧不稳定患者,其中男30例,女12例;年龄25～46(37.6±12.4)岁;左足15例,右足27例;受伤至手术时间3～...     

Stress test and anatomical study of the lateral collateral ligaments of the ankle

Many authors have discussed on the instability of the ankle joint. We have therefore investigated the variety, courses and the functions of the lateral collateral ligament by dissecting 16 freshly amputated limbs. It was composed of 4 ligaments, i.e., the anterior talofibular, the posterior talofibular, the calcaneofibular and the lateral talocalcaneal ligaments. These ligaments have various courses and influence the stability of the ankle joint in various manners. Transection of the anterior talofibular ligament alone caused inversion and forward instability, and transection of calcaneofibular ligament alone caused adduction instability of the ankle and subtalar joint, but posterior talofibular and the lateral talocalcaneal ligament and other ligaments, however, played an important role in the stability of the ankle joint, so that injuries of the anterior talofibular ligament or the calcaneofibular ligament caused varying degrees of instability in this joint. Conclusion: To evaluate this injury the following methods of taking X-ray pictures are indispensable, namely, stress inversion, stress anterior drawer, and stress adduction radiography.