MRI与术中外旋应力试验在旋后-外旋踝关节骨折中的应用价值比较

背景：旋后-外旋骨折占所有踝关节骨折的40%~75%。其治疗方式的选择主要依赖对内侧结构损伤程度的判断，特别是内侧三角韧带是否有损伤。循证医学的资料表明，术前MR扫描与术中外旋应力试验是判断三角韧带损伤的方法。那么，术前MR扫描是否可以替代术中应力试验，明确三角韧带损伤的情况并指导踝骨折采用保守治疗或手术治疗。本文试图通过手术验证两者的敏感性是否一致。目的：探讨MRI与术中外旋应力试验在判断踝关节旋后-外旋型损伤程度中的应用价值。方法：2008年1月至2012年12月，我院收治的Lauge-Hansen分型旋后-外旋型踝关节骨折患者，共计30例，术前常规行X线、MR扫描，记录踝关节内侧三角韧带损伤情况。麻醉后行踝关节外旋应力位摄片，依据踝关节内侧间隙是否正常判定三角韧带损伤情况。再比较外旋应力试验与MR结果。结果：MR扫描对三角韧带损伤情况判定，等同于术中外旋应力试验。结论：MRI对于判断三角韧带是否损伤有一定价值，可以指导旋后-外旋型踝关节骨折不同程度损伤的鉴别与治疗方法的选择。

A comparative study on MRI and stress test in determining supination-external rotation ankle fracture

Background：Lauge-Hansen supination external rotation （SER） ankle fractures account for 40%~75%of all ankle fractures. A SERⅡinjury is an isolated lateral malleolus fracture with an intact medial ligamentous complex and is amenable to non-operative treatment. A SERⅣinjury consists of a lateral malleolar fracture with a deep deltoid ligament disruption, a medi-al malleolar fracture, or both. Surgical treatment is usually required in SER Ⅳ fracture. So the treatment depends on the judgment of the injury of medial structure, especially the deltoid ligament. Results of evidence-based medicine show that both pre-operative MRI scanning and external rotation stress-test during operation can give guidance for treatment. But is the value of these two methods equivalent？ We want to compare and testify the results by operation. Objective：To compare the application of MRI with stress test in the treatment of SER injury of ankle. Methods：A retrospective study was conducted in 30 patients with SER ankle fracture treated in our hospital between Janu-ary 2008 and December 2012. Preoperative MRI scanning and X-ray examination of ankle joint were performed to assess the injury of deltoid ligament. Stress test was performed during operation and the medial sides of ankle were cut open to de-tect the integrity of deltoid ligament. Results：MRI scanning and stress test had the equal value in determining the injury of deltoid ligament. Conclusions：MRI scanning can determine the degree of deltoid ligament injury, and help to guide the treatment of supina-tion-external rotation injury of ankle.