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。     

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…     

踝关节慢性前外侧不稳的手术治疗

目的: 探讨治疗踝关节慢性前外侧不稳定 (踝关节外侧不稳定合并距下关节不稳定) 的合理而有效的手术方式。方法: 自 1999 ~2003年, 应用Chrisman Snook术式, 以腓骨短肌腱前半部分重建距腓前韧带、跟腓韧带和距跟外侧韧带,治疗踝关节慢性前外侧不稳 8例患者,共 13例关节。结果: 术后随诊 6个月~5年, 平均 19个月。术后所有踝关节均达到功能稳定, 关节活动度基本恢复正常, 没有复发性踝关节不稳发生。以Good评级标准作为疗效评价, 10例关节 (77% ) 为优, 2例关节 (15% ) 为良, 1例关节为中 (7% ), 优良率达 92%。结论: Chrisman Snook术式重建了距腓前韧带、跟腓韧带和距跟外侧韧带, 有效地矫正了踝关节外侧不稳定和距下关节不稳定, 是治疗踝关节慢性前外侧严重不稳定的合理而有效的治疗方法。     

距腓前韧带损伤的MRI诊断价值及临床研究

目的讨论距腓前韧带损伤临床机理及MRI诊断价值。方法回顾性分析2009年1月至2011年12月在本院诊治的距腓前韧带损伤病人20例,所有患者均行MRI常规TSE序列轴位、矢状位、冠状位及矢状位SPIR序列扫描并经临床及切开手术证实。结果全部病例均显示距腓前韧带损伤的MRI表现,其中12例早期完全恢复,6例不同程度恢复延迟,2例遗留创伤性关节炎表现。结论踝关节内翻损伤中,距腓前韧带是最常损伤的韧带,MRI检查具有高度敏感性及良好诊断价值,可为临床早期诊断与治疗提供依据。     

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 观察高频肌骨超声诊断踝关节外侧副韧带损伤的图像特征,探讨高频肌骨超声评估韧带损伤预后的临床价值。方法 纳入自2019-06—2020-12诊治的98例踝关节外侧副韧带损伤,所有患者入院后常规进行高频肌骨超声检查,以MRI检查或手术探查结果为金标准,比较高频肌骨超声检查踝关节外侧副韧带损伤类型和损伤程度的准确性。Ⅰ度与轻Ⅱ度踝关节外侧副韧带损伤患者采取非手术治疗,重Ⅱ度及Ⅲ度踝关节外侧副韧带损伤患者进行手术治疗,采用高频肌骨超声评估损伤踝关节外侧副韧带恢复程度。结果 高频肌骨超声明确诊断90例踝关节外侧副韧带损伤,8例无法确诊,准确率为91.8%。高频肌骨超声确诊的90例踝关节外侧副韧带损伤中,单纯距腓前韧带损伤64例,单纯跟腓韧带损伤16例,距腓前韧带合并跟腓韧带损伤7例,距腓后韧带损伤3例;Ⅰ度损伤16例,轻Ⅱ度损伤20例,重Ⅱ度损伤22例,Ⅲ度损伤32例。高频肌骨超声诊断踝关节外侧副韧带损伤类型、损伤程度的准确性与金标准比较,差异无统计学意义(P>0.05)。结论 高频肌骨超声诊断踝关节外侧副韧带损伤的准确率高,可确定韧带损伤类型及程度,具有无创、快速、可重复性强、随访...     

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…     

踝关节创伤的MRI应用

MRI作为一种可全面评价骨与软组织损伤的检查手段,目前在踝关节的应用主要集中于韧带损伤、距骨骨软骨损伤、以及踝周肌腱病变等方面。一、外侧副韧带损伤踝部最易损伤的韧带为外侧副韧带,多发生在足跖屈、内翻内旋时,以距腓前韧带的损伤最为常见,其次为跟腓韧带损伤,距腓后韧带损伤则较为罕见。MRI横断面为诊断距腓前韧带损伤的最重要方位,常可在单     

前交叉韧带损伤:3.0TMR影像与关节镜对照分析

目的分析膝关节前交叉韧带损伤的3．0TMRI特征,并与关节镜手术结果对照。方法回顾性分析来我院行3．0T MR膝关节检查的36例前交叉韧带损伤患者的40个膝关节,全部病例经关节镜检查确诊。应用3．0T MR机（Philips Achieva型）,膝关节专用线圈,进行斜矢状位TSE T1WI、TSE T2WI、PD-SPIR和冠状位、轴位TSE T2WI扫描。前交叉韧带损伤分为完全断裂、撕裂（部分断裂）及胫骨端撕脱。将膝关节前交叉韧带损伤的3．0T MR影像特征与关节镜手术结果进行对照分析。结果前交叉韧带完全断裂MRI直接征象表现为韧带连续性中断,断端肿胀（21／25）,间接征象为交叉韧带过度弯曲、T2WI和PD-SPIR股骨髁间窝外侧骨挫伤;MRI与关节镜诊断完全符合率为84．00％。前交叉韧带撕裂（部分断裂）MRI直接征象为ACL矢状T2WI和PD-SPIR显示形态不规则、部分撕裂,ACL局部肿胀增粗,信号增高,仍可见连续存在的纤维低信号;MRI与关节镜诊断完全符合率为66．67％。前交叉韧带胫骨端撕脱MR检查直接征像为胫骨近端可见T1WI、T2WI低信号撕脱骨片（3／3）,ACL水肿、形态不规则,周围可见出血、积液,MRI与关节镜诊断符合率为100％。结论高场强3．0TMR膝关节诊断的多平面、多序列影像相结合可形成ACL立体影像观,结合临床能够有效诊断ACL损伤。     

踝关节镜探查并距腓前韧带重建治疗习惯性踝关节扭伤

目的评价踝关节镜探查清理合并腓骨短肌腱重建距腓前韧带治疗习惯性踝关节扭伤的临床疗效。方法自2007年9月至2008年10月,对13例习惯性踝关节扭伤患者行踝关节镜探查清理合并腓骨短肌腱重建距腓前韧带治疗。患者年龄16～54岁,平均31.5岁,术前病程3～36个月,平均11.3个月。所有患者术前有距腓前韧带不同程度损伤,关节滑膜增生,踝关节前侧关节囊撕裂。手术先行踝关节镜探查清理,外踝下小切口取部分腓骨短肌腱,腓骨上锚入式重建距腓前韧带。结果 13例患者术后平均随访12.5个月（6～21个月）,美国足踝外科（AOFAS）踝-后足功能评分术前56.3±3.5分（44～70分）,术后85.6±5.1分（78～96分）,且随访期间未发现踝关节不稳复发或其他并发症。结论踝关节镜探查清理合并腓骨短肌腱锚入式重建踝关节距腓前韧带,是治疗距腓前韧带损伤导致的习惯性踝关节扭伤一种安全、有效的方法。     

慢性踝关节外侧不稳的手术治疗

踝关节扭伤是最常见的运动损伤,有报道在美国每天有23 000个踝关节扭伤[1].踝关节的外侧稳定性由骨性结构和韧带、肌肉结构共同维持,其中外侧韧带包括距腓前韧带(ATFL)、跟腓韧带(CFL)和距腓后韧带(PTFL).因解剖结构的特点,外侧韧带最易损伤,其中又以ATFL受损最常见,约占66.6%,CFL损伤次之,占20%[2],PTFL则极少损伤.有报道称[3],在一次踝关节急性扭伤后,有20%～40%的人会发展为慢性踝关节不稳.     

Finite element analysis of the influence of anterior talofibular ligament injury on Hook test results

AimTo determine whether the anterior talofibular ligament injury will influence the Hook test result.MethodA three-dimensional model of the ankle was established based on CT scan of a healthy volunteer and ligament attachment through references; Four groups (A–D) of operating conditions were set up. In group A, the anterior and posterior ligaments of the inferior tibiofibular joint were cut off and the anterior talofibular ligament was kept intact; in group B, all the anterior and posterior tibiofibular ligaments and the anterior talofibular ligament were cut off; in group C, the medial and lateral ligaments of the ankle joint and the inferior tibiofibular ligament were kept intact; in group D, only the talofibular ligament was cut off and other ligaments were kept intact. The proximal end of the model was restrained in all four groups, an outward pulling force of 100 N perpendicular to the fibula was applied, and displacement and rotation of the distal end of the fibula in the four groups was observed.ResultsWhen the inferior tibiofibular joint injury was associated with an anterior talofibular ligament injury, the Hook test indicated about 3.19 mm of displacement of the distal end of the fibula, and obvious external rotation occurred due to increased activity of the anterior border of the fibula. In the other groups, a single inferior tibiofibular joint injury or a single anterior talofibular ligament injury did not increase displacement or rotation of the distal end of the fibula.     

Changes in the flexibility characteristics of the ankle complex due to damage to the lateral collateral ligaments: An in vitro and in vivo study

This study was part of a long-term effort to develop a reliable diagnostic procedure for ankle ligament injuries. Earlier efforts led to the development and validation of a six-degrees-of-freedom instrumented linkage capable of measuring the flexibility characteristics of the ankle complex in vitro and in vivo. The major goal of the present study was to determine if these flexibility measurements are sufficiently sensitive to detect the presence of damage to the lateral collateral ligaments of the ankle joint both in vitro and in vivo. The in vitro testing was conducted on the legs from six fresh cadavers before and after serial sectioning of the anterior talofibular ligament and the calcaneofibular ligament. The flexibility in inversion-eversion, anterior drawer, and internal-external rotation was measured before and after resection of the ligaments. The in vivo testing was conducted on five patients with unilateral injuries to the ankle ligament. The flexibility evaluation used for in vitro specimens was also performed on both the injured and the intact ankles. For the in vitro testing, the data analysis was based on comparison of flexibility values before and after resection of the ligaments, whereas the data analysis for the in vivo testing was based on comparison of the flexibility of the injured joint with that of the intact contralateral joint. The results of the in vitro study indicated that both an isolated rupture of the anterior talofibular ligament and combined damage of the anterior talofibular and calcaneofibular ligaments produce statistically significant changes in flexibility. Furthermore, the most sensitive parameters to the presence of ligament injuries were found to be early flexibility in anterior drawer, early flexibility in inversion, and the amount of coupling between internal rotation and inversion. These parameters provided a basis for differentiating between an isolated injury to the anterior talofibular ligament and a combined anterior talofibular and calcaneofibular ligament injury. For an isolated anterior talofibular ligament injury, a significant increase in flexibility in anterior drawer was present, whereas the increase in inversion flexibility or in the amount of coupling was insignificant. However, the increases in inversion flexibility and the amount of coupling became significant when both ligaments were involved. The results of the in vivo study indicated that significant changes in flexibility can be detected in patients with lateral ankle injuries. Finally, both the in vitro and in vivo results suggest that development of a reliable diagnostic test for ankle ligament injury based on changes in passive flexibility may be possible.     

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.     

Associations between MRI Findings and Symptoms in Patients with Chronic Ankle Sprain

Magnetic resonance imaging (MRI) provides an accurate method of observing and diagnosing injuries of the ligament complex of the ankle. However, the association between ankle symptoms and MRI findings has been unclear. The purpose of the present study was to evaluate the relationship between ankle pain and MRI findings. This prospective study included 40 patients with ankle pain after inversion injury and 10 healthy volunteers. Correlations among the ankle symptoms (tenderness on the anterior talofibular ligament, pain during varus stress in a neutral and plantarflexed ankle), and MRI findings were analyzed. A complete tear of the anterior talofibular ligament correlated with ankle pain during varus stress in the neutral position (r = 0.365, p = .031) and tenderness at the anterior talofibular ligament (r = 0.362, p = .032). The results of our study suggest that a complete tear of the anterior talofibular ligament will correlate with lateral ankle pain.     

3D MRI evaluation of morphological characteristics of lateral ankle ligaments in injured patients and uninjured controls

BackgroundWith ultrasonography or 2D magnetic resonance imaging (MRI) of the lateral ankle ligament, it is particularly difficult to show the entire calcaneofibular ligament (CFL). The purpose of this study was to evaluate the morphological characteristics of the lateral ankle ligaments in injured patients and uninjured controls using 3D MRI.MethodsA total of 64 ankles of 59 healthy volunteers and lateral ligament injury patients (mean age of 32.4 years) were examined. The 64 ankles included a healthy group of 11 ankles, an acute injury group of 12 ankles that underwent MRI a month after injury, and a chronic injury group of 41 ankles that underwent MRI more than 3 months after injury. Using a 3.0-T MRI system, imaging was done with fast imaging employing steady-state acquisition cycled phases. Oblique sagittal images that most clearly depicted the entire anterior talofibular ligament (ATFL) and CFL were prepared manually and evaluated using a workstation.ResultsIn the healthy group, both the ATFL and CFL were clearly and entirely visualized. The mean width in the central portion was 4.0 ± 1.0 mm in the ATFL and 4.8 ± 0.6 mm in the CFL. 3D MRI in the acute injury group showed findings of diffuse swelling with hyperintensity in the ATFL of all patients. The CFL in 7 of 12 ankles showed findings of diffuse swelling with hyperintensity. In the chronic injury group, morphological abnormalities of the ATFL were seen in 19 of 41 ankles. The ligament signal disappeared in 2 ankles, thinned in 4 ankles, and showed swelling in 13 ankles. Morphological abnormalities of the CFL were seen in 17 of 41 ankles. The ligament signal disappeared in 1 ankle, thinned in 2 ankles, and showed swelling in 14 ankles.Conclusion3D MRI may be a useful modality to visualize both the ATFL and the CFL.     

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.     

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.     

膝关节韧带损伤的MRI诊断价值

目的:探讨膝关节韧带损伤的MRI特点与诊断价值。方法:收集2008年6月至2010年2月经MRI检查的74例膝关节损伤患者,男47例,女27例;年龄12～76岁,平均37.3岁;病程2h～10d。临床表现为膝关节肿胀、疼痛,关节不稳、伸屈活动障碍,外翻试验、抽屉试验阳性,膝内侧明显压痛。对其MRI表现进行回顾性分析。结果:74例韧带损伤,其中前交叉韧带19例,后交叉韧带18例,外侧副韧带13例,内侧副韧带24例。韧带完全断裂12例,其中8例交叉韧带MR表现为韧带的连续性中断、断端回缩,局部或弥漫性肿胀,PDWI上呈中等信号,T2WI和脂肪抑制序列呈高信号;4例侧副韧带MR表现为韧带连续性中断或韧带肿胀增粗,PDWI上呈中等信号,T2WI和脂肪抑制序列呈高信号。部分纵形撕裂62例,MR表现为韧带连续性完整,韧带增粗,PDWI上呈中等信号,T2WI和脂肪抑制序列呈高信号。经手术、关节镜检查确诊44例,与MRI诊断相符41例。结论:MRI能诊断膝关节韧带损伤,是一种理想的诊断膝关节外伤的检查方法,宜作为常规检查。     

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.     

Usefulness of oblique axial scan in magnetic resonance imaging evaluation of anterior talofibular ligament in ankle sprain

The purpose of the present study was to clarify the usefulness of the oblique axial scan parallel to the course of the anterior talofibular ligament in magnetic resonance imaging of the anterior talofibular ligament in patients with chronic ankle instability. We evaluated this anterior talofibular ligament view and routine axial magnetic resonance imaging planes of 115 ankles. We diagnosed the grade of the anterior talofibular ligament injury and confirmed full-length views of the anterior talofibular ligament. Associated lesions were also checked. The subjective diagnostic convenience of associated problems was determined. The full-length view of the anterior talofibular ligament was checked in 85 (73.9%) patients in the routine axial view and 112 (97.4%) patients in the anterior talofibular ligament view. The grade of injury increased in the anterior talofibular ligament view in 26 (22.6%) patients compared with the routine axial view. There were 64 associated injuries. The anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, and posterior tibialis tendinitis were more easily diagnosed on the routine axial view than on the anterior talofibular ligament view. An additional anterior talofibular ligament view is useful in the evaluation of the anterior talofibular ligament in patients with chronic ankle instability.