陈旧性前十字韧带损伤的诊断

目的评估前抽屉试验、Lachman试验、轴移试验和MRI在陈旧性前十字韧带损伤诊断中的意义。方法107例手术证实为陈旧性前十字韧带损伤患者,术前均行前抽屉试验、Lachman试验、轴移试验和MR检查。术后计算各项检查的敏感性,并分析产生假阴性的原因。结果前抽屉试验的阳性率为78.5%,Lachman试验为97.2%,轴移试验为91.6%,而MRI敏感性为93.5%。10例患者的关节镜检查显示前十字韧带近侧撕裂端再附着于后十字韧带。在此10例中,前抽屉试验的阳性率为60%,Lachman试验为80%,轴移试验为60%,而MRI敏感性为40%。本组9例轴移试验假阴性的患者中,有4例为撕裂的前十字韧带再附着于后十字韧带而替代了部分前十字韧带的功能,因此关节镜下显示胫骨外侧髁半脱位受限。2例Lachman试验假阴性的患者经关节镜证实为前十字韧带断端再附着伴有半月板桶柄样撕裂。在10例再附着患者中有3例MRI表现为韧带倾斜度变化。结论Lachman试验对诊断陈旧性前十字韧带损伤敏感性最高。MRI和轴移试验较敏感,但结果受MR检查技术和伴发损伤等诸多因素的影响。

Diagnosis of chronic injury of anterior cruciate ligament

Objective To estimate the value of anterior drawer test, Lachman test, pivot shift test and MRI in diagnosis of chronic anterior cruciate ligament injury. Methods One hundred and seven patients with the diagnosis of chronic injuries of the anterior cruciate ligament arthroscopically underwent the anterior drawer test, Lachman test, the pivot shift test and MR examination before operation. The sensitivity of each examination was calculated and the causes of false negative was analyzed postoperatively. Results 78.5%of the patients had positive anterior drawer test, 97.2% had positive Lachman test and 91.6% had positive pivot shift test. The sensitivity of MRI was 93.5%. In 10 cases (9.35%), arthroscopic examination showed reattachment of the proximally torn end of anterior cruciate ligament to the posterior cruciate ligament. Of those, 60% had positive anterior drawer test, 80% had positive Lachman test and 60% had positive pivot shift test. The sensitivity of MRI was 40%. Nine cases with a false negative pivot shift test, arthroscopy showed blockage of anterior subluxation of the lateral tibial condyle by a partially functioning portion of the anterior cruciate ligament, which was reattached to the posterior cruciate ligament in 4 cases. In 2 cases with a false negative Lachman test, there was firm reattachment of the torn end of anterior cruciate ligament to the proximal portion of the posterior cruciate ligament combined with a bucket handle tear of the medial meniscus. In 10 cases with reattachment, the obliquity of ligament on MRI was changed in 3 cases. Conclusion The Lachman test was most sensitive in diagnosing chronic injuries of the anterior cruciate ligament. The pivot shift and MRI were also sensitive but were influenced by many factors such as MR technique and concomitant injury.