Acute knee trauma: role of ultrasound
Acute knee trauma: role of ultrasound
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DOI：
10.1007/s00330-006-0319-x
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发表时间：
2006-11-01
影响因子：
5.9
通讯作者：
Hauger, Olivier
中科院分区：
文献类型：
--
作者：
Bonnefoy, Olivier;Diris, Benoit;Hauger, Olivier
本研究的目的是确定高空间分辨率超声（US）在检测膝关节脂血的诊断准确性，并评估该体征作为关节内骨折的标准。48例临床怀疑膝关节骨折的患者在创伤后48小时内前瞻性地接受了常规X线摄影、超声检查和计算机断层扫描（CT）检查，以描述关节内骨折的直接（骨折线）和间接（关节脂血）体征。关节脂血症定义为股四头肌下隐窝的多层聚集。CT被认为是直接和间接骨折标准的金标准。31例（65%）患者的CT成像显示了关节内骨折的直接征象。在这些患者中，30例（97%）有关节脂血。26例患者（54%）的常规X线片显示关节内骨折。其中，18例（69%）有脂血关节病。超声检查不能显示关节内骨折的任何直接征象，但在29例（93%）经CT证实骨折的患者中显示关节脂血。这允许描述五分之四的隐匿性膝关节骨折。超声诊断脂血关节病的敏感性、特异性、阳性预测值和阴性预测值分别为97%、100%、100%和94%，而X线平片分别为55%、100%、100%和55%。以关节积脂血作为骨折诊断标准，超声诊断早期膝关节内骨折的敏感性、特异性、阳性预测值和阴性预测值分别为94%、94%、97%和89%，而常规X线片分别为84%、88%、93%和75%。我们的结论是，高分辨率超声通过显示方头肌下隐窝的关节脂血，是一种可靠和准确的技术，用于评估膝关节内骨折。
The purpose of this study was to determine the diagnostic accuracy of high spatial resolution ultrasonography (US) in the detection of lipohemarthrosis of the knee and to evaluate this sign as criteria of intra-articular fracture. Forty-eight patients with clinical suspicion of knee fracture were prospectively examined by conventional radiography, sonography examination and computed tomography (CT) within 48 h after trauma in order to depict direct (fracture line) and indirect (lipohemarthrosis) signs of intra-articular fracture. Lipohemarthrosis was defined as a multi-layered collection in the subquadricipital recess. CT was considered as the gold standard for both direct and indirect fracture criteria. CT imaging showed direct signs of intra-articular fracture in 31 patients (65%). Among these patients, 30 (97%) had a lipohemarthrosis. Conventional radiographs showed intra-articular fracture in 26 patients (54%). Among these, 18 (69%) had a lipohemarthrosis. Sonographic examinations could not depict any direct sign of intra-articular fracture but showed a lipohemarthrosis in 29 (93%) of patients with proven fracture via CT. This allowed the depiction of four out of five occult knee fractures. The sensitivity, specificity, positive predictive value, negative predictive value of sonography for the diagnosis of lipohemarthrosis was 97, 100, 100 and 94%, respectively, compared with 55, 100, 100 and 55% with conventional radiographs. Using lipohemarthrosis as criterion of fracture, the sensitivity, specificity, positive predictive value and negative predictive value of sonography for early detection of intra-articular knee fractures was 94, 94, 97 and 89%, respectively, compared with 84, 88, 93 and 75% with conventional radiographs. We concluded that, by showing lipohemarthrosis in the subquadricipital recess, high-resolution sonography is a reliable and accurate technique for the evaluation of intra-articular knee fractures.