上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (11): 1513-.doi: 10.3969/j.issn.1674-8115.2017.11.011

• 论著（临床研究） • 上一篇    下一篇

4 种物理检查方法在前交叉韧带完全断裂诊断中的应用价值

吴宇峰 1*，陈亮 1*，高大伟 1#，王金武 2#   

  1. 1. 广东省中山市中医院骨科，中山 528400；2. 上海交通大学 医学院附属第九人民医院骨科，上海市骨科内植物重点实验室，上海  200011
  • 出版日期:2017-11-28 发布日期:2018-01-10
  • 通讯作者: 高大伟，电子信箱：Gaodawei0829@21cn.com。王金武，电子信箱：jinwu_wang@sohu.com。#共同通信作者
  • 作者简介:吴宇峰（1971—），男 , 主任医师，硕士；电子信箱：wyfdoc301@163.com。陈 亮（1981—），男，主治医师，硕士；电子信箱：chenliang211@163.com。 * 共同第一作者
  • 基金资助:
     国家重大科学研究计划（2011CB013300）；上海市卫生系统重要疾病联合攻关项目(2013ZYJB0501）；上海市教育委员会高峰高原学科建设计划 （20152224）；上海市卫生系统重要薄弱学科建设项目（2015ZB04904）；上海申康医院发展中心促进市级医院临床技能与临床创新三年行动计划（16CR3088B）； 中山市新型研发机构产业化项目（2016F2FC0019）

Evaluation of four physical examinations in diagnosis of complete rupture of anterior cruciate ligament

WU Yu-feng1*, CHEN Liang1*, GAO Da-wei1#, WANG Jin-wu2#   

  1. 1. Department of Orthopaedics, Hospital of Traditional Chinese Medicine of Zhongshan, Zhongshan 528400,China; 2. Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
  • Online:2017-11-28 Published:2018-01-10
  • Supported by:
    National Basic Research Program of China, 2012CB933604; Joint Research Project of Shanghai Municipal Important Diseases, 2013ZYJB0501; Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support, 20152224; Key Developing Disciplines program of Shanghai Health System, 2015ZB04904; Clinical Research Plan of Shanghai Hospital Development Center, 16CR3088B; Industrialization Project of New Research and Development Institutions in Zhongshan Grant Support, 2016F2FC0019

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摘要： 目的 · 探讨4 种物理检查方法在前交叉韧带完全断裂诊断中的应用价值。方法 · 对 2016 年 7 月 11 日—2017 年 6 月 10 日 100 例因单侧膝关节外伤初诊怀疑膝关节韧带或半月板损伤而接受手术治疗患者的资料进行回顾性分析。患者均接受以下物理检查： Lachman 试验、前抽屉试验、杠杆试验和轴移试验。以术中关节镜检查结果为金标准，对 4 种物理检查对于前交叉韧带完全断裂诊 断的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、准确度等进行综合性分析。结果 · 经关节镜检查证实， 100 例患者中确诊为前交叉韧带完全断裂 81 例；对于前交叉韧带完全断裂的患者，前抽屉试验、杠杆试验、轴移试验、Lachman 试验 的灵敏度分别为87.7%、100.0%、97.5%、96.3%，特异度分别为84.2%、78.9%、73.7%、63.2%，阳性预测值分别为95.9%、95.3%、 94.0%、91.8%，阴性预测值分别为 61.5%、100.0%、87.5%、80.0%，准确度分别为 87%、96%、93%、90%，阳性似然比分别为 5.6、 4.7、3.7、2.6，阴性似然比分别为0.1、0、0、0.1。结论 · 前抽屉试验确定前交叉韧带完全断裂最有效；杠杆试验排除前交叉韧带完 全断裂最有效，且敏感性强，易于操作，对于新鲜、急性损伤及患肢肿胀肥胖患者更为适宜，其诊断价值较高。

关键词: 前交叉韧带断裂, 物理检查, 诊断, 评价

Abstract:

Objective · To estimate the value of four physical examination methods in the diagnosis of anterior cruciate ligament complete rupture.  Methods · A retrospective study was conducted on 100 patients who underwent surgical treatment for knee joint injury from July 11, 2016 to June 10, 2017. They received four physical examinations including Lachman test, anterior drawer test, lever sign test and pivot shift test. The results of the arthroscopy inspections were used as gold standard. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, accuracy and other parameter of four physical examinations were comprehensively discussed.  Results · Arthroscopic examination confirmed that 81 patients had complete rupture of anterior cruciate ligament. The sensitivities of anterior drawer test, lever test, pivot shift test and Lachman test were 87.7%, 100.0%, 97.5% and 96.3%, and the specificities were 84.2%, 78.9%, 73.7% and 63.2%, respectively. The positive predictive values were 95.9%, 95.3%, 94.0% and 91.8%, while the negative predictive values were 61.5%, 100.0%, 87.5% and 80.0%, respectively. The accuracies were 87%, 96%, 93% and 90%,  respectively. The positive likelihood ratios were 5.6, 4.7, 3.7 and 2.6, while the negative ones were 0.1, 0, 0 and 0.1, respectively.  Conclusion · Anterior drawer test is the most effective in diagnosing the complete rupture of the anterior cruciate ligament, while lever sign test is the most effective in excluding one. Lever sign test is the most sensitive and easy to operate, especially for fresh bruise, acute injury, limb swelling and obesity, with high diagnostic value.

Key words: anterior cruciate ligament rupture, physical examination, diagnosis, evaluation

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