| 丁明,廖炳辉,上官磊,等.踝关节距腓前韧带应力位前抽屉试验的诊断效力评估.骨科,2026,17(2): 132-135. |
| 踝关节距腓前韧带应力位前抽屉试验的诊断效力评估 |
| Diagnostic efficacy assessment of stress anterior drawer test in ankle joint anterior talofibular ligament injuries |
| 投稿时间：2025-05-21 |
| DOI：10.3969/j.issn.1674-8573.2026.02.007 |
| CN KeyWords: 距腓前韧带 关节镜 体格检查 踝关节 |
| EN KeyWords: Anterior talofibular ligament Arthroscopy Physical examination Ankle joint |
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| CN Abstract: |
| 目的 评估应力位前抽屉试验对距腓前韧带（anterior talofibular ligament，ATFL）损伤的诊断效力。方法 本队列研究收集了2024年5月至2024年11月经门诊诊断为ATFL损伤的41例患者，由3名医师分别完成标准前抽屉试验及应力位前抽屉试验，以关节镜探查为诊断金标准，记录两种体格检查方法的阳性、阴性、假阳性、假阴性结果，计算两种方法的灵敏度、特异度、诊断准确率、阳性预测值及阴性预测值，并检验临床医师体格检查的一致性。结果 36例接受关节镜探查，确诊单纯ATFL损伤的患者共有28例，无ATFL损伤者6例，另2例ATFL损伤合并跟腓韧带断裂者退出研究。临床医师对应力位前抽屉试验的一致性良好，Kendall Wa=0.727（P＜0.001）。应力位前抽屉试验的灵敏度高于标准前抽屉试验（86.90% vs. 61.90%），诊断准确率优于标准前抽屉试验（79.41% vs. 64.71%），但特异度低于标准前抽屉试验（44.44% vs. 77.78%）。标准前抽屉试验和应力位前抽屉试验均具有较高的阳性预测值（92.86%、87.95%）和较低的阴性预测值（30.34%、42.11%）；将上述两种方法作为ATFL损伤的暴露因素，均与之具有较高的相关性[OR=5.688，95% CI（1.721，18.794）；OR=5.309，95% CI（1.723，16.357）]。结论 踝关节应力位前抽屉试验检查对ATFL损伤具有较高的灵敏度及诊断准确率，且临床医师体格检查一致性较高，是一种可靠且诊断效力较高的临床体格检查方法。 |
| EN Abstract: |
| Objective To evaluate the diagnostic efficacy of the stress anterior drawer test for anterior talofibular ligament (ATFL) injuries. Methods A total of 41 outpatients diagnosed with ATFL injuries from May 2024 to November 2024 were enrolled in this cohort study. Three physicians performed the standard anterior drawer test and the stress anterior drawer test independently, with arthroscopic exploration as the diagnostic gold standard. Positive, negative, false-positive, and false-negative results of the two examination methods were recorded, and the sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value of the two examination methods were calculated. The consistency of the physical examination among clinicians was also tested. Results Among the 36 patients who underwent arthroscopic exploration, 28 were confirmed to have isolated ATFL injury, 6 exhibited no ATFL injury, while 2 patients with concurrent ATFL injury and calcaneofibular ligament rupture were withdrawn from the study. Clinicians showed consistency in the stress anterior drawer test (P＜0.001), with good consistency (Kendall Wa=0.727). The stress anterior drawer test demonstrated higher sensitivity than the standard anterior drawer test (86.90% vs. 61.90%), and it also exhibited superior diagnostic accuracy (79.41% vs. 64.71%). Nevertheless, its specificity was lower than that of the standard anterior drawer test (44.44% vs. 77.78%). Both the standard anterior drawer test and the stress anterior drawer test exhibited significantly high positive predictive values (92.86% and 87.95%, correspondingly) and comparatively low negative predictive values (30.34% and 42.11%, correspondingly). When these two methods were employed as exposure factors for ATFL injury, they both demonstrated a robust correlation with the injury [OR=5.688, 95% CI (1.721, 18.794); OR=5.309, 95% CI (1.723, 16.357)]. Conclusion The stress anterior drawer test for ankle joint examination has high sensitivity and diagnostic accuracy for ATFL injuries, and clinicians have shown high consistency in physical examination, making it a reliable and highly effective clinical physical examination method. |
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