| 【Objective】Anterior talofibular ligament(ATFL)injury is a common ankle injury in the military training of troops at the grassroots level.In order to improve the inspection ability of grassroot troops,the portable high-frequency ultrasound combined with a new solid-state gelatin(GEL)pad was explored for ankle joint injury inspection.Its effectiveness and diagnosis accuracy in detection of the ATFL injury need to be evaluated.The feasibility of this method under the condition of military training is discussed.【Method】80 Patients who visited our hospital for ankle injury due to military training from January 2019 to January 2020 were enrolled as the research subjects.The ankle injury was detected by musculoskeletal ultrasound.All subjects were examined by portable high-frequency ultrasound combined with ordinary couplant(conventional group),portable high-frequency ultrasound combined with GEL pad(GEL group)and high-resolution desktop musculoskeletal ultrasound combined with ordinary couplant(reference group)in sequence.The thicknesses,internal echo,fibrous continuity,surrounding soft tissues of the ATFL were observed.Also,the effusion in the joint cavity and the condition of bone at the ligament attachment was evaluated.The results of conventional and GEL groups were compared.【Results】Of the 80 subjects included in this study,70 males(87.5%),10 females(12.5%),the mean age was 26.8±5.4 years.Using musculoskeletal ultrasound for detection,the mean thickness of the ATFL was 1.9±0.3 mm on the healthy side,and was 3.8±0.9 mm on the affected side.There were 58(72.5%)of type I injuries,11(13.75%)of type II injuries,and 11(13.75%)of type III injuries.The thickness of the affected ligament was the largest if subjects had a type II injury or injury time less than1 week.With the results of musculoskeletal ultrasound examination as the standard,the thickness of the ligament measured in the conventional group deviated by 0.14±0.09mm,and that of the GEL group by 0.04±0.05 mm,showing a significant difference between the two groups(P<0.001).Similarly,measurement of the end-to-end distance was deviated by 0.25±0.07 mm in the conventional group and 0.07±0.06 mm in the GEL group,and the difference achieved statistical significance(P<0.001).With the results of musculoskeletal ultrasound combined with clinical diagnosis and surgical results as the standard,for subjects in the conventional group,the diagnostic accuracy rate was 100%for type I injury,72.7%for type II injury,83.3%for type III injury,and94.0%for the overall,and there was no statistical difference as compared with the standard diagnosis(P=0.063).The Spearman correlation r_s=0.933 and the Kappa value was 0.856,P<0.001.For the determination of joint effusion,the sensitivity was91.8%,the specificity 100%,the Jordan index 0.918,and the negative likelihood ratio0.082.In contrast,for subjects in the GEL group,the diagnostic accuracy rate was 100%for type I injury,90.9%for type II injury,91.7%for type III injury,and 97.6%for the overall,and there was no statistical difference as compared with the standard diagnosis(P=0.500).The Spearman correlation r_s=0.977,and Kappa value was 0.944,P<0.001.For the determination of joint effusion,the sensitivity was 95.9%,the specificity 100%,the Jordan index 0.959 and the negative likelihood ratio 0.041.【Conclusion】Portable high-frequency ultrasound combined with GEL pad has a good accuracy in detecting ATFL injury and determining the degree of injury.It is potentially an important method for detection of ankle injury in officers and soldiers of grassroot troops. |
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