A Comparative Study Of X-ray And MSCT On Combined Injury Of Lower Tibiofibular Syndesmosis

Objective:The lower tibiofibular syndesmosis injury is a clinical commonly ankle fracture with associated injuries.How to screen and diagnose the combined tibiofibular injury in patients with acute injury is the key to treatment.The imaging methods that can be used for this type of injury are X-ray,CT scan and MRI,of which the former two are the main ones.With the advent of multislice spiral CT(MSCT),it can clearly observe the anatomy of the ankle joint and the subtle changes of the lower tibiofibular structure.Therefore,the diagnostic value of plain X-ray film and multislice spiral CT in ankle joint fracture with combined tibiofibular injury is discussed here to guide clinical application.Methods: From January 2015 to January 2020,103 patients with "closed ankle fractures" diagnosed in our hospital and undergoing surgical treatment in our hospital(including 60 male patients and female patients)were selected.(43 cases),with an average age of 38.79 ± 4.58 years,as the study object.All subjects underwent standard ankle x-rays and MSCT plain scans of both ankles before surgery.On the X-ray orthophoto,tibiofibular overlap(TFO),tibiofibular clear space(TFCS),and medial ankle space(media clear space,MCS)/ superior tibial joint space(SCS)(MCS-SCS rate)were measured and recorded.MSCT is also used to measure the TFCS at the front,middle,and back on a CT cross-sectional image parallel to the distal articular surface of the tibia at 10 mm.Each TFCS is measured twice,the average value is taken,and a record is made.Data analysis was performed using SPSS 21.0 software for statistical analysis.Kappa consistency test,Roc curve,and chi-square test were used to analyze and compare the diagnostic value of X-ray examination and MSCT.P <0.05 had statistical significance.Results:Among the 103 patients,the results of intraoperative exploration showed 87(84.5%)positive and 16(15.5%)negative.Among the 87 positive patients,62(71.3%)were positive,25(28.7%)were negative,and 16 were negative.Among the patients,6(37.5)were positive and 10(62.5%)were negative.MSCT test results showed that among 87 positive patients,80(92.00%)were diagnosed with MSCT,7(8%)were diagnosed as negative.Among the 16 negative patients,1(6.25%)was diagnosed as positive for MSCT and 15(93.75%)as negative.Consistency test results showed that the consistency of X-ray,MSCT and intraoperative exploration were statistically significant(P <0.05).The Kappa value of X-ray examination was 0.227,which was lower than 0.4,suggesting that X-ray examination and intraoperative exploration The Kappa value of the MSCT examination is not high enough,which is higher than 0.7,indicating that the MSCT examination has better consistency with the intraoperative exploration.The results of Roc curve analysis showed that the area under the X-ray and MSCT examination were statistically significant(P <0.05).The area under the X-ray examination was 0.669,and the area under the MSCT examination was 0.929,indicating the diagnosis of MSCT.Value is better than X-ray.The sensitivity,specificity,and coincidence rate of MSCT examination with intraoperative exploration were significantly better than X-rays,and the differences were statistically significant(P <0.05).The analysis results also showed that the positive likelihood ratios of the X-ray and MSCT tests were 1.90 and 14.71,and the negative likelihood ratios of 0.46 and 0.09,suggesting that the application value of the MSCT tests is better than that of the X-rays.Conclusion: Clinically,it is unreliable to rely solely on X-rays to diagnose combined tibiofibular injuries.Compared with X-rays,MSCT significantly reduces the rate of misdiagnosis and missed diagnosis of combined tibiofibular injuries.Significant improvement in sex,MSCT provides important value for clinical diagnosis and treatment of combined tibiofibular injury.For patients with a negative X-ray diagnosis and a high degree of suspicion of the tibiofibular joint injury,MSCT should be given in time as a supplementary examination.It can also combine MSCT with traditional X-rays,physical examination,and medical history to make comprehensive judgments to guide clinicians in early screening and judgment of the combined tibiofibular injury,and appropriate treatment can be implemented early.