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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >The Broken “Ring of Fire”: A New Radiological Sign as Predictor of Syndesmosis Injury?
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The Broken “Ring of Fire”: A New Radiological Sign as Predictor of Syndesmosis Injury?

机译：破碎的“火环”：新的放射征象可预测成年综合征的发生？

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Background:Subcircumferential periosteal edema above the ankle joint is frequently present on magnetic resonance imaging (MRI) with syndesmosis injuries but has not been previously reported. Fluid height within the interosseous membrane also has not previously been shown to be associated with syndesmosis injury severity.Purpose:To investigate whether a new sign on MRI and measurement of the length of fluid within the interosseous membrane above the ankle may be used to enable identification of a syndesmosis injury and allow differentiation from lateral ligament injury.Study Design:Cohort study (diagnosis); Level of evidence, 3.Methods:Three groups of patients (those with an isolated syndesmosis injury [SI group], isolated lateral ligament injury [LLI group], and no injury [NI group]) who had an ankle MRI for another reason were identified from a patient notes database and the MRI scans retrieved. The scans were anonymized and independently assessed by 8 clinicians (surgeons and radiologists) who were blinded to the diagnosis. The maximum length of fluid above the ankle within the intraosseous membrane was measured for each patient. The presence or absence of distal anterior, lateral, and posterior tibial periosteal edema was recorded (broken “ring of fire”).Results:Measurement of the length of fluid above the ankle had excellent intraobserver reliability (intraclass correlation coefficient, 0.97; 95% CI, 0.93-0.99) but poor interobserver reliability. Fluid extended higher in both the LLI group (P = .0043) and SI group (P = .0058) than the NI group, but there was no significant difference between the LLI and SI groups (P = .3735), indicating that this measurement cannot differentiate between the injuries. The presence of the broken “ring of fire” around the distal tibia was significantly more frequent in the SI group when compared with both LLI and NI groups (P < .00001). The sensitivity of this sign is 49%, but when present, this sign has a 98% specificity for syndesmosis injury.Conclusion:The presence of tibial subcircumferential periosteal edema 4 to 6 cm above the ankle joint (the “ring of fire”) is highly suggestive of a syndesmosis injury. This new radiological sign can assist with early identification of such injuries. The measurement of height of fluid above the ankle within the interosseous membrane is variable and cannot differentiate severe ankle sprains from high ankle sprains involving the syndesmosis.
机译：背景：踝关节上方的环周骨膜下水肿常在伴有下突损伤的磁共振成像（MRI）上出现，但以前尚未见报道。目的：研究是否可以使用MRI上的新体征和测量踝关节上方的骨膜内液体长度来识别研究设计：队列研究（诊断）;证据级别，3。方法：三组因其他原因进行踝关节MRI的患者（分别为单纯性下颌联合损伤[SI组]，单纯性外侧韧带损伤[LLI组]和无损伤[NI组]）。从患者备忘数据库中识别出来，并检索MRI扫描。扫描是匿名的，由对诊断不知情的8位临床医生（外科医生和放射科医生）进行了独立评估。对每位患者测量了骨膜内踝上方的最大液体长度。记录胫骨远端前，外侧和后部骨膜水肿的存在与否（“火圈”破裂）。结果：测量踝关节上方的液体长度具有极好的观察者内可靠性（组内相关系数为0.97; 95％） CI，0.93-0.99），但观察者之间的可靠性差。 LLI组（P = .0043）和SI组（P = .0058）的液体扩散均高于NI组，但LLI和SI组之间无显着差异（P = .3735），这表明测量无法区分伤害。与LLI组和NI组相比，SI组中胫骨远端周围“火圈”破裂的发生率明显更高（P <.00001）。该体征的敏感性为49％，但当存在时，该征兆对下颌联合症的特异性为98％。结论：在踝关节上方4至6 cm处存在胫骨下环骨膜水肿（“火环”）强烈提示有肉芽肿。这种新的放射学迹象可以帮助及早发现此类伤害。骨间膜内踝关节上方的液位高度的测量值可变，无法区分严重的踝关节扭伤和涉及联合症的高踝关节扭伤。

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