前距腓韌帶受傷之超音波影像之臨床應用

Ultrasonographic Features of Anterior Talofibular Ligament Injury in Clinical Staging

本研究是利用10MHz高頻率超音波來偵測前距腓韌帶於足踝扭傷後之病理變化，以作為臨床治療之參考。研究方法是採迴潮性病歷研究，收集民國85年10月到民國86年10月接受足踝超音波檢查之足踝扭傷患者131人，因有部份病患為雙側扭傷或再次追蹤，共得148例。超音波檢查儀器為HD13000b(Advanced Technology Laboratories，Bothell，Weshington，U.S.A)並使用10MHz線性排列探頭(linear array transducer)。依據前距腓三角區水腫或韌帶纖維化情形，將足踝扭傷的超音波圖像分為五種型態；分別是正常、急性期、修復期、慢性期和反覆性扭傷。正常者為前距腓韌帶緊貼腓骨及距骨，呈現凹陷的前距腓三角區。急性期為腫脹之低回音前距腓三角區。修復期則前距腓三角區腫脹消退呈凹陷型，近前距腓韌帶處有高回音之肉芽組織，但前距腓三角區較深處仍有關節液存在。慢性期則可見到高回音之瘢痕纖維化組織充滿前距腓三角區。反覆性扭傷則可見前距腓三角區的高回音訊號中有界線明顯之低回音區。結果顯示此148例患者以反覆性扭傷者最常見共84例(57%)，其次為修復期之35例(24%)，慢性期之21例(14%)和急性期之8例(5%)。由本研究得知在足踝扭傷患者中，以反覆扭傷的比例為最高；故對足踝扭傷病患加強其足踝本體覺教育及足踝之保護，應可大大降低足踝扭傷之復發率。

In this retrospective study, we reviewed sonograms of anterior talo-fibular ligaments of 131 patients (148 ankles)with ankle sprain. A 10-MHz linear array ultrasound transducer (Advanced Technology Laboratories, Bothell, Washington, USA)was used to perform the examination. A normal anterior talofibular ligament appears as a hyperechoic band connecting the lateral malleolus and talar neck with a concave hypoechoic articural pouch. Sprains of the anterior talofibular ligament were divided into four subtypes according to the shape of the anterior talofibular ligament and the content of articular pouch on sonography. A bulging anterior talofibular ligament with an underlying hypoechoic shadow was considered to indicate an acute stage sprain. Less convex anterior talofibular ligaments with underlying hyperechogenicity were considered to be in the healing stage. Diffuse hyperechogenicity filling the articular pouch was considered to indicate a chronic stage sprain. An area of hypoechogenicity with a clear margin in the hyperechogenic pouch indicated a recurrent injury. According to this system, 5% of the sprains were classified as acute, 24% as subacute, 14% as chronic, and 57% as repeated. We found that this method of classification of the sonograms of sprain a anterior talofibular ligaments, which reflects the status of the healing process, is simple and useful. Based on the finding of the high incidence of recurrent sprains, more effective therapy and patient education should be instituted.