Objective: To evaluate the efficiency of modified Ottawa Ankle Rules (OAR) for the differential diagnosis of fractures in acute foot and ankle injuries. Methods: From October 2016 to December 2016, 272cases (135 males and 137 females) of foot and ankle injury in emergency department of Tianjin Hospital were prospective enrolled in the study.The median age was 27.5 years (7-87); left limb 155, right 117 cases; injury time ranged from 0.3 to 24 h (median 4 h). Conventional and modified OAR was applied on physical examination, subsequently radiography performed to determine the occurrence of fractures.The efficiency of the two methods were compared and analyzed. Results: Fractures were found in 100 cases (36.8%), 49 cases of ankle and 51 cases of foot fractures.With the imaging results as the standard, the sensitivity for conventional and modified OAR were 93.0% and 100%, specificity were 9.9% and 8.7%, the positive predictive value were 37.5% and 38.9%, the negative predictive value were 70.8% and 100%, the accuracy were 40.4% and 42.3%, missed diagnosis rate were 7% and 0% respectively.The sensitivity, positive likelihood ratio, positive predictive value, negative predictive value, accuracy, negative likelihood ratio and missed diagnosis ratio were better than in modified OAR compared with Conventional OAR, while the specificity was slightly lower compared to Conventional OAR.The Kappa value of modified OAR was 0.065 (P>0.05), which is better than conventional OAR.Conventional OAR can reduce 6.3% (17/272) X-ray and modified OAR decline 5.5% (15/272). Conclusion: Modified OAR significantly reduces the rate of missed diagnosis of foot fractures, but its specificity is poor. Ultrasound can be assisted to improve the specificity and reduce the number of unnecessary X-rays.
目的： 探讨改良Ottawa踝准则(Ottawa ankle rules，OAR)对急性足踝损伤骨折鉴别诊断的临床效果。 方法： 2016年10至12月天津医院骨科前瞻性纳入急诊连续收治的足踝损伤患者272例，男135例，女137例；中位年龄27.5(7～87)岁；左侧肢体155，右侧117例；受伤至就诊中位时间4 (0.3～24) h。参照传统和改良OAR进行体格检查，然后行足踝X线确定骨折发生情况，对比两种方法对足踝骨折的检出效果。 结果： 272例患者骨折100例(发生率36.8%)；踝关节骨折49例，足部骨折51例。以影像学检查结果为标准，传统和改良OAR灵敏度分别为93.0%、100%，特异度9.9%、8.7%，阳性预测值37.5%、38.9%，阴性预测值70.8%、100%，准确度40.4%、42.3%，漏诊率7%、0%。改良OAR灵敏度、阳性似然比、阳性预测值、阴性预测值、准确度、阴性似然比、漏诊率均优于传统OAR，特异度略低于传统OAR。改良OAR的Kappa值＝0.065(P>0.05)，对足踝骨折的诊断一致性优于传统OAR。传统OAR可以减少6.3%(17/272)X线检查，改良OAR减少5.51%(15/272)。 结论： 改良OAR明显降低了足部骨折漏诊率，但其特异度较差，临床需辅助超声检查提高其特异度并减少不必要X线检查。.
Keywords: Ankle injuries; Diagnosis; Emergency medical services; Foot injuries; Ottawa ankle rules.