| 引用本文： |
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关 清,汤光宇,华 婷,等.前交叉韧带急性和慢性损伤的核磁共振诊断价值比较研究[J].同济大学学报（医学版）,2019,40(1):82-86. [点击复制]
- GUAN Qing,TANG Guang-yu,HUA Ting,et al.Magnetic resonance imaging in diagnosis of acute and chronic anterior cruciate ligament injuries[J].同济大学学报（医学版）,2019,40(1):82-86. [点击复制]
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| 摘要: |
| 目的 探讨前交叉韧带(anterior cruciate ligament, ACL)损伤急性期和慢性期的核磁共振（magnetic resonance imaging, MRI）直接征象和间接征象的诊断价值，为临床提供参考。方法 收集同济大学附属第十人民医院2015年2月—2018年5月骨科收治的因前交叉韧带损伤并行关节镜手术的患者，共计527例。以6周为急性、慢性临界，其中急性损伤302例，慢性损伤225例。分别由两名专业MRI阅片医师对所有患者影像资料进行分析，评估MRI对急性、慢性前交叉韧带损伤的诊断效力。结果 直接征象上，急性ACL损伤T2加权像上ACL冗长高信号、T1加权像上韧带不连续的比例明显高于慢性损伤（P<0.05）;韧带信号消失及假瘤形成的比例却明显低于慢性损伤（P<0.05）；二者在T2加权像上ACL积聚高信号及T1加权像上韧带方向异常上无明显差异（P>0.05）。间接征象上： 急性ACL损伤半月板桶柄样撕裂的概率高于慢性损伤，而内侧半月板后角损伤概率低于慢性损伤（P<0.05）；急性ACL损伤内侧副韧带损伤概率明显高于慢性损伤组（P<0.001）；接吻征、沟槽征、Segond骨折主要发生于急性ACL损伤患者（P<0.05）；慢性ACL损伤后交叉韧带（PCL）走行异常概率高于急性损伤（P=0.004），软骨损伤则多见于慢性ACL损伤患者（P=0.008）;两组损伤在骨挫伤及Blumenseat角异常的发生概率上无明显差异（P>0.05）。结论 MRI能够比较准确的诊断前交叉韧带损伤，将直接征象及间接征象整合可以降低前交叉韧带损伤的漏诊率，为关节镜手术提供可靠的影像学依据。 |
| 关键词: 前交叉韧带损伤 核磁共振 关节镜 直接征象 间接征象 |
| DOI：10.16118/j.1008-0392.2019.01.016 |
| 投稿时间：2018-08-15 |
| 基金项目:上海申康医院发展中心临床三年行动计划项目（16CR4029A） |
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| Magnetic resonance imaging in diagnosis of acute and chronic anterior cruciate ligament injuries |
| GUAN Qing,TANG Guang-yu,HUA Ting,RUAN Jian-ping |
| (Dept. of Radiology, Tenth People’s Hospital, Tongji University, Shanghai 200072, China) |
| Abstract: |
| Objective To explore the diagnostic values of direct and indirect signs on magnetic resonance imaging(MRI) for patients with acute or chronic anterior cruciate ligament(ACL) injuries. Methods From February 2015 until May 2018,527 patients who were diagnosed with ACL injury in Tenth People’s Hospital, Tongji University and received arthroscopic surgery were retrospectively enrolled. There were 302 cases of acute injury and 225 cases of chronic injury based on a 6-week interval. Two independent reviewers analyzed the MRI images to differentially diagnose for acute or chronic ACL injuries. Results For direct signs on MRI, higher incidence of diffuse high signal of T2 weighted images and discontinuity signal of T1 weighted images were found in acute ACL injury(P<0.05); however, lower incidence of ligament signal disappearance and pseudinoma formation were found in acute ACL injury compared with chronic ACL injury(P<0.05). No significant differences were found on the incidence of focal high signal of T2 weighted images and abnormal orientation of T1 weighted images(P>0.05). For indirect signs on MRI, Bucket shank tear of meniscus in acute ACL injury was higher and posterior horn injury of medial meniscus was lower than in chronic ACL injury(P<0.05). Incidence of medial collateral ligament injury was significantly higher in acute ACL group(P<0.001). Kissing contusion, Notching syndrome and Segond fracture were mainly showed in acute ACL injury group(P<0.05). Incidence of abnormal PCL was higher in chronic injury than acute ACL injury(P=0.004) and cartilage damage was mainly showed in chronic ACL injury(P=0.008). No significant differences were found in regarding the total bone contusion and abnormal Blumenseat angle between groups(P>0.05). Conclusion MRI is able to correctly diagnose ACL injury, integrating direct and indirect signs may decrease the misdiagnoses of ACL injury, which provides reliable basis for arthroscopic treatment. |
| Key words: anterior cruciate ligament injury magnetic resonance image arthroscopy direct sign indirect sign |
