膝关节半月板损伤MRI表现与关节镜下表现的临床-第三军医大学学报.DOC

MRI诊断半月板损伤类型的对比研究 段小军，杨柳*，文亚名，戴刚，陈光兴，郭林，王晓宇 （第三军医大学西南医院关节外科中心 400038） 摘要：目的 在对比性研究半月板损伤磁共振（MRI）检查和关节镜探查的基础上，研究半月板不同损伤形态的MRI表现。方法 对200610-01—2007-03.31入院拟行关节镜手术的患者，在术前常规行MRI，高年资医师独立阅片，并预测是否存在半月板损伤及其损伤形态，关节镜探查术所见半月板损伤为诊断金标准，统计MRI诊断的准确性。结果 本组共纳入268例患者的288膝关节，MRI检查疑诊半月板损伤269例，经关节镜探查术证实半月板损伤267例。MRI检查对半月板损伤诊断的敏感度为98.5％，特异度为84.2％，准确度为97.6％。尤其是在半月板桶柄样损伤方面敏感度较高，但对半月板小于1cm的纵行撕裂和半月板白区损伤的诊断仍存在一定困难。结论 准确认识内、外侧半月板损伤后MRI的表现，可以显著提高术前半月板损伤诊断的准确性，从而有利于完善手术方式和预后。 关键词：半月板；磁共振成像；诊断；损伤；膝关节 maging features of knee meniscus injury of different types DUAN Xiao-jun, YANG Liu, WEN Ya-ming, DAI Guang, CHEN Guang-xing, GUO Lin, WANG Xiao-yu (Center of Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China) Abstract: Objective Taking arthroscopic diagnosis of meniscus injury as gold standard, to identify the different types of meniscus injury by MR imaging. Methods All patients who would receive arthroscopic surgery for meniscus injury or cruciate ligament injury underwent MRI in our unit from Oct. 2006 to Mar. 2007. MR diagnosis of meniscus injury was evaluated by the criteria of Crues et al, then verified by arthroscopic diagnosis. Results Totally 268 patients and 288 knees were included. A total of 269 knees of meniscus injury were described by MR diagnosis and 268 knees of meniscus injury were proven by arthroscopy. The sensitivity, specificity and accuracy of MR diagnosis of meniscus injury respectively were 98.5%, 84.2% and 97.6%. The signal described as grade Ⅲ in the menisci was a reliable sign of complete meniscal tears. Conclusion MR imaging is reliable, highly accurate and noninvasive diagnostic technique for meniscus injury. It is a very important examination before arthroscopy for consummate surgery scheme and prognosis . Key words: meniscus; MR imaging; diagnosis; injury; knee  半月板损伤是引起膝关节疼痛的常见疾病，正常半月板是随着膝关节运动而移动的，由于半月板的游离缘缺乏血供，损伤后难于自行修复，因此，半月板损伤后往往需要及时手术治疗。可是通过临床问诊查体，往往难以确定半月板损伤的部位和类型，目前已公认磁共振（MRI）检查在半月板损伤的诊断中具有重要价值。本研究旨在总结各种半月板损伤类型