医学毕业论文--膝关节前内侧骨关节炎影像学诊断方法比较.docVIP

PAGE \* MERGEFORMAT 1 膝关节前内侧骨关节炎影像学诊断方法比较 作者：何川,杨庆铭,冯建民,陆勇 【摘要】 ［目的］ 认为膝关节前内侧骨关节炎适合于单髁置换治疗，传统是用应力位摄片帮助诊断前内侧骨关节炎。核磁共振（MRI）能够精确和直观地反应软骨和韧带情况，却很少用于膝关节前内侧骨关节炎的诊断。通过前瞻性对照研究了解MRI是否能在膝关节前内侧骨关节炎的术前诊断起作用。［方法］ 把52例准备接受单侧全膝关节置换的病人随机分为摄片组和MRI组，每组各26膝。其中摄片组平均年龄67.4岁 (59～71岁)，MRI组平均年龄69.9岁 (58～73岁)。在摄片组，病人摄内/外翻应力正位片和屈膝90°侧位片，分析X线片特征并作出诊断。MRI组根据MRI影像诊断软骨缺损的部位，对软骨缺损严重程度进行Noyes分级，对韧带、半月板、骨赘和软骨下骨囊腔改变情况进行评定，并诊断是否属于前内侧骨关节病变。在TKA术中对软骨缺损和前叉韧带进行观察后作出最终诊断。通过与术中诊断进行对比得出两种术前影像学诊断方法的准确性。［结果］摄片组误差主要发生在对OA较少累及间室及较浅表的软骨缺损情况进行判定时，能够鉴别膝内/外翻崎形能否被动矫正。MRI判断Noyes ⅡB，ⅢA，ⅢB软骨缺损的准确率分别为66.7%, 75%和 65.5%，但不能判定膝内/外翻崎形能否被动矫正。摄片和MRI诊断膝关节前内侧OA的准确率分别是84.6%和 92.3%(两者均与术中诊断无显著差异, Pgt;0.05）。［结论］应力位摄片拍摄和读片要求较高，但经过适当训练可以在大多数OA病人中获得很高的诊断率，对于一些困难的病例可以结合MRI软骨和韧带成像以帮助诊断。 【关键词】 膝关节； 前内侧骨关节炎； 磁共振； 应力位摄片； 诊断 Abstract: ［Objective］It is extensively conceived that the anteromedial osteoarthritis (OA) of knee is suitable for unicompartmental knee replacement (UKR). Traditionally, stress radiographs are used to establish diagnosis of the anteromedial osteoarthritis of the knee, whereas MR imaging, as a sensitive instrument for early diagnosis, is less commonly used. Therefore, the two methods have been compared in prospectivel study if MRI has a role in pre-operative assessment of patients with anteromedial OA of the knee. ［Method］Fifty-two OA patients who subsequently underwent total knee arthroplasty (TKA) were divided into the radiograph group (26 knees) and the MRI group (26 knees) randomly. The mean ages of the patients were 67.4 (59 to 71) and 69.9 (58 to 73) in the radiograph and MRI group. In the radiograph group, AP varus/valgus stress views and lateral radiographs in 90 of flexion were taken and assessed. In the MRI group, MR images were taken and assessed for location and severity of defects of cartilage by Noyes classification, osteophytes, subchondral cysts, sclerosis, meniscal and/or ligamentous tears. The primary diagnosis of the anteromedial OA knee was made based on radiographs and MR imaging findings re