前交叉韧带损伤的MRI诊断与临床诊断比较研究  

Comparison of Diagnoses of ACL Tear by MRI and Clinical Examination

作　　者：高凯[1] 王立德[2] 齐志明[2] 张羽飞[2] 

机构地区：[1]上海体育学院运动科学系,上海200438 [2]大连医科大学附属第一医院骨科

出　　处：《中国运动医学杂志》2005年第5期521-525,共5页Chinese Journal of Sports Medicine

基　　金：上海市重点学科建设项目(编号:T0901)资助。

摘　　要：目的:探讨核磁共振(MRI)和临床检查对急性前交叉韧带(anteriorcruciateligament,ACL)损伤诊断的价值。方法:自2000年9月～2003年12月,对76例急性创伤性膝关节血肿病例进行前抽屉试验、Lachman试验两项临床检查和MRI检查,后进行关节镜手术检查。所有病例平均年龄28.0±7.9岁,关节镜手术距受伤时间平均为5.0±1.4天,其中男性58例,女性18例;左膝损伤25例,右膝损伤51例,运动损伤32例,交通伤25例,滑倒扭伤、摔伤19例。所有病例伤后8小时内均出现膝关节肿胀、疼痛、活动受限。以关节镜检查结果为标准,对临床检查和MRI检查诊断ACL损伤的结果进行比较。结果:关节镜检查发现ACL损伤52例,正常24例。前抽屉试验、Lachman试验两项临床检查共诊断出ACL损伤31例,正常45例;MRI检查共诊断出ACL损伤51例,正常25例。以关节镜检查为标准,临床检查诊断结果:真阳性数28例,真阴性数24例,假阳性数3例,假阴性数21例,准确度、敏感度、特异度分别为68.4%、57.1%、88.9%;MRI诊断结果:真阳性数49例,真阴性数22例,假阳性数2例,假阴性数3例,准确度、敏感度、特异度分别为93.4%、94.2%、91.7%。MRI诊断急性ACL损伤的准确度显著高于临床检查(P<0.01)。结论:临床检查诊断急性前交叉韧带损伤的假阴性率较高,MRI是早期诊断急性前交叉韧带损伤的有效方法。Objective To evaluate the role of MRI and the clinical examination in diagnosing acute anterior cruciate ligament（ACL）tears. Methods Clinical diagnoses of 76 patients who suffered from acute traumatic hemarthrosis were compared with that of subsequent MRI. Arthroscopic examination was used as evaluating standard in this study. The average age of patients was 28 - year- old, ranging from 16 to 55 years old. The duration from injuries to surgery was 3 to 7 days. All patients had swelling, tenderness and impaired function. Clinical examination included anterior draw test and Lachman test. The accuary, sensitivity and speciality of clinical diagnosis and that of diagnostic MRI were compared in accordant to the arthroscopic finding. Results 52 cases of ACL tears were diagnosed through arthroscopy. Clinical examination resulted in 45 normal ACL and 31 abnormal ACL. MRI evaluation revealed 25 normal ACL and 51 abnormal.Therefore, the accuracy, sensitivity and speciality for clinical diagnosis were 68.4%, 57.1% and 88.9%, respectively, and for MRI were 93.4%, 94.2% and 91.7%, respectively. Conclusions In acute ACL tears, clinical diagnosis revealed a high false - negative, while MRI showed a higher accuracy, sensitivity and speciality.

关 键 词：核磁共振 临床诊断 关节镜检查 前交叉韧带损伤 膝关节损伤 急性前交叉韧带损伤 MRI诊断 临床检查 诊断比较 ACL损伤 关节镜手术 假阴性率 MRI检查 膝关节肿胀 

分 类 号：R445.2[医药卫生—影像医学与核医学]