膝关节外伤性骨挫伤的MR诊断及临床意义  

The MR diagnosis and clinical significance of bone contusion of knee

作　　者：刘伟[1] 杨军[1] 邵康为[1] 朱才松[1] 诸英[1] 翟渌澜[1] 

机构地区：[1]上海市长宁区中心医院影像科,200336

出　　处：《中华放射学杂志》2007年第12期1319-1322,共4页Chinese Journal of Radiology

基　　金：上海市医学重点专科建设及科研基金资助(05Ⅱ025)

摘　　要：目的评价 MRI 对骨挫伤的诊断价值和临床意义。方法选取145例 X 线平片未显示股骨和胫骨骨折但 MRI 显示有外伤性骨髓水肿的膝关节外伤患者,MR 检查时间为外伤后1～3 d,采用膝关节专用线圈,快速 SE(FSE)序列,T_1WI、T_2WI、质子密度加权成像(PDWI)+脂肪抑制,行冠状面、矢状面、横断面、斜矢状面扫描,层厚3 mm,层间距0.5 mm。根据骨髓水肿的分布,将膝关节外伤性骨挫伤分成5类:轴向旋转性损伤、夹击损伤、仪表盘式损伤、过伸型损伤和髌骨外侧脱位。其中48例行关节镜检查。结果 145例中 MRI 显示轴向旋转性损伤43例,夹击损伤53例,仪表盘式损伤40例,过伸型损伤9例。骨髓水肿在 PDWI 或T_2WI 脂肪抑制序列上为片状地图样高信号,在 T_1WI上为低信号,边界不清。48例行关节镜检查,发现前交叉韧带撕裂11例,后交叉韧带撕裂13例,半月板撕裂22例,5例 MRI 诊断半月板撕裂而关节镜未能显示,MRI 诊断与关节镜诊断结果符合率为89.6%。结论 MRI 可以准确显示膝关节骨挫伤的部位和范围及膝关节附属结构的损伤,推断其受伤机制,对临床诊断、治疗具有重要意义,应作为常规检查方法应用。Objective To evaluate MRI in the diagnosis of the bone contusion of the knee joint and its clinical significance. Methods Using special coil for knee joint, coronal, sagittal, axial and oblique sagittal plane scanning with fast spin-echo sequence（ T1 WI,T2 WI, PDWI ＋ FS） was performed on knee joint in 205 patients in three days after injury. According the distributing bone marrow edema and injury mechanism,bone contusion were classified five types as pivot shift injury, clip injury, dashboard injury, hyperextension injury and lateral patellar dislocation. Results One hundred and forty-five cases of the 205 patients were found bone marrow edema without fracture on X-ray films. Among them, pivot shift injury was found in 43 cases accompanied with anterior cruciate ligament rupture in 30 cases, tear of the posterior horn of the lateral or medial meniscus in 12 and tears of the medial collateral ligament in 8 cases; clip injury in 53 cases accompanied with anterior cruciate ligament rupture in 10 cases, tear of the posterior horn of the lateral or medial meniscus in 15 and tears of the medial collateral ligament in 38 cases; dashboard injury 40 cases accompanied with posterior cruciate ligament rupture in 16 cases, hyperextension injury 9 cases accompanied with anterior cruciate ligament rupture in 2 cases, posterior cruciate ligament rupture in 3 cases. No lateral patellar dislocation was found. Forty-eight of 145 patients had undergone arthroscopy, 43 cases （89. 6% ） of them were in accordance with MRI diagnosis. Bone contusion were defined as geographic regions of abnormal signal intensity,that is, low signal intensity in T1-weighted images and high signal intensity in PD-weighted or T2-weigeted images with fat saturation. Conclusion MRI can accurately display the location and area of bone contusion of the knee joint as well as its adjunctive structure injury and deduce their injury mechanism. MRI should be used routinely for knee trauma.

关 键 词：膝关节 膝损伤 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]