膝关节髌内侧滑膜皱襞直接关节造影磁共振表现与关节镜分型的临床对比研究  

Direct MRA arthrography and arthroscopic findings of mediopatellar synovial plica of knee:a comparative clinical study

作　　者：何锐[1] 杨柳[1] 王晓宇[1] 郭林[1] 文亚名[1] 杨滨[1] 谭洪波[1] 韩琳[1] 

机构地区：[1]第三军医大学西南医院关节外科中心,重庆400038

出　　处：《第三军医大学学报》2008年第9期864-867,共4页Journal of Third Military Medical University

摘　　要：目的对比研究膝关节髌内侧滑膜皱襞在直接关节造影磁共振(MRA)检查下的影像和在关节镜检查下的形态表现,分析滑膜皱襞MRA影像与镜下分型之间的相关性,以提高MRA对髌内侧滑膜皱襞综合征的诊断率。方法甲组,选取我院33例已在关节镜下确诊为膝关节髌内侧滑膜皱襞综合征的患者,按照Sakakibara分型标准分为4组,测量患者术前膝关节MRA影像中髌内侧皱襞相对宽度,拟定在MR图像中使用滑膜皱襞相对宽度作为指标进行分型诊断的初步数据范围。乙组,选取34例已行MRA检查的患者,按照MRA分型标准分为3组,关节镜下对MRA分型诊断的初步标准进行验证。结果甲组33例患者33膝MRA图像测量结果显示,SakakibaraA型滑膜皱襞相对宽度为(0.226±0.039);B型(0.463±0.053);C型(0.738±0.037);D型(0.825±0.026)。A、B型与C型皱襞相对宽度测量结果具有明显的统计学差异(P<0.05);D型与C型之间无明显差异。乙组34例34膝MRA分型和关节镜分型的一致性检验结果:Kappa值>0.6;符号秩检验Wilcoxon法的P值>0.05。结论膝关节髌内侧滑膜皱襞MRA表现与关节镜下形态紧密相关。MRA分型诊断的初步标准与关节镜下Sakakibara分型具有一致性。MRA是诊断膝关节滑膜皱襞极有价值的方法,是采用膝关节镜手术治疗髌内侧滑膜皱襞综合征术前的重要检查。Objective To identify the MR image type of mediopatellar plica by comparing direct MR arthrography with arthroscopy findings. Methods The MR image and arthroscopic findings of 67 patients were retrospectively compared. Among them, 33 cases （Group A）who underwent diagnostic and operative video arthroscopy and diagnosed as mediopatellar plica were divided to 4 types according to Sakakibara＇ s criteria. Then the width of their plica on MR image were measured and the results were compared with anthroscopic findings. Another 34 patients （Group B） receiving MR image examination were divided according to the width of plica, then the results were further testified when undergoing arthroscopy. Results In group A, the width of type A plica was （0. 226±0. 039）, type B （0. 463±0. 053）, type C （0. 738±0. 037）, and type D （0. 825±0. 026）. There was significant difference between type A and type C, and type B and type C. In group B, the agreement Kappa test and Wilcoxon signed rank test showed that the type diagnosis made by MRA was almost concordance with that of arthroscopy （ Kappa 〉 O. 6, P 〉 0.05 ）. Conclusion The features of direct MR arthrography is coordinate with the arthroscopic findings in mediopatellar plica. MRA is a valuable diagnostic technique, and a very important examination before arthroscopy for mediopatellar plica syndrome.

关 键 词：膝关节 髌内侧滑膜皱襞 磁共振造影成像 关节镜 

分 类 号：R322.73[医药卫生—人体解剖和组织胚胎学] R445.2[医药卫生—基础医学]