急性创伤性髌骨外侧脱位后内侧髌股韧带和股骨外侧髁关节软骨损伤的MRI分析  

MRI Analysis on Injury of Medial Patellofemoral Ligament and Articular Cartilage of the Lateral Femoral Condyle After Acute Traumatic Lateral Patella Dislocation

作　　者：郑雷[1] 刘禄明[1] 孙百胜[1] 姜辉[1] 都基权[1] 何伟华[1] 

机构地区：[1]中国人民武装警察部队山东省总队医院影像科武警部队医学影像诊断中心,山东省济南市250014

出　　处：《临床放射学杂志》2012年第9期1306-1311,共6页Journal of Clinical Radiology

摘　　要：目的探讨急性创伤性髌骨外侧脱位后内侧髌股韧带(MPFL)和股骨外侧髁关节软骨损伤的MRI特点。方法回顾性分析51例经临床证实的急性创伤性髌骨外侧脱位患者的MRI资料。51例病例均行常规MRI矢状面、冠状面和横断面T1WI、T2WI、脂肪抑制FSE双回波序列扫描,并与手术结果相对照。结果急性创伤性髌骨外侧脱位后,MPFL损伤发生率为100%,其中完全性MPFL撕裂31例,部分性MPFL撕裂20例,股骨侧撕裂30例,髌骨侧撕裂19例,体部撕裂2例,MRI诊断MPFL部分性撕裂的敏感性、特异性和准确性分别为85%、93.5%和90.2%,MRI诊断完全MPFL撕裂的敏感性、特异性和准确性分别为93.5%、85%和90.2%。股骨外侧髁关节软骨损伤17例,发生率为33.3%,其中13例位于股骨外侧髁承重面关节软骨,1例位于股骨滑车,3例股骨滑车和股骨外侧髁承重面关节软骨均受累;17例股骨外侧髁关节软骨损伤病例中,16例(94.1%)关节软骨损伤位于股骨外侧髁骨挫伤的偏后部分,1例(5.9%)位于骨挫伤的中间部分;MPFL髌骨侧损伤病例中,57.9%(11/19)伴发股骨外侧髁关节软骨损伤,MPFL股骨侧损伤病例中,20%(6/30)伴发股骨外侧髁关节软骨损伤,二组数据比较,差异具有显著统计学意义(χ2=5.80,P=0.016)。MPFL完全撕裂、部分撕裂病例中,股骨外侧髁骨软骨骨折发生率分别为19.4%(6/31)、0%(0/20),二者比较,差异具有显著统计学意义(χ2=4.39,P=0.036)。结论急性创伤性髌骨外侧脱位后,MPFL股骨侧最易损伤,其次为髌骨侧,MRI诊断MPFL损伤准确性高;急性创伤性髌骨外侧脱位后股骨外侧髁关节软骨损伤比较常见,MPFL髌骨侧损伤病例易于伴发股骨外侧髁关节软骨损伤,而MPFL完全撕裂较部分撕裂更易伴发股骨外侧髁骨软骨骨折;股骨外侧髁关节软骨损伤多位于股骨外侧髁承重关节面处,绝大多数位于股骨外侧髁骨挫伤的偏后部分。Objective To evaluate MRI findings of medial patellofemoral ligament（MPFL） tear and articular cartilage injury of the lateral femoral condyle after acute traumatic lateral patella dislocation.Methods MR images of 51 patients with acute traumatic lateral patella dislocation proved clinically were reviewed.Routine MR scanning was performed in sagittal,coronal and axial planes,including T1WI,T2WI and a fat suppression sequence.Results Among 51 patients,complete MPFL tear was seen in 31 cases and partial MPFL tear in 20 cases.30 cases with MPFL tear showed at its femoral attachment,19 cases teared at its patellar attachment and 2 cases with midsubstance tear.The sensitivity,specificity and accuracy of MR diagnosis of partial MPFL tear were 85%,93.5%and 90.2% respectively;The sensitivity,specificity and accuracy of MR diagnosis of complete MPFL tear were 93.5%、85% and 90.2% respectively.Articular cartilage injury of the lateral femoral condyle after acute traumatic lateral patella dislocation was seen in 17 cases and the incidence rate was 33.3%.13 cases with articular cartilage injury of the lateral femoral condyle were isolated to the midlateral weight bearing portion of the lateral femoral condyle,1 case involved the articular surface of the trochlear groove and 3 cases involved the articular surface of both the trochlear groove and the midlateral weight bearing portion of the lateral femoral condyle.16 cases（94.1%） with articular cartilage injury of the lateral femoral condyle located along the posterior margin of the subchondral edema and 1 case（5.9%） centered to the subchondral edema.Among the patients with MPFL tear at patellar attachment,57.9% showed articular cartilage injury of the lateral femoral condyle,while 20% showed articular cartilage injury of the lateral femoral condyle with MPFL tear at femoral attachment,there was significant difference between above two locations for the incidence rate of articular cartilage injury of the lateral femoral condyle after acute traumatic lateral patella

关 键 词：创伤性髌骨外侧脱位 内侧髌股韧带 关节软骨 创伤和损伤 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R686[医药卫生—诊断学]