侧方应力摄片测量和膝关节MRI诊断内侧副韧带损伤的临床研究  

Diagnosis of medial collateral ligament injury by stress X-ray and MRI of knee joint

作　　者：张龙君[1] 陈建良[1] 许勇[1] 朱少兵[1] 

机构地区：[1]上虞市中医院骨伤科,浙江上虞312300

出　　处：《中国骨伤》2012年第11期951-953,共3页China Journal of Orthopaedics and Traumatology

基　　金：浙江省中医药科技计划项目(编号:2009CA100)~~

摘　　要：目的:研究双膝外翻应力位摄片对膝关节内侧副韧带损伤的诊断意义。方法:自2008年1月至2011年6月收治膝关节内侧副韧带损伤46例,31例行手术治疗,15例保守治疗,其中1例保守治疗3个月无效后手术。其中男32例,女14例;年龄28～72岁,平均(49.46±22.54)岁;左膝22例,右膝24例。常规行损伤侧、正常侧的应力位下和非应力位下X线摄片和MRI检查,对于内侧间隙明显增宽和MRI表现有深层断裂及后交叉韧带损伤的择期行切开内侧副韧带行缝合或重建术。以胫骨平台内侧髁和外侧髁作一条连线记为A线,将此线向上平移至股骨内侧髁最内缘记为B线,然后测量这2条线的垂直距离记为C。间隙差比值(R)计算方法为(患侧应力下间隙-患侧无应力下间隙)/(健侧应力下间隙-健侧无应力下间隙)。总结R值区间与术中所见韧带损伤种类的关系。结果:46例中17例有韧带浅层撕裂,21例深层断裂,8例合并有后关节囊或后交叉韧带断裂,当比值介于1.51～5.24时,内侧副韧带损伤表现为浅层撕裂的有15例,实际损伤为17例,诊断正确率为88.24%;当比值介于5.28～13.85时,表现为深层断裂的有19例,实际损伤为21例,诊断正确率为90.48%;当比值介于15.61～26.25时,表现为合并后关节囊或交叉韧带断裂的有7例,实际损伤为8例,诊断正确率为87.50%。结论:以膝关节受伤侧关节间隙差值与正常侧差值的比值作为衡量标准,可以提供膝关节内侧副韧带损伤的量化分级。Objective：To study the application of stress X-ray of knee joint for the diagnosis of medial collateral ligament injury. Methods：From January 2008 to June 2011,46 patients with medial collateral ligament injury were reviewed. Among the patients,32 patients were male and 14 patients were female,ranging in age from 28 to 72 years,with an average of （49.46±22.54） years. Left knee joint injuries occurred in 22 patients,and 24 patients had injuries in right knee joint. Thirty-one patients were treated with surgical method,and 15 patients were treated with conservative method including 1 patient finally received operation after 3 months treatment with conservative method without effect. The injury side and normal side were observed by X ray under stress and non stress,as well as MRI. Operation was used to treat patients with medial gap markedly widen and the deep layer of medial collateral ligament injury in MRI. A line （line A） was drawn from medial condyle to lateral condyle of tibia platform. The line A was translated to the inner margin of condylus medialis femoris ,which was line B. The perpendicular distance was measured,which was line C. The ration of space difference （R） was calculated by （space at stress force of injured side space at non stress force of injured side） / （space at stress force of normal side space at non stress force of normal side）. The relationship between R and ligament injury type were investigated. Results：There were 17 patients with in- juries of superficial lamella,21 patients with injuries of deep lamella. Eight patients had associated injuries of articular capsule and posterior cruciate ligament. When R value was between 1.51 to 5.24 ,the injury of superficial ligament was found in 15 patients,actual injuries were found in 17 patients. When R value between 5.28 and 13.85 ,the injuries of bathypelagic ligament were found in 19 patients,actual injuries were found in 21 patients. When R value was between 15.61 and 26.25 ,the associated injuries of articular caps

关 键 词：膝关节 内侧副韧带 放射摄影术 

分 类 号：R686.505[医药卫生—骨科学]