膝关节韧带损伤及伴发半月板损伤的MRI分析  

Knee ligaments injuries and associated meniscal tears:a MRI study

作　　者：孙百胜[1] 郑雷[1] 纪丙军[1] 姜辉[1] 何伟华[1] 李永亮[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,济南250014

出　　处：《中华临床医师杂志（电子版）》2013年第14期70-74,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨膝关节单发韧带损伤、多发韧带损伤及二者伴发半月板损伤的特点,比较分析MRI诊断单发韧带损伤、多发韧带损伤及伴发半月板损伤的准确性。方法对187例经临床手术证实为膝关节韧带损伤的MRI病例资料进行回顾性分析。结果 187例病例中,单发韧带损伤103例,多发韧带损伤84例;单发韧带损伤组中,前交叉韧带(ACL)损伤38例,内侧副韧带(MCL)损伤36例,后交叉韧带(PCL)损伤14例,内侧髌股韧带(MPFL)损伤10例,髌韧带(PT)损伤3例,外侧副韧带(LCL)损伤2例,伴发内侧半月板(MM)损伤35例,伴发外侧半月板(LM)损伤23例;多发韧带损伤组中,ACL、MCL联合损伤37例,ACL、PCL联合损伤21例,ACL、PCL、MCL联合损伤10例,MPFL、MCL联合损伤8例,MPFL、MCL、ACL联合损伤4例,ACL、PT联合损伤2例,ACL、PCL、LCL联合损伤2例,伴发MM损伤43例,伴发LM损伤35例;单发韧带组与多发韧带组中,MRI诊断韧带损伤的敏感性、特异性、准确性分别为90.3%、97.7%、96.4%和81.5%、88.4%、85.9%,二者比较差异均有统计学意义(P<0.05);二者伴发MM、LM损伤的发生率分别为34%、22.3%和51.2%、41.7%,二者比较差异有统计学意义(P<0.05),MRI诊断二者间伴发MM损伤的敏感性、特异性、准确性分别为88.6%、89.7%、89.3%和76.7%、65.9%、71.4%,二者比较特异性、准确性差异有显著统计学意义(P<0.01),而敏感性差异无统计学意义(P>0.05),MRI诊断二者间伴发LM损伤的敏感性、特异性、准确性分别为87%、93.8%、92.2%和85.7%、77.6%、77.4%,二者比较特异性、准确性差异有统计学意义(P<0.05),而敏感性差异无统计学意义(P>0.05)。结论单发韧带损伤以ACL损伤最为多见,其次为MCL;多发韧带损伤以ACL、MCL联合损伤最为常见,其次为ACL、PCL联合损伤,再次为ACL、PCL、MCL联合损伤;MRI诊断多发韧带损伤的敏感性、特异性、准确性均较单发韧带损伤下降;多发韧带损伤较单发韧带损伤更易伴发Objective To evaluate the characteristics of isolated and combined ligament injuries of knee joint, and compare the accuracy of MR imaging between above two type ligament injuries, incidence rate and diagnostic accuracy of concomitant meniscal tear. Methods MR images of 187 patients with ligament injuries proved clinically were reviewed. Results Among 187 patients, isolated ligament injury was seen in 103 cases and combined ligament injury in 84 cases. In isolated ligament injury group, there were 38 cases of anterior cruciate ligament （ACL） tear, 36 cases of medial collateral ligament （MCL） tear, 14 cases of posterior cruciate ligament （PCL） tear, 10 cases of medial patellofemoral ligament （MPFL） tear, 3 cases of patellar tendon （PT） tear, 2 cases of lateral collateral ligament （LCL） tear, which concomitant with 35 cases of medial meniscal （MM） tear and 23 cases of lateral meniscal （LM） tear. In combined ligaments injury group, there were 37 combined ACL and MCL injuries, 21 combined ACL and PCL injuries, 10 combined ACL, PCL, and MCL injuries, 8 combined MPFL and MCL injuries, 4 combined ACL, MCL, and MPFL injuries, 2 combined ACL and PT injuries, 2 combined ACL, PCL, and LCL injuries, which concomitant with 43 cases of MM tear and 35 cases of LM tear. The sensitivity, specificity and accuracy for diagnosing ligament tears to be 90.3%, 97.7%and 96.4%respectively in isolated ligament injury group, and 81.5%, 88.4% and 85.9% respectively significant（P〈0.05）. The concomitant incidence rate of MM tear and LM tear were 34% vs. 51.2% and 22.3% vs. 41.7% respectively, and the sensitivity, specificity and accuracy for diagnosing MM tear and LM tear were 88.6%vs. 76.7%, 89.7%vs. 65.9%, 89.3%vs. 71.4%and 87%vs. 85.7%, 93.8%vs. 77.6%, 92.2%vs. 77.4%respectively between isolated and combined ligaments injury group, which was statistically significant in incidence rate, diagnostic specificity and accuracy of concomitant meniscal tear（P〈0.05）, while no statistical difference in dia

关 键 词：膝关节 韧带 创伤与损伤 磁共振成像 

分 类 号：R686[医药卫生—骨科学]