胫骨平台骨折患者膝关节韧带及半月板损伤的多层螺旋CT诊断  

Diagnosis of Ligament and Meniscal Injury in Tibial Plateau Fractures with Multi-slice Computed Tomography

作　　者：方挺松[1] 柯祺[1] 黄钰坚[1] 袁健祥[1] 彭涛[1] 

机构地区：[1]广州中医药大学附属佛山中医院放射科CT室,广东佛山528000

出　　处：《现代医用影像学》2014年第2期96-99,共4页Modern Medical Imageology

摘　　要：目的：探讨多层螺旋CT（MSCT）扫描对胫骨平台骨折患者的膝关节韧带、半月板损伤的诊断价值以及关节面的塌陷、劈裂程度与半月板损伤之间的相关性。材料与方法：回顾性分析65例胫骨平台骨折患者的临床及影像资料，在MSCT多平面重建（MPR）图像上对膝关节韧带及半月板的损伤情况进行评估，同时对关节面的塌陷及劈裂程度进行测量。CT检查后一周之内（平均3天）行核磁共振（MRI）检查。结果：以MRI为参考标准，CT诊断韧带损伤的敏感性、特异性、阳性预测值、阴性预测值、准确率分别为79％，94％，68％，97％、92％。MRI发现半月板损伤患者共38例（约58％，38／65），其平均关节面塌陷程度为1．2cm（0—2．1cm），关节面劈裂距离为1．4cm（0—2．7cm）；另27例没有半月板损伤的患者中，其平均关节面塌陷程度为0．6cm（0～1．4cm），关节面劈裂距离为0．5cm（range0～1．3cm）；这两组病例的两个测量参数之间的差异均有统计学意义（P=0．01）。结论：MSCT对胫骨平台骨折患者膝关节韧带损伤的诊断有较好的特异性、准确率及阴性预测值；关节面塌陷及劈裂程度与半月板损伤之间存在一定的相关性。Purpose： To determine the value of multi-slice computed tomography （MSCT） in the evaluation of ligament and meniscal injury in patients with tibial plateau fractures, and to evaluate the correlation between the amount of articular depression, cleavage distance and the meniscal injury. Materials and Methods： A retrospective review was performed on the data of 65 patients with tibial plateau fractures. Ligament and meniscal injury were assessed on the multi - planar reconstruction（MPR） images of MSCT, articular depression and cleavage distance were also measured. Magnetic resonance imaging （MRI） were performed within 1 weeks （mean 3 days） in relation to MSCT. Results： The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT for predicting ligament injury were 79% , 94% , 68% , 97% , 92% , using MRI findings as the reference standard. Meniscal injury were found on MR imaging in 38（58% , 38/65） patients, articular depression and cleavage distance was 1.2 cm （range 0 -2. 1 cm） and 1.4cm （range 0 -2. 7 cm） , respectively. Average articular depression and cleavage distance in the others （27 cases ） without meniscal injury was 0. 6cm （ range 0 - 1.4cm） and0. 5cm（ range 0 - 1.3cm） , respectively. There was a statistically significant difference in both param- eters of two groups（ p = 0. 001 ）. Conclusion： MSCT can detect ligament injury with good specificity, accuracy and negative predictive value. The amount of articular plateau depression, cleavage distance are related to the mensical injury in tibial plateau fractures.

关 键 词：胫骨平台骨折 韧带 半月板损伤计算机断层成像 

分 类 号：R687.3[医药卫生—骨科学]