MRI诊断前交叉韧带重建患者前内侧束和后外侧束损伤的价值  

Value of MRI in diagnosis of anteromedial and posterolateral bundle tears in patients undergoing anterior cruciate ligament reconstruction

作　　者：郑雷[1] 张广英[2] 孙百胜[1] 谷川[1] 纪丙军[1] 何伟华[1] 白正武[3] 赵斌[4] 

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,济南250014 [2]山东大学附属千佛山医院超声诊疗科 [3]山东大学附属千佛山医院关节外科 [4]山东省医学影像学研究所

出　　处：《中华放射学杂志》2015年第4期306-309,共4页Chinese Journal of Radiology

摘　　要：目的探讨MRI诊断前交叉韧带（ACL）重建患者前内侧束（AMB）和后外侧束（PLB）损伤的价值。方法回顾性分析行关节镜下ACL重建术且术前行患侧膝关节MRI检查的141例患者资料。MRI检查与关节镜下ACL重建术时间间隔为4—29d，中位时间11d。在MRI上观察AMB和PLB的损伤情况，并行正常、部分撕裂、完全撕裂分级。以关节镜结果为金标准，应用X^2检验比较MRI诊断AMB、PLB损伤诊断符合率的差异。结果关节镜下，单束损伤13例（9.2％，13／141），其中AMB损伤11例，PLB损伤2例；AMB和PLB均损伤128例（90．8％，128／141）。单束损伤和双束损伤发生率的差异有统计学意义（X^2=6．532，P=0．011）。MRI上，正常纤维束表现为韧带纤维束形态、走行、信号正常；部分撕裂表现为纤维束局限性撕裂，连续性中断，并可见残存的纤细呈正常信号的纤维束；完全撕裂表现为韧带纤维束连续性中断。MRI诊断AMB损伤的正确率为85．8％（121／141），诊断PLB损伤的正确率为72．3％（102／141），二者差异有统计学意义（X^2=7．737，P=0．005）。MRI诊断ANB、PLB部分撕裂的符合率分别为77．8％（14／18）、50．0％（15／30），二者差异无统计学意义（X^2=3．630，P=0．057）；MRI诊断AMB、PLB完全撕裂的符合率分别为87．6％（106／121）、84．0％（84／100），二者差异无统计学意义（X^2=0．589，P=0．443）；MRI诊断AMB部分撕裂与完全撕裂符合率的差异无统计学意义（X^2=1．282，P=0．258）；MRI诊断PLB部分撕裂与完全撕裂符合率的差异有统计学意义（X^2=14．690，P=0．001）。结论在ACL重建患者中，AMB、PLB完全撕裂常见，AMB、PLB单束损伤少见。MRI诊断ACL损伤具有价值，能较准确显示AMB、PLB完全撕裂及AMB部分撕裂，但对于PLB部分撕裂的诊断符合率仍需要进一步提高。Objective To analyze the value of MRI in the diagnosis of anteromedial bundle（AMB） and posterolateral bundle （PLB） tears in patients undergoing anterior cruciate ligament （ACL） reconstruction. Methods MRI of 141 knees undergoing ACL reconstruction were retrospectively reviewed with using arthroscopy as golden standard to evaluate diagnostic accuracy of MRI to predict AMB and PLB injury conditions. The interval time between MRI and arthroscopic ACL reconstruction was 4 days to 29 days. The median time was 11 days. The injury patterns of AMB and PLB was observed on MRI and classified into normal type, partial tear and complete tear. Using the arthroscopic findings as the golden standard, MRI diagnostic accuracy of AMB and PLB tears was compared with Chi-square test . Results Thirteen cases （9.2%, 13/141） with isolated bundle injury were identified in the arthroscopic assessments among 141 patients, including 11 cases with isolated AMB injury and 2 cases with isolated PLB injury. Combined AMB and PLB injury were all identified in the remaining 128 knees （90.8%, 128/141）. There was statistical difference between the incidence rate of isolated bundle injury and double-bundles injury （X2=6.532, P=0.011）. Partial tear was defined as partially torn or interrupted fiber bundles with remaining normal fiber bundles. Complete tear was defined as the fiber bundles in the expected region of the ligament were completely discontinuous. The diagnostic accuracy of MRI in prediction of AMB injury was better than PLB [85.8% （121/141） versus 72.3% （102/141）; X2=7.737, P=0.005]. There was no statistical difference between the accuracy rate of MRI in diagnosis of partial AMB and PLB tear [77.8% （14/18） versus 50.0% （15/30）;X2=3.630, P=0.057]. There was no statistical difference between the accuracy rate of MRI in diagnosis of complete AMB and PLB tear [87.6% （106/121） versus 84.0% （84/100）; X2=0.589, P=0.443]. There was no statistical difference between the accuracy rate of MRI in diagnos

关 键 词：前交叉韧带 创伤与损伤 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R686.5[医药卫生—诊断学]