踝关节剥脱性骨软骨炎微骨折术后修复组织的MRI定量评估  

Quantitative MRI evaluation of repair tissue after microfracture treatment for ankle osteochondritis dissecans

作　　者：鹿蓉 乔洋[1] 陶虹月[1] 尚西亮[2] 冯晓源[1] 陈爽[1] 

机构地区：[1]复旦大学附属华山医院放射科,上海200040 [2]复旦大学附属华山医院运动医学科,上海200040

出　　处：《放射学实践》2015年第8期855-860,共6页Radiologic Practice

摘　　要：目的：探讨定量 MRI评估踝关节剥脱性骨软骨炎（OCD）微骨折术后早期和中期软骨修复情况的临床价值。方法：2010－2012年在我院运动医学科进行微骨折治疗的踝关节OCD患者20例，在术后312个月（早期）及1224个月（中期）分别进行两次踝关节 MRI 扫描及临床疗效评分。MRI 扫描序列主要为3D 双回波稳态序列（3D-DESS）、T2-mapping和T2 STIR序列，分别用于测量修复组织的厚度指数、T2指数及修复区下骨髓水肿（BME）体积。采用美国足踝外科评分系统（AOFAS）评估临床疗效。采用配对样本t检验比较早期和中期修复组织的定量 MRI 参数（厚度指数、T2指数、BME体积）及AOFAS评分的差异，采用Pearson相关分析评估定量 MRI参数与AOFAS评分的相关性。结果：微骨折术后中期修复组织的厚度指数高于早期（分别为0．813±0．104和0．687±0．123，P＜0．05），T2指数低于早期（1．109±0．171和1．392±0．174，P＜0．05），BME体积小于早期（0．646±0．70和0．992±0．924，P＜0．05）；AOFAS评分高于早期（85．050±7．660和76．750±9．419，P＜0．05）。厚度指数、T2指数及BME 体积与 AOFAS 评分均存在相关性（r＝0．412、－0．531和－0．357，P值均小于0．05）。结论：踝关节OCD微骨折术后损伤区逐渐填充，修复组织逐渐成熟， BME范围逐渐缩小，患者临床症状改善，定量MRI与临床疗效存在相关性。MRI 3D-DESS、T2-mapping、T2 STIR能从修复厚度、组织生化构成和BME等方面全面有效评估踝关节OCD微骨折术后的修复情况。Objective：To evaluate repair tissue at short-term and middle-term follow-up after microfracture treatment for ankle osteochondritis dissecans （OCD）using quantitative MRI.Methods：Twenty patients with ankle OCD who under-went microfracture treatment from Sports Medicine Department of Huashan Hospital were recruited in this study.The pa-tients underwent twice MRI scans and twice clinical evaluations of therapy effect for the ankle joint at 3-12 months post-op （short-term）and 12-24 months post-op （middle-term）,respectively.The ankle MRI mainly included 3D double echo steady state sequence （3D-DESS）,T2-mapping,and T2 STIR,in order to measure the thickness index,T2 index of repair tis-sue （RT）and the volume of bone marrow edema （BME）under RT.The clinical outcomes were evaluated using American Orthopaedic Foot and Ankle Society （AOFAS）scoring system.The paired samples t-test was used to compare the differ-ences of quantitative MRI parameters （thickness index,T2 index and BME volume）and AOFAS scores between the two fol-low-ups;Pearson correlation coefficient was used to analyze the correlation between quantitative MR parameters and AO-FAS scores.The difference would be statistically significant if P〈0.05.Results：The thickness index of RT at middle-term after microfracture treatment was significantly higher than that at short-term （0.813±0.104 vs 0.687±0.123,P〈0.05）;T2 index was significantly lower at middle-term than that at short-term （1.109±0.171 vs 1.392±0.174,P〈0.05）;BME volume was significantly lower at middle-term than that at short-term （0.646±0.70 vs 0.992±0.924,P〈0.05）;and AO-FAS score was higher at middle-term than that at short-term （85.050±7.660 vs 76.750±9.419,P〈0.05）.The thickness index,T2 index and BME volume were weakly to moderately correlated with AOFAS scores （r= 0.412,-0.531 and-0.357 respectively;all P〈0.05）.Conclusion：After microfracture treatment,RT gets matured and fills the defect region gradually,and BME under the RT

关 键 词：踝关节 剥脱性骨软骨炎 微骨折 磁共振成像 双回波稳态进动序列 

分 类 号：R687.3[医药卫生—骨科学] R445.2[医药卫生—外科学]