磁共振成像技术在膝关节软骨损伤术前评判中的临床应用价值  

Preoperative magnetic resonance imaging evaluation of knee cartilage injury

作　　者：刘广红[1] 张兵[1] 张辉[1] 

机构地区：[1]河南省漯河医学高等专科学校第三附属医院影像科,462002

出　　处：《中华创伤骨科杂志》2015年第8期699-703,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨磁共振成像（MRI）技术在膝关节软骨损伤术前风险评判和手术方案制定中的临床应用价值。方法2013年1月至2014年6月共收集经手术证实的69例膝关节软骨损伤患者，男29例，女40例；年龄为15～76岁，平均46．9岁。69例患者术前均行1．5T磁共振四肢关节专用诊断仪常规检查，检查后依据Outerbridge分级标准进行分型，评估手术风险并制定相应手术方式（如钻孔术、微骨折术及自体软骨移植术）。对比术中实际观察所见结果与术前MRI检查的符合情况。结果本组69例患者术前MRI检查发现345个软骨面，其中208个软骨面MRI表现异常：Ⅰ级75个（21．7％），表现为轮廓完整或略微隆起，软骨内有点片状低或高信号；Ⅱ级39个（11．3％），表现为关节软骨变薄、缺损，但未超过全层的50％，或（和）软骨表面不光整、呈锯齿状或波浪状，软骨内有点片状高低信号混杂影，关节腔内可见积液信号；Ⅲ级43个（12．5％），表现为软骨明显变薄，软骨局部缺损超过全层50％，多有关节腔内积液；Ⅳ级51个（14．8％），可见局部软骨全层缺损，缺损部位软骨下骨质暴露且伴有相邻组织结构异常。MRI检查结果（膝关节软骨损伤数量和程度）与术中所见基本一致。结论MRI能够准确显示膝关节软骨损伤的位置、大小、范围，可为临床制定手术方案提供可靠依据。Objective To explore clinical value of magnetic resonance imaging （MRI） in preoperative risk assessment and choice of operation scheme for knee cartilage injury. Methods A retrospective study was conducted of the 69 eases of knee cartilage injury which had been confirmed by surgery between January 2013 and June 2014. They were 29 males and 40 females, aged from 15 to 76 years （average, 46.9 years）. All cases underwent preoperative 1.5 T MRI by a special diagnostic instrument for limbs. The injury was assessed after MRI according to the Outerbridge criteria to evaluate surgical risks and choose an appro- priate operation scheme （drilling, micro-fracture or autoallergie cartilage grafting）. The intraoperative obser- vations were compared with the preoperative images. Results MRI found in the 69 patients 345 cartilage surfaces, of which 208 were abnormal. Of the abnormal ones, 75 （21.7%） were grade Ⅰ which presented with intact or slightly eminent contour and dots or patches of low or high signals in the cartilage; 39 （11.3% ） were grade Ⅱ which presented with thinned cartilage, defects 〈 50% of the full thickness, or （and） indented or wavy cartilage surface, dots or patches of low or high signals in the cartilage, and dropsy signals in cavity; 43 （12.5%） were grade Ⅲ which obviously thinned cartilage, defects 〉 50% of the full thickness, and massive dropsy signals in cavity; 51 （14.8%） were grade Ⅳ which presented with full thickness defects of cartilage, subchondral bone exposure beneath the defcts, and abnormal adjacent tissues. The preoperative findings were in agreement with what were observed during surgery in terms of number and extent of cartilage injury. Conclusion Because MRI can exactly display knee cartilage injury in terms of location, degree, and size, it provides solid evidence for preoperative risk assessment and choice of operation scheme for knee cartilage injury.

关 键 词：膝关节 软骨 关节 创伤和损伤 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R684[医药卫生—诊断学]