青少年膝关节局灶性骺板区水肿磁共振表现及临床意义  

Focal perlphyseal edema zone on MRI and cfinical significance of the adolescent knee

作　　者：白荣杰[1] 詹惠荔 刘悦[1] 钱占华[1] 叶薇[1] 李亚雄[1] 张慧博[2] 

机构地区：[1]北京积水潭医院放射科北京市创伤骨科研究所,100035 [2]首都医科大学附属北京朝阳医院放射科

出　　处：《中华医学杂志》2016年第25期1965-1970,共6页National Medical Journal of China

基　　金：基金项目：国家自然科学基金面上项目（81371515）;北京市自然科学基金面上项目（7142075）;首都卫生发展科研专项项目（首发2016-2-1122）

摘　　要：目的 研究青少年膝关节局灶性骺板区水肿的影像学特点及临床意义,为正确诊断和治疗提供影像学依据.方法 选择2010年3月至2015年10月12例无外伤且膝关节疼痛的青少年患者（男9例,年龄12～16岁,平均年龄14岁;女3例,年龄12～15岁,平均年龄13岁）和16例外伤后膝关节疼痛的青少年患者（男12例,年龄10 ～15岁,平均年龄14岁;女4例,年龄11 ～13岁,平均年龄12岁）.所有患者均行膝关节磁共振（MR）检查,对照分析无外伤膝关节疼痛患者与外伤后膝关节疼痛患者局灶性骺板区水肿的MRI特点,并测量水肿最远处距骨骺板的平均距离.分别在质子压脂（PD-FS）序列冠状位、矢状位及T1WI矢状位上,测量水肿区最远处距骺板的垂直距离,取三者平均值,即为水肿最远处距骨骺板的平均距离.将其影像学表现与手术或随访结果进行对照分析,并由双盲法分析确认.结果 12例无外伤膝关节疼痛的青少年患者局灶性骺板区水肿的MR特点为以骺板为中心波及邻近骨骺和干骺端的局灶性斑片状或细线状T1WI低信号,PD-FS高信号改变,水肿范围为（14.5±6.6）mm.16例青少年外伤后膝关节疼痛患者骨骺板区水肿的MR特点为骨骺板周围关节面下范围较大的T1WI低信号、PD-FS高信号区,水肿范围为（26.2±8.8）mm.无外伤骺板区水肿范围与外伤引起的骺板区水肿范围差异有统计学意义（e =4.346,P＜0.05）.结论 青少年膝关节局灶性骺板区水肿与青少年生长期疼痛和生理性骨骺板闭合有关,不要误诊为异常.而骨骺板周围较大范围的水肿与膝关节创伤有关.Objective To investigate the MR image characteristics and clinical significance of focal periphyseal edema （FOPE） zone of the adolescent knee which was with or without trauma history,and provide the basis for the correct diagnosis and treatment.Method A total of 12 patients （9 boys,age range 12-16 years,average age 14 years old,3 girls,age range 12-15 years,average age 13 years）who had pain of the knee without the traumatic history and 16 patients （12 boys,age range 10-15 years,average age 14 years;4 girls,age range 11-13 years,average age 12 years） who were painful in the knee after trauma were included in this study.The knee MR examinations were performed in all the patients.The characteristics of MRI between painful knee without trauma and painful knee after trauma were compared and analyzed,and the average vertical distances from the farthest of the edema area to the epiphyseal plate were measured.The vertical distances were measured respectively in sagittal view and coronal view in PD-FS and in sagittal view in T1WI,and the average for the three were calculated.At last,the images with the results of operation or follow-up examinations were compared and confirmed by double blind method.Results The MRI characteristics of FOPE zone in the 12 adolescent who complained painful knee but had no trauma showed low signal intensity in T1WI and high signal intensity in PD-FS.The edema centered at the physis and extended into both the adjacent epiphysis and metaphysic.In addition,it shaped like patches and thread,and edema range （14.5 ± 6.6） mm.The MRI findings of the 16 adolescent had pain of the knee after injury characterized by a wide range of low T1WI signal intensity and increased PD-FS signal intensity involving the articular surface of the epiphysis.The range of edema was （26.2 ± 8.8） mm.There was statistically significant difference between non-traumatic edema and the edema caused by trauma （t =4.346,P 〈0.05）.Conclusion A FOPE zone of the adolescent knee is likely to be related to pa

关 键 词：磁共振成像 膝 骨骺 青少年 

分 类 号：R445.2[医药卫生—影像医学与核医学] R726.8[医药卫生—诊断学]