成人完全型外侧盘状半月板损伤的形态学特征及MRI评价  

Morphological Characteristics of Adult Patients with Complete Discoid Lateral Meniscus Tears and Their MRI Evaluation

作　　者：孙晓新 周伟[2] 左淑萍[3] 刘昊 刘昊 宋敬峰 余向前 张岩 梁春雨 张柳 

机构地区：[1]华北理工大学附属医院,河北唐山063000 [2]唐山市第三医院 [3]唐山工人医院

出　　处：《中国运动医学杂志》2016年第9期799-803,831,共6页Chinese Journal of Sports Medicine

基　　金：河北省科技支撑项目(2015,项目编号:152777139)

摘　　要：目的:探讨形态学指标在成人完全型外侧盘状半月板损伤MRI评价中的价值。方法:回顾性分析具有完整术前MRI影像资料并经关节镜手术证实的成人完全型外侧盘状半月板病例68例(70膝)。由一名放射学住院医师(甲)和一名运动医学主任医师(乙)采用双盲法独立分析所有病例MRI图像资料。采用楔形征、板形征、游离缘肥厚征和肥角征等4个形态学指标作为评价外侧盘状半月板形态学特征的指标。以膝关节镜作为诊断金标准,探讨上述4个形态学指标评价成人完全型外侧盘状半月板损伤的能力。采用Kappa检验评价2名医师诊断结果的一致性。结果:Kappa评价显示2名医师评价结果的一致性极佳(K值>0.75,P<0.001)。外侧盘状半月板损伤组中游离缘肥厚征和肥角征的发生率明显高于无损伤组(P<0.05);无损伤组楔形征的发生率明显高于损伤组(P<0.05)。两组板形征的发生率间比较差异无统计学意义(P>0.05)。楔形征病例中外侧盘状半月板损伤的发生率为14.8%(甲)和12.0%(乙),板形征为33.3%(甲)和37.5%(乙),游离缘肥厚征为94.1%(甲)和100%(乙),肥角征甲、乙均为100%。与楔形征比较,游离缘肥厚征和肥角征预示存在外侧盘状半月板损伤的风险更高(P<0.001)。而板形征与楔形征间比较差异无统计学意义。结论:损伤与无损伤的成人完全型外侧盘状半月板的MRI形态学特征有所不同。形态学指标对于评价成人完全型外侧盘状半月板损伤具有一定价值。Objective To discuss the value of morphological characteristics in evaluating the complete discoid lateral meniscal(CDLM)tears among adult patients. Methods Sixty eight patients(seventy knees)with CDLM tears were reviewed. The preoperative magnetic resonance imaging(MRI)was checked in 70 knees with CDLM tears. All MR images were analyzed by a radiology residency(doctor A)and a sports physician(doctor B)independently,and the morphological findings were classified into 4 categories: a wedge sign,a slab sign,a hypertrophic-free-edge sign and a hypertrophied-horn sign. Tear pattern classifications were diagnosed based on arthroscopic findings. The feasibility of evaluating the CDLM tears using the above morphological indexes was discussed,and the diagnostic agreement of the two doctors was evaluated using the Kappa statistics.Results The Kappa statistics for CDLM tears demonstrated a good inter-observer agreement(K〉0.75,P〈0.001).The hypertrophic free edge sign and hypertrophied-horn sign were observed significantly more in patients with CDLM tears,but the wedge sign was significantly more frequently found in patients without CDLM tears than those with CDLM tears(P〈0.05). No significant differences were found in the appearance of the slab sign in the MRI of patients with or without CDLM tears(P〉0.05). The incidence of CDLM tears in cases with the wedge sign was 14.8%(according to doctor A)and 12.0%(according to doctor B),while that of with the slab sign,the hypertrophic free edge sign and the hypertrophied-horn sign was 33.3% and 37.5%,94.1 % and 100%,and both 100 % accordingly. Compared with the wedge sign,the appearance of hypertrophic free edge sign and hypertrophied-horn sign indicated significantly higher risk of CDLM tears(P〈0.001). There were no significant differences between the slab sign and the wedge sign. Conclusions There are significant morphological differences between a torn CDLM and an intact CDLM in their MR images. The morphological characteristics of the CDLMs may be reliable indicators f

关 键 词：成人 外侧盘状半月板 形态 核磁共振成像 

分 类 号：R684[医药卫生—骨科学] R445.2[医药卫生—外科学]