磁共振成像评估膝关节剥脱性骨软骨炎分级及稳定性  

Evaluation of grade and stability of osteochondrositis dissected of the kneeby magnetic resonance imaging

作　　者：孙虎林 张雪松 韩跃峰 SUN Hu-lin;ZHANG Xue-song;HAN Yue- feng(Department of Imaging , Mary＇ s Orthopedic Hospital, Beijing 100012, China)

机构地区：[1]北京麦瑞骨科医院影像科,北京100012

出　　处：《中国实验诊断学》2018年第6期977-980,共4页Chinese Journal of Laboratory Diagnosis

摘　　要：目的评价术前磁共振成像诊断膝关节剥脱性骨软骨炎分级及稳定性的准确性及使用价值。方法回顾性分析2012年6月至2017年6月在我院就诊的膝关节剥脱性骨软骨炎患者86例,由2名医生分析MR诊断结果,并与关节镜手术记录进行对比分析,评价MR判断OCD稳定性的特异度、敏感度和准确度,医师间的一致性。结果86例膝关节OCD患者,共89个病灶。其中,48个病灶位于股骨外侧髁,34例位于股骨内侧髁,7例位于股骨滑车。医师术前MR判断膝关节OCD分级结果为Ⅰ级8、8例,Ⅱ级19、22例,Ⅲ级31、27例,Ⅳ级31、32例。关节镜膝关节OCD分级结果为Ⅰ级8例、Ⅱ级20例、Ⅲ级31例、Ⅳ级30例。医师A术前MR分级与膝关节OCD分级一致性较好(Kappa=0.809,P<0.001),医师B术前MR分级与膝关节OCD分级一致性较好(Kappa=0.810,P<0.001)。两名医师间诊断OCD分级的一致性较好(Kappa=0.841,P<0.001)。两名医师MR诊断膝关节OCD不稳定征象的特异度、敏感度、准确度均较高,其中两名医师诊断MR征象与母体骨交界面状高信号的特异度、敏感度、准确度最高,软骨骨折线(累及全层)最低。结论术前磁共振成像诊断膝关节剥脱性骨软骨炎的分级情况及稳定性准确性高,医师间一致性好,值得使用。Objective Evaluation of the accuracy and value of preoperative magnetic resonance imaging in the diagnosis of grade and stability of osteochondrositis of the knee.Methods Retrospective analysis of 86 cases of osteochondrositis of the knee joint from June 2012 to June 2017 in our hospital,analysis of MR diagnosis by 2 doctors,to evaluate the specificity,sensitivity and accuracy of MRI in judging the stability of OCD,and the consistency between physicians.Results 86 cases of knee joint OCD with 89 lesions.48 lesions were located on the lateral condyle of the femur,34 in the medial condyle of the femur,and 7 in the femoral pulley.Preoperative OCD grading of knee Joint judged by MRI in8,8 cases of GradeⅠ,19,22 cases of GradeⅡ,31,27 cases of Grade Ⅲ,31,32 cases of Grade Ⅳ.Arthroscopic OCD classification of knee joint were stagesⅠ,Ⅱ,Ⅲ and Ⅳlesions were detected in 8,20,31 and 30 cases.The consistency between MRI grade and OCD grade of knee joint before physician A is good（Kappa= 0.809,P〈0.001）.There is good consistency between preoperative MRI grade and OCD grade of knee joint in physician B（Kappa= 0.810,P〈0.001）.There is good consistency between the two physicians in the diagnosis of OCD classification（Kappa= 0.841,P〈0.001）.The specificity,sensitivity and accuracy of two doctors in the diagnosis of OCD instability of knee joint by MRI.The specificity,sensitivity and accuracy of the two physicians in diagnosing MRI signs at the interface between the maternal bone and the maternal bone were the highest,and the cartilage fracture line（involving the whole layer）was the lowest.Conclusion Preoperative magnetic resonance imaging diagnosis of knee osteochondritis exfoliative osteochondritis with high accuracy,good consistency between doctors and worthy of use.

关 键 词：磁共振成像 剥脱性骨软骨炎 关节镜 

分 类 号：R684.3[医药卫生—骨科学]