MRI检查结果对膝关节单髁置换术前患者选择的价值  

MRI value for preoperative case selection in unicondylar knee arthroplasty

作　　者：张攀[1] 白希壮[1] ZHANG Pan;BAI Xi-zhuang(Department of Sports Medicine and Joint Surgery,Liaoning People＇s Hospital,Liaoning,Shenyang 110016,China)

机构地区：[1]辽宁省人民医院运动医学与关节外科,辽宁沈阳110016

出　　处：《中国骨与关节损伤杂志》2018年第10期1030-1034,共5页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨MRI检查在膝关节单髁置换术前患者选择时的应用价值。方法纳入自2012-07—2014-07诊治的20例(22膝)膝关节单间室骨性关节炎,拟行膝关节单髁置换术,术前完善MRI检查,以术中所见为金标准,评价术前MRI检查的灵敏度、特异度及Kappa值。结果术前MRI检查后,3膝不适合行膝关节单髁置换术;3膝MRI显示前交叉韧带内存在高信号,诊断为Ⅰ级损伤,但轮廓及走行良好,且骨性关节炎均集中于前内侧,可行单髁置换术;上述结果与术中探查结果一致。术前MRI诊断前交叉韧带损伤的敏感度为100%,特异度为94.4%,Kappa值为0.86;术前MRI诊断膝关节软骨损伤的敏感度为94.9%,特异度为98.3%,Kappa值为0.93。对17例(19膝)行单髁置换术的患者进行随访,随访时间平均19(15～24)个月。术后1年膝关节HSS评分由术前(45.4±6.3)分提高至(90.7±3.4)分。结论采用MRI检查评价膝关节内前交叉韧带功能及软骨缺损范围、程度、位置是一种非常可靠的方法,对于明确单髁置换术的适应证有非常高的临床应用价值。Objective To investigate MRI value for preoperative case selection in unicondylar knee arthroplasty （UKA）. Methods From July 2012 to July 2014, 22 knees of 20 patients who were scheduled to undergo UKA were evaluated by MRI preoperatively. The sensitivity, specificity and Kappa values of preoperative MRI were evaluated with intraoperative findings as the gold standard. Results The preoperative MRI examination found that 3 knees were not suitable for UKA. Three knees with anterior crueiate ligament （ACL） high signal on MRI was diagnosed as I level injury, with good contour and tension of ACL and with osteoarthritis concentrated in the anteromedial facet, were feasible for UKA. These results were in line with intraoperative findings. The sensitivity and specificity of preoperative MRI in diagnosing anterior cruciate ligament injury were 100%, 94.4%, and the Kappa value were 0.86. The sensitivity, specificity and Kappa value were 94.9%, 98.3% and 0.93 respectively in diagnosing cartilage injury. Seventeen patients （19 knees） who underwent UKA were followed up for 15-24 months, with an average of 19 months. The HSS score of knee joint 1 year after operation increased from 45.4＋6.3 to 90.7-＋3.4. Conclusion MRI is reliable for evaluation of the function of ACL and scope, degree and location of cartilage defect in the knee joint. MRI has very high clinical application value for confirming indication of UKA.

关 键 词：膝关节 单髁置换术 MRI 前交叉韧带 软骨损伤 

分 类 号：R687.42[医药卫生—骨科学]