MRI诊断前交叉韧带断裂合并Ramp损伤的价值及前交叉韧带断裂合并Ramp损伤的发病特征分析  

Value of MRI in diagnosis of anterior cruciate ligament rupture combined with Ramp lesions and analysis of its onset characteristics

作　　者：沈雯 李广军 张峭巍[2] SHEN Wen;LI Guangjun;ZHANG Qiaowei(Deqing People's Hospital,Deqing 313299,Zhejiang,China;Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,Zhejiang,China)

机构地区：[1]德清县人民医院,浙江德清313299 [2]浙江大学医学院附属邵逸夫医院,浙江杭州310016

出　　处：《中医正骨》2022年第1期28-32,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:探讨MRI诊断前交叉韧带(anterior cruciate ligament,ACL)断裂合并Ramp损伤的价值,分析ACL断裂合并Ramp损伤的发病特征。方法:回顾性分析术前行膝关节MRI检查并采用关节镜ACL重建术治疗的ACL断裂患者的病例资料,由2名具有5年以上工作经验的影像专业医师分析MRI结果,诊断是否合并Ramp损伤,与关节镜下确诊结果比较,计算MRI诊断ACL断裂合并Ramp损伤的敏感度、特异度、阳性预测值、阴性预测值、约登指数和优势比。根据关节镜下确诊结果将纳入患者分为合并Ramp损伤组和不合并Ramp损伤组,比较2组患者的性别、年龄、ACL断裂类型、ACL断裂程度及后交叉韧带损伤、胫骨后外侧骨挫伤、胫骨后内侧骨挫伤、内侧副韧带损伤、外侧副韧带损伤、内侧半月板损伤、外侧半月板损伤情况,分析ACL断裂合并Ramp损伤的发病特征。结果:共纳入463例患者的病例资料,MRI诊断ACL断裂合并Ramp损伤40例,其中假阳性2例;关节镜下确诊ACL断裂合并Ramp损伤78例。2名医师的诊断结果一致性一般(Kappa=0.598)。MRI诊断ACL断裂合并Ramp损伤的敏感度为48.7%、特异度为99.5%、阳性预测值为95.0%、阴性预测值为90.5%、约登指数为48.2%、优势比为181.925。合并Ramp损伤组纳入78例,不合并Ramp损伤组纳入385例。合并Ramp损伤组患者ACL慢性断裂、合并胫骨后内侧骨挫伤的发生率均高于不合并Ramp损伤组(χ^(2)=10.179,P=0.001;χ^(2)=7.507,P=0.006);2组患者性别、年龄、ACL断裂程度及后交叉韧带损伤、胫骨后外侧骨挫伤、内侧副韧带损伤、外侧副韧带损伤、内侧半月板损伤、外侧半月板损伤情况比较,组间差异均无统计学意义(χ^(2)=0.852,P=0.356;χ^(2)=2.680,P=0.444;χ^(2)=3.296,P=0.069;χ^(2)=0.005,P=0.943;χ^(2)=2.143,P=0.143;χ^(2)=2.276,P=0.131;χ^(2)=3.008,P=0.083;χ^(2)=3.087,P=0.079;χ^(2)=3.001,P=0.083)。结论:MRI诊断ACL断裂合并Ramp损伤具有一定的应用价值,ACL断Objective:To explore the value of magnetic resonance imaging(MRI)in diagnosis of anterior cruciate ligament(ACL)rupture combined with Ramp lesions, and to analyze its onset characteristics.Methods:The medical records of patients who received knee MRI examination and underwent arthroscopic ACL reconstruction for ACL rupture were analyzed retrospectively.The MRI outcomes were analyzed by 2 imaging specialists with more than five years work experience to confirm whether the Ramp lesions were present, followed by the comparison with the arthroscopic diagnosis results, and then the sensitivity, specificity, positive predictive value, negative predictive value, Youden index and odds ratio of MRI in the diagnosis of ACL rupture combined with Ramp lesions were calculated.According to the arthroscopic diagnosis results, the included patients were divided into the Ramp lesions group and non-Ramp lesions group.The gender, age, ACL rupture type, ACL rupture degree, posterior cruciate ligament(PCL)injury, posterolateral tibial bone contusion, posteromedial tibial bone contusion, medial collateral ligament(MCL)injury, lateral collateral ligament(LCL)injury, medial meniscus(MM)injury and lateral meniscus(LM)injury were compared between the 2 groups, and the onset characteristics of ACL rupture combined with Ramp lesions was then analyzed.Results:Four hundred and sixty-three patients were included in the final analysis, 78 cases in Ramp lesions group and 385 cases in non-Ramp lesions group.The ACL rupture combined with Ramp lesions was confirmed by MRI examination in 40 patients(including false-positive result in 2 cases)and by arthroscopy in 78 cases.The consistency of diagnosis results was moderate between the 2 physicians(Kappa=0.598).The sensitivity, specificity, positive predictive value, negative predictive value, Youden index and odds ratio of MRI in diagnosing ACL rupture combined with Ramp lesions were 48.7%,99.5%,95.0%,90.5%,48.2% and 181.925 respectively.The incidence rates of chronic ACL rupture and posteromedial tib

关 键 词：膝关节 前交叉韧带损伤 Ramp损伤 磁共振成像 关节镜检查 

分 类 号：R687.4[医药卫生—骨科学]