磁共振成像诊断前交叉韧带撕裂伴Ramp损伤的价值  

Value of magnetic resonance imaging in the diagnosis of anterior cruciate ligament tear with ramp lesion

作　　者：董晚亭 王浩东[1] 潘小文[1] 罗飞[1] 易雪冰[1] Dong Wanting;Wang Haodong;Pan Xiaowen;Luo Fei;Yi Xuebing(Department of Medical Imaging,Sichuan Provincial Orthopedic Hospital,Chengdu 610000,China)

机构地区：[1]四川省骨科医院医学影像科,成都610000

出　　处：《保健医学研究与实践》2023年第12期65-69,共5页Health Medicine Research and Practice

基　　金：四川省中医药管理局中医药科研专项课题(2021MS330)。

摘　　要：目的探讨前交叉韧带(ACL)撕裂患者术前磁共振成像(MRI)诊断Ramp损伤的价值,以期为临床治疗提供参考。方法选取2019年6月—2022年7月在四川省骨科医院治疗的ACL撕裂患者126例为研究对象,给予MRI和关节镜检查。比较分析MRI诊断Ramp损伤的价值,同时分析合并和未合并Ramp损伤患者临床资料、影像资料差异,尝试明确ACL撕裂合并Ramp损伤的影响因素。结果MRI诊断与关节镜检查一致性Kappa值为0.527,P<0.001,一致性一般。MRI诊断ACL合并Ramp损伤的灵敏性、特异性、准确性、阳性预测值和阴性预测值分别为45.00%、98.11%、89.68%、82.82%和90.43%。合并Ramp损伤组病程≥6周患者比例高于未合并Ramp损伤组患者(P<0.05);2组患者性别构成、年龄、身体质量指数等比较,差异无统计学意义(P>0.05)。合并Ramp损伤组内侧半月板后角与关节囊连接处出现线样液性高信号、内侧半月板后角边缘出现纵行撕裂、胫骨前移、股骨内侧髁骨挫伤、ACL完全撕裂患者所占比例高于未合并Ramp损伤组患者,差异均有统计学意义(P<0.05)。多因素逐步Logistic回归分析结果显示:病程、内侧半月板后角与关节囊连接处出现线样液性高信号、内侧半月板后角边缘出现纵行撕裂、胫骨前移、股骨内侧髁骨挫伤是ACL撕裂患者发生Ramp损伤的影响因素(P<0.05)。结论MRI诊断ACL撕裂合并Ramp损伤的灵敏性较低,但特异性较高。ACL撕裂合并Ramp损伤受病程、内侧半月板后角与关节囊连接处出现线样液性高信号、内侧半月板后角边缘出现纵行撕裂、胫骨前移、股骨内侧髁骨挫伤的影响。本研究基本复制了临床情况,具有实用价值。Objective To explore the value of preoperative magnetic resonance imaging(MRI)in diagnosing Ramp lesions in patients with anterior cruciate ligament(ACL)tears,in order to provide clinical support.Methods A total of 126 patients with ACL tears treated at the Sichuan Provincial Orthopedic Hospital from June 2019 to July 2022 were selected as the study participants and underwent MRI and arthroscopic examination.The value of MRI in diagnosing Ramp lesions was compared and analyzed,and the clinical and imaging data differences between patients with and without Ramp lesions were analyzed to determine the influencing factors of ACL tear with Ramp lesion.Results The Kappa value of consistency between MRI diagnosis and arthroscopic examination was 0.527(P<0.001),indicating moderate consistency.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of MRI in diagnosing ACL with Ramp lesion were 45.00%,98.11%,89.68%,82.82%,and 90.43%,respectively.The proportion of patients with a disease course of≥6 weeks in the combined Ramp lesion group was higher than that in the non-combined Ramp lesion group(P<0.05).No statistically significant difference was observed in gender composition,age,body mass index,and other factors between the two groups(P>0.05).In the combined Ramp lesion group,significantly higher proportions of high-signal linear fluid were found at the posterior horn of the medial meniscus connected to the joint capsule,longitudinal tears at the posterior horn of the medial meniscus,anterior displacement of the tibia,medial condyle bruising of the femur,and complete ACL tear compared to the non-combined Ramp lesion group(P<0.05).The results of multivariate stepwise logistic regression analysis showed that the disease course,high-signal linear fluid at the posterior horn of the medial meniscus connected to the joint capsule,longitudinal tears at the posterior horn of the medial meniscus,anterior displacement of the tibia,and medial condyle bruising of the femur were influencing fac

关 键 词：前交叉韧带撕裂 磁共振成像 Ramp损伤 诊断价值 

分 类 号：R686.5[医药卫生—骨科学]