膝关节交叉韧带损伤患者MRI影像特点及诊断价值分析  

MRI Imaging Features and Diagnostic Value in Patients with Cruciate Ligament Injuries of the Knee

作　　者：代承忠 王浩东[1] DAI Chengzhong;WANG Haodong(Sichuan Orthopedic Hospital,Sichuan Chengdu 610041,China)

机构地区：[1]四川省骨科医院医学影像科,四川成都610041

出　　处：《河北医学》2024年第8期1358-1362,共5页Hebei Medicine

基　　金：四川省中医药管理局科学技术研究专项课题,(编号:2020JC0097)。

摘　　要：目的:观察膝关节前交叉韧带(ACL)损伤患者MRI影像特点,并对其诊断价值进行分析。方法:选取2020年3月至2023年12月在本院收治的109例膝关节损伤患者,均完善MRI检查和关节镜,以关节镜为“金标准”分为ACL组和非ACL组,比较两组MRI影像特点(直接征象和间接征象),并利用Kappa一致性分析各影像特点对膝关节前交叉韧带的诊断价值,并计算敏感度和特异度。结果:经关节镜检查,有46例患者存在ACL,其中完全断裂32例,部分断裂9例,ACL胫骨止点处断裂5例。ACL组与非ACL组3个直接征象(ACL不连续、走行异常、水肿增粗)、10个间接征象表现(Blumensaat角、PCL角、PCL指数、骨挫伤、Notch征、胫骨前移位、半月板后角裸露征、空髁间窝征、外侧副韧带单层显示、PCL单层显示)差异均具有统计学意义(P<0.05)。经Kappa一致性分析显示,直接征象中以走行异常的Kappa一致性最高,间接征象中以Blumensaat角Kappa一致性最高,Kappa值分别为0.790、0.569(P<0.001);敏感度以直接征象走行异常最高,特异度以间接征象空髁间窝征最高(P<0.05)。结论:ACL患者MRI影像特征明显,主要征象水肿增粗、走行异常,间接征象Blumensaat角可作为主要诊断依据,间接征象空髁间窝征、Notch征、PCL单层显示可作为主要辅助依据。Objective:To observe imaging features of MRI in patients with anterior cruciate ligament(ACL)injury of knee joint,and to analyze their diagnostic value.Methods:This study included 109 patients with knee joint injuries treated at our hospital from March 2020 to December 2023.All patients underwent MRI and arthroscopy,with arthroscopy serving as the"gold standard."Patients were divided into an ACL group and a non-ACL group.The MRI imaging features(direct and indirect signs)of both groups were compared.Kappa consistency analysis was used to evaluate the diagnostic value of each imaging feature for ACL injuries,and sensitivity and specificity were calculated.Results:Arthroscopy revealed 46 cases of ACL injuries,including 32 complete tears,9 partial tears,and 5 tibial avulsions.There were significant differences between the ACL group and the non-ACL group in three direct signs(ACL discontinuity,abnormal course,and edema and thickening)and ten indirect signs(Blumensaat angle,PCL angle,PCL index,bone contusion,notch sign,anterior tibial displacement,uncovered posterior horn of the meniscus,empty intercondylar notch sign,single-layer display of the lateral collateral ligament,and single-layer display of the PCL)(P<0.05).Kappa consistency analysis showed that among the direct signs,the abnormal course had the highest Kappa consistency(Kappa=0.790,P<0.001),and among the indirect signs,Blumensaat angle had the highest Kappa consistency(Kappa=0.569,P<0.001).Sensitivity was highest for the direct sign of abnormal course,while specificity was highest for the indirect sign of empty intercondylar notch sign(P<0.05).Conclusion:MRI imaging features of ACL injuries are distinct,with primary signs being edema and thickening,and abnormal course.The indirect sign of Blumensaat angle can serve as a primary diagnostic basis,while the indirect signs of empty intercondylar notch sign,notch sign,and single-layer display of the PCL can serve as key auxiliary indicators.

关 键 词：膝关节交叉韧带 磁共振成像 影像特征 诊断价值 

分 类 号：R445.2[医药卫生—影像医学与核医学] R686.5[医药卫生—诊断学]