前交叉韧带损伤MRI诊断价值与治疗方案选择的初步研究

Value of MRI for diagnosis and treatment decision of ACL injury:a pilot cases control study

目的探讨MRI对膝关节前交叉韧带损伤的诊断价值以及对治疗方法选择的指导意义。方法195例怀疑膝关节损伤的关节镜手术患者,术前MRI除常规斜矢状位、冠状位及横断面序列扫描外,加扫斜冠状位序列,通过分析斜矢状位及斜冠状位图像作出稳定型前交叉韧带(纤维束低度部分损伤或未受损)和非稳定型前交叉韧带(纤维束高度部分损伤或完全损伤)的判断,并将MRI诊断结果与关节镜下所见进行对比。结果关节镜检查发现非稳定型前交叉韧带81例,全部行关节镜下骨-髌腱-骨(B-T-B)重建手术治疗,MRI检查共诊断出非稳定型前交叉韧带82例,以关节镜诊断为标准,其中真阳性数77例,假阳性数5例,MRI诊断前交叉韧带非稳定型的准确性、敏感性和特异性分别为95.4%、95.1%、95.6%。结论MR能较准确地诊断膝关节前交叉韧带损伤程度,把前交叉韧带损伤划分为稳定型和非稳定型后,取代以往正常、部分及完全损伤的划分,能提高诊断敏感性,并为临床制订治疗方案提供依据,更有实际意义。

Objective To investigate the diagnostic value of MRI for damaged anterior cruciate ligament（ACID of knee joint and guiding significance for treatment decision. Methods One hundred and ninety-five patients with high clinical suspicion of internal derangement of the knee were performed both MRI and arthroseopy examination. The MR examinations included routine sequences and oblique coronal sequence. The imagings of ACL were scored as stable form when low-grade of the ligament fibers injuries or intact ligaments ,whereas high-grade of the ligament fibers injuries or total injuries ligaments were scored as instable form. The arthroseopie findings were taken as diagnostic standard. Result Eighty-one cases of instable form of ACL were diagnosed through arthroscopy and all were reconstructed ACL assisted with arthroscopy. Eighty-two cases of instable form of ACL were diagnosed through MRI. Depending on the exploration in arthroscopy, the accuracy, sensitivity and specificity for the diagnosis of instable form of ACL were 95.4% ,95.1% ,95.6%, respectively. Conclusion MRI can show the degree of ACL injury accurately with the grading of stable and instable ACL and it can be very useful for the clinical decision making of the treatment.