无移位半月板桶柄样撕裂的诊断与可修复性判断

Nondisplaced Bucket-Handle Meniscus Tear:Diagnosis and Criteria for Reparability

目的：回顾性研究进行手术修补的半月板桶柄样撕裂（BHT）的病例，探讨无移位的半月板桶柄样撕裂的临床诊断方法及可修补性判断。方法：2002年9月～2006年10月，对实施修补手术的126例129个半月板桶柄样撕裂的术前核磁共振（MRI）表现（是否存在Ⅲ度信号及其形态、发生区域、累计层面等）以及相关因素（临床表现、是否合并陈旧前交叉韧带（ACL）损伤、发生侧别以及可修复性判断等）进行评估和统计分析。结果：在进行BHT修补手术的129个半月板中，术前MRI无移位表现的共38例39个半月板（30．2％），其中外侧半月板7个（17．9％），内侧半月板32个（82．1％）。在上述39个半月板中，19个冠状面或矢状面出现Ⅲ度信号（垂直或斜形）的层数≥3（层厚0．4mm，间距4．0mm），术前存在特异性的交锁-解锁症状26例（68．4％），合并陈旧性ACL损伤35例（92．1％），均为完全性ACL损伤。结论：无移位的半月板桶柄样撕裂，建议诊断方法如下：（1）冠状面或矢状面出现Ⅲ度信号的层数≥3（层厚0．4mm，间距4．0mm）；（2）交锁和伸膝受限；（3）合并陈旧性ACL损伤（受伤至手术时间大干6周）。可修复性MRI判断标准如下：（1）Ⅲ度信号距离滑膜缘小于4mm；（2）Ⅲ度信号距离滑膜缘小于4mm的MRI冠状位层数≥3（层厚0．4mm，间距4．0mm）；（3）半月板无明显退行性变。

Objectives In this study, MRI of repairable bucket-handle meniscus tear （BHT） was retrospectively reviewed to investigate the clinical diagnostic approach and predicted value of MRI in the diagnosis of non-displaced bucket-handle tear. Methods From Sept 2002 to Oct 2006, 126 cases with 129 bucket-handle menisci tears were enrolled in this study. The MRI（ Ⅲ-degree signals, shape of signals, rim width, levels）and related factors （symptoms, sites, combined chronic injured of anterior cruciate ligament, prediction for reparability） were analyzed. Results In 129 patients with BHT, 39 menisci of 38 patients （25 men and 13 women） were non-displaced. 7 of 39（17. 9%）and 32 of 39 （82.1 %） menisci were lateral and medial respectively. In 19, the sagittal or coronal levels of W-degree signals were 93 levels （slice thickness was 4 mm with a 0.4mm between slice intervals）. 26 of 38 （68.4%） patients had locking or catching before surgery. 35 （92.1%） patients had undergone chronic anterior crueiate ligament reconstructions. Conclusions Recommended diagnostic criteria included （1） the sagittal or coronal levels of Ⅲ-degree signals ≥3 levels （slice thickness was 4 mm with a 0.4mm between slice interval）, （2） Locking or catching symptom, and （3） combined with chronic injury of anterior cruciate ligament （ 〉6 weeks）. MRI used for prediction of BHT reparability included （1） the distance from Ⅲ-degree signal to membrane less than 4 mm wide, （2） 1 cm or greater tear length, regardless of the total lesion length, （3） no degeneration in the peripheral body or the inner portion.