超声评价膝关节软骨退行性变与手术的对照研究

Ultrasonographic assessment of articular cartilage degeneration in knee compared with qperation

目的探讨膝关节软骨不同时期退行性变(退变)的超声表现,并进一步分析超声的诊断价值。方法对行关节镜手术的9个膝关节用超声术中经皮实时观察,对关节置换术的2个膝关节标本(置生理盐水中)进行离体观察。总结正常软骨及Ⅰ～Ⅳ期软骨退变的超声表现。以此为超声诊断标准,术前检查40例患者的41个膝关节,将超声诊断与关节镜结果及手术切除标本对照。结果正常软骨表现为高-低-高"夹心饼断面"样回声带,Ⅰ期退变常无异常,Ⅱ期退变软骨表面毛糙,轻度变薄或局部隆起,Ⅲ期退变软骨局部变薄,Ⅳ期退变软骨层完全丧失。超声诊断膝关节软骨退变的敏感性、特异性、准确性分别为64.9%、92.0%、76.5%。结论除Ⅰ期外,其余各期关节软骨退变在超声上均有一定特点。超声可作为诊断膝关节软骨退变的重要辅助手段。

Objective To estimate the sonographic features of different grades of cartilage degeneration and evaluate the diagnositic value of ultrasound. Methods Nine knees underwent arthroscopic surgery and two knees underwent total knee arthroplasty were entered into the study group. We used ultrasound （US） to study the cartilage lesions which were detected and graded by direct visualization in knee specimens or in arthroscopic surgery. Then, the US appearance of all grades of cartilage degeneration were determined. Forty patients （forty-one knees） who were go to undergo arthroscopic surgery or complete knee arthroplasty were examined using high frequency ultrasound probe. Results Normal cartilage was typically seen as a homogeneously hypoechoic band with sharp anterior and posterior margins. A grade 1 degeneration usually appeared as the same as normal cartilage. A grade 2 appeared as localized loss of hyperechoic superficial margin of cartilage, focal areas with swelling or thinning mildly. A grade 3 appeared as incomplete loss of cartilage thickness. A grade 4 was shown as complete loss of cartilage. Identification of overall cartilage degeneration by ultrasound was： sensitivity 64.9%, specificity 92.0%, accuracy 76.5%. Conclusion Grades 2, 3 and 4 cartilage degeneration of the femoral condyles showed some sonographic features. Ultrasound may be used as an adjuvant method for diagnosis of articular cartilage degeneration in knee.