MRI检查在膝关节交叉韧带损伤中的应用

Magnetic resonance imaging and arthroscopy in patients with cruciate ligament injury of knee joints

目的:观察MRI检查在膝关节交叉韧带损伤诊断中的应用情况。方法:收集2009年1月至2011年3月广东省揭阳市人民医院收治的74例膝关节交叉韧带损伤患者的临床资料,以关节镜检查的诊断结果作为金标准,分析比较MRI检查的准确率。结果:本组74例膝关节交叉韧带损伤患者中,关节镜诊断阳性率、临床体检阳性率、MRI检查初次诊断阳性率分别为100%(74/74)、99%(73/74)、86%(64/74),MRI检查与前两者比较,差异具有统计学意义(P<0.05)。MRI检查的诊断假阳性率为14%(10/74)。患者MRI影像表现较为复杂,如韧带连续性中断、信号增高、外形不规则、韧带水平走向等,尤其是急性损伤的高信号及积液的高信号常常影响MRI检查结果。结论:MRI检查对于膝关节前后交叉韧带损伤的诊断和手术方案的准备都治必不可少,但需结合临床的分析,可疑患者必要时应进行膝关节镜检查,以免造成漏诊。

Objective：To determine the diagnostic accuracy of magnetic resonance imaging （MRI） and arthroscopy in patients with cruciatc ligament injury of knee joint. Methods ： We collected the clinical profiles of 74 patients with cruciate ligament injury of knee joint admitted to Jieyang People＇s hospital between January 2009 and March 2011. The diagnostic accuracy of MRI was explored by using arthroscopy as the gold standard. Results： Of the 74 patients with eruciate ligament injury of knee joints, the positive rate of arthroscopy （100%, 74/74） differed statistically from that of physical examination （99%, 73/74） and initial MRI （86%, 64/74） （ both P 〈 0.05 ）. MRI was found to have a false positive rate of 14% （10/74）. MRI manifestations exhibited a complex myriad of discontinuous ligament, inereased signal intensity, irregular shapes, horizontal ligament travelling, and in particular, high-intensity signals suggesting acute injury and effusion that may have impact on the results. Conclusion： MRI is indispensible to guide the diagnosis and surgical strategies for cruciate ligament injury of knee joints. Combination with clinical manifestations is required. Arthroscopy should therefore be considered, if necessary, in those with suspicious cruciate ligament injury, thereby avoiding missed diagnoses