磁共振成像与关节镜诊断前交叉韧带损伤的对比研究

Comparison between Athroscopy and MRI in the Diagnosis of Anterior Cruciate Ligament Injury

目的探讨磁共振成像(MRI)与关节镜诊断前交叉韧带(ACL)损伤的价值,为临床手术提供依据。方法收集唐山市人民医院骨科2008年10月—2013年9月怀疑ACL损伤患者35例,术前均行MRI扫描,并将MRI征象与关节镜下所见进行对比。结果关节镜诊断ACL损伤:完全断裂18例,部分断裂8例,韧带下止点撕脱骨折2例,正常7例。MRI诊断ACL损伤的敏感度为85.7%,特异度为60.0%,准确度为86.7%,阳性预测值为87.7%,阴性预测值为60.0%。两种方法检查结果 Kappa值为0.163,P<0.000 1。结论 MRI显示ACL正常时,可靠性很高;MRI提示部分撕裂时,有相当一部分是完全撕裂;MRI提示完全撕裂时,可靠性很高,多与关节镜下所见一致。

Objective To evaluate the efficacy of ahroscopy and MRI in the diagnosis of anterior cruciate ligament（ACL） injury.Methods A total of 35 suspected patients with ACL injury who were treated in department of orthopaedics,Tangshan People′s Hospital from October 2008 to September 2013,were selected as study subjects.All cases were examined by preoperative MRI before they underwent treatment through arthroscopy,and then MRI features were compared with arthroscopic findings.Results According to arthroscopic findings,complete tear was found in 18 cases,partial tear was found in 8 cases,avulsion fracture under ligament was found in 2 cases,and 7 cases were normal.The sensitivity,the specificity,the accuracy,the positive predictive value,and negative predictive value of MRI in the diagnosis of ACL injury was 85.7%,60.0%,86.7%,87.7% and 60.0% respectively.The results of MRI and arthroscopy were compared,the difference was significant（ Kappa value=0.613,P〈0.000 1）.Conclusion MRI has high value in the diagnosis of ACL injury,which may reveal absent ACL with very high reliability; Some patients were diagosed with partial tear by MRI,but they were actually diagnosed with complete tear by arthroscopy;MRI can reveal complete tear with high relability,the MRI results are always consistent with findings by the athroscopy.