合并前交叉韧带损伤的膝关节隐性骨折模式MRI诊断

MRI diagnosis of occult fracture patterns of the knee associated with anterior cruciate ligament tears

目的 探讨合并前交叉韧带 (ACL)损伤的膝关节隐性骨折模式 ,提高MRI诊断ACL损伤的准确性。 方法 回顾性分析 4 8例合并ACL损伤的膝关节隐性骨折病灶分布特点。 结果 膝关节隐性骨折和外侧部隐性骨折合并ACL损伤率分别为 86 % ( 4 8/5 6 )和 88% ( 4 2 /4 8) ;股骨外侧髁、胫骨外侧平台前缘和胫骨外侧平台后缘隐性骨折合并ACL损伤率分别为 86 % ( 2 4 2 8)、90 % ( 9/1 0 )和 92 % ( 2 2 2 4 )。 1 6例胫骨外侧平台后缘和股骨外侧髁隐性骨折 (“对吻骨挫伤”)及 1 8例胫骨髁间前区隐性骨折病例 ,全部合并ACL损伤。 结论 膝关节隐性骨折或外侧部隐性骨折作为ACL损伤的间接征象是可靠的。胫骨外侧平台后缘和股骨外侧髁的“对吻骨挫伤”和胫骨髁间前区隐性骨折 ,提示ACL损伤。

Objective To evaluate occult fracture patterns of the knee associated with anterior cruciate ligament (ACL)tears, and to improve the accuracy of ACL tears with MR imaging. Methods Locations and distributive characteristics of occult fracture lesions of the knee associated with ACL tear were retrospectively studied in 48 cases. Results There were 48 ACL tears in 56 cases with occult fracture of the knee and 42 ACL tears in 48 cases with occult fracture of the lateral compartment of the knee. The rate of ACL tear is 86%(24/28)?90%(9/10)and 92%(22/24)with occult fracture situated in the lateral femoral condyle(LFC)? anterolateral tibial plateau (ALTP)and posterolateral tibial plateau(PLTP) respectively. All ACL were torn in 16 cases with occult fracture of the LFC and the PLTP ('kissing contusion')and in 18 cases with occult fracture of the anterior intercondylar area. Conclusion Occult fracture of the knee or of the lateral compartment of the knee is a reliable indirect sign associated with ACL tears. The 'kissing contusion'of occult fracture situated in the LFC and the PLTP,and occult fracture of the anterior intercondylar area are suggestive of ACL tear.