关节镜和磁共振成像在评价膝关节软骨缺损中的价值分析

Analysis on Values of Arthroscopy and Magnetic Resonance Imaging for Evaluating Knee Cartilage Defects

目的研究关节镜和磁共振成像测量膝关节软骨缺损的特点及临床诊断价值.方法回顾分析通过手术确诊为膝关节软骨缺损的65例患者临床资料,术前行磁共振成像检查,根据情况行膝关节清理术和软骨缺损修复术,术中行关节镜检查膝关节软骨缺损情况和缺损面积,对软骨缺损行Noyes分级,并与磁共振成像进行对比.结果 MRI和关节镜测量缺损病灶均为163个,人均2.51个,差异无统计学意义(t=0,P=1);MRI测量股骨滑车、内侧和外侧股骨髁软骨缺损面积均小于关节镜测量面积,差异具有统计学意义(P<0.05);2名影像科医师采用MRI的FSE序列对软骨损伤进行分级,与关节镜分级相一致的均为50例(76.92%);以关节镜作为诊断金标准,MRI诊断敏感度为81.83%,特异度为86.12%,准确度为84.31%.结论关节镜为微创检查,在单纯膝关节软骨缺损诊断中具有局限性,而磁共振成像为无创检查,是术前诊断的常规手段,在显示病灶数目和病灶特征上与关节镜检查相一致,但在缺损面积、缺损范围、缺损程度等方面较关节镜仍有差异.

Objective To investigate the characteristics of arthroscopy and magnetic resonance imaging used for evaluating knee cartilage defects,and analyze their values in the clinical diagnosis. Method A retrospective analysis on the clinical data of 65 patients with knee cartilage defects confirmed through operation in our hospital was conducted.The patients were examined with MRI before surgery.The knee debridement and repair of cartilage defects were performed depending on the circumstances.During the surgery,the knee cartilage defects and defect area were observed with an arthroscopy,and the cartilage defects were graded by Noyes Method,which was compared with the evaluation of magnetic resonance imaging.Results Defect lesions measured by both MRI and arthroscopy were 163,with an average of 2.51 for each patient,the difference between them was not statistically significant（ t = 0,P = 1）; defect areas of the femoral trochlea,and medial and lateral femoral condyle cartilage measured by MRI were smaller than those measured by arthroscope,with statistically significant differences（ P 〈0.05）; 2 physicians at the department of radiology used FSE sequence of MRI to grade the cartilage injury,and the result was consistent with that of the arthroscopic grading in 50 cases（ 76. 92%）; taking arthroscopy as a diagnostic gold standard,the diagnostic sensitivity of MRI was 81.83% and the specificity was 86. 12% and the accuracy was 84. 31%. Conclusion The arthroscopic examination is minimally invasive one,with some limitations in the diagnosis of simple articular cartilage defects,while MRI is a noninvasive examination andconventional method for preoperative diagnosis,showing a consistency with arthroscopy in the display of the number and characteristics of lesions,but it is still poorer than arthroscopy in the measurement of the defect area,scope and extent.