骨性关节炎患者膝关节软骨损伤的关节镜与MRI诊断分级研究

Arthroscopy and magnetic resonance imaging for the classification of knee articular cartilage injury in patients with osteoarthritis

[目的]提出关节镜及核磁共振成像(magnetic resonance imaging,MRI)诊断骨性关节炎(osteoarthrisis,OA)患者膝关节软骨损伤的分级法,探讨MRI在诊断关节软骨损伤中的价值。[方法]回顾性分析行关节镜检查的123例骨性关节炎患者的膝关节术前MRI表现;按部位将膝关节软骨分为6处;根据形态和信号改变,结合损伤部位,将膝关节软骨损伤在关节镜与MRI的表现加以分析并分级;以关节镜所见为参考标准,计算MRI诊断各级软骨损伤的敏感性、特异性、准确性。[结果]在关节镜及MRI上,膝关节软骨损伤均可分为Ⅰ~Ⅳ级;在738处软骨中,损伤505处(68.43%),其中髌股关节最多,外侧胫股关节最少,且损伤以Ⅲ~Ⅳ级为主;关节镜与MRI判断软骨损伤差异具有统计学意义(χ~2=107.52,P<0.001)。MRI诊断软骨损伤总的敏感性、特异性、准确性分别为70.10%、93.13%、77.37%。[结论]骨性关节炎患者膝关节软骨损伤在关节镜及MRI的表现可被分为4级;软骨损伤以髌股关节最多;MRI诊断骨性关节炎软骨损伤的特异性较高,但敏感性和准确性相对较低。

[Objective] To investigate the classification of knee articular cartilage injury based on arthroscopy and mag- netic resonance imaging （MRII in patients with osteoarthritis （OA} , as well as the value of MRI in the diagnosis of knee articular cartilage injury. [Methods] A retrospective analysis was performed for the preoperative MRI findings of knee joint from 123 OA patients who underwent arthroscopy. According to the injured parts, the knee articular cartilage was divided into 6 areas. The arthroscopic and MRI findings of knee joint were analyzed and classified based on the changes in morphology and sig- nal intensity and the injured parts. The arthroscopic findings were applied as the reference standard to calculate the sensitivity, specificity, and accuracy of MRI in the diagnosis of each class of cartilage injury. [Results] Based on the arthroscopic and MRI findings, the knee articular cartilage injury was classified into grades I-IV. Among the 738 cartilage areas, 505 areas （68.43%} were found injured, with the most injured parts in the patellofemoral joint and the fewest injured parts in the lateral tibiofemoral joint, and the injuries mainly had a grade of III-IV. Arthroscopy and MRI showed a significant difference in judg- ing cartilage injury （X^2 = 107.52, P 〈0.001 ） . In the diagnosis of cartilage injury, MRI had an overall sensitivity of 70.1%, an overall of specificity of 93.13%, and an overall accuracy of 77.37%. [ Conclusions ] The arthroscopic and MRI findings of knee articular cartilage injury in OA patients can be classified into four grades. Most cartilage injuries occur in the patellofemo- ral joint. MRI shows a high specificity in the diagnosis of cartilage injury in OA patients, but its sensitivity and accuracy remain relatively low.