MRI在急性髌骨一过性脱位诊断中的应用

Application of MRI in diagnosis of transient dislocation of patella

目的:探讨MRI对急性髌骨一过性脱位的诊断价值。方法:回顾性分析2015年1月至2017年12月间收治的35例急性髌骨一过性脱位患者的DR与MRI资料,其中男12例,女23例,年龄10~23岁,平均17岁。将DR与MRI诊断与手术或出院诊断对比,比较两者诊断膝部解剖位置异常、骨损伤、体征、软组织损伤的区别,采用Wilcoxon符号秩检验(Wilcoxon signed rank test)进行统计学分析。结果:35例MRI结果与术后或出院诊断结果完全相符。MRI诊断髌骨高位7例,髌骨半脱位7例;DR诊断髌骨高位7例,髌骨半脱位0例;MRI诊断14处,DR诊断7处,两者在髌骨解剖位置异常诊断中差异有统计学意义(v=10,P<0.05)。MRI诊断出骨损伤112处,DR诊断0处,两者在骨损伤诊断中差异有统计学意义(v=16,P<0.05)。MRI诊断软组织损伤43处,DR诊断0处,两者在软组织损伤诊断中差异有统计学意义(v=21,P<0.05)。MRI诊断膝关节积液35例,DR诊断30例,两者在关节积液诊断中差异无统计学意义(v=32,P>0.05)。结论:MRI对急性髌骨一过性脱位的诊断优于DR,MRI应作为急性髌骨一过性脱位诊断的首选影像学检查,可避免漏诊及误诊。

Objective：To explore the diagnostic value of MRI in the transient dislocation of the patella. Methods：The DR and MRI data of 35 patients with acute patellar transient dislocation from January 2015 to December 2017 were retrospectively analyzed,including 12 males and 23 females,ranging in age from 10 to 23 years old,with an average of 17 years old. The differences between DR and MRI diagnosis and surgical or discharge diagnosis were compared,and the difference between them in diagnosis of knee anatomical position,bone injury,signs and soft tissue injury were compared. The R statistical software Wi Lcoxon signed rank test（Wi Lcoxon signed rank test） was used for statistical analysis. Results：All 35 MRI findings were completely consistent with postoperative or discharge diagnosis. According to MRI,7 cases of high patella and 7 cases of patella subluxation were diagnosed. According to DR,7 cases of high patella and 0 cases of patella subluxation were diagnosed.Fourteen dislocations were diagnosed by MRI and 7 dislocations were diagnosed by DR. There was statistically significant difference between the two methods in the diagnosis of abnormal position of patella（v=10,P〈0.05）. Total 112 cases of bone injuries were diagnosed by MRI,and 0 was diagnosed by DR. There was statistically significant difference between the two methods in the diagnosis of bone injuries（v=16,P〈0.05）. Total 43 cases of soft tissue injuries were diagnosed by MRI,and 0 was diagnosed by DR. There was statistically significant difference between the two methods in the diagnosis of soft tissue injuries（v=21,P〈0.05）. Total 35 cases of hydrops of the knee joint were diagnosed by MRI,and 30 were diagnosed by DR. There was statistically significant difference between the two methods in the diagnosis of hydrops of the knee joint（v=32,P〈0.05）. Conclusion：MRI is superior to DR in the diagnosis of acute temporal bone dislocation. MRI should be used as the first choice for imaging diagnosis of acute temporal bone dislocation. It can avoid missed diagnosis and misdiagnosis.