膝关节前交叉韧带断裂中内侧半月板撕裂的MRI漏诊分析

The missing MRI analysis of medial meniscus tear in anterior cruciate ligament rupture of knee

目的:提高膝关节前交叉韧带(anterior cruciate ligament,ACL)断裂中内侧半月板MRI的诊断正确率,以减少漏诊。方法:回顾性分析2018年1月—2021年9月绵阳市第三人民医院收治的ACL断裂患者300例的临床资料,其中经关节镜证实前交叉韧带断裂并内侧半月板撕裂271例,并与术前MRI诊断对照,分析漏诊原因。结果:ACL断裂患者300例,关节镜证实其中271例合并内侧半月板撕裂;MRI诊断结果与关节镜相比较,差异具有统计学意义(χ^(2)=56.71,P<0.05);关节镜证实ACL断裂并半月板撕裂患者共271例,其中漏诊42例,漏诊率为15.5%(42/271)。漏诊病例中,半月板后角关节囊缘撕裂30例(71.4%,30/42),内侧半月板游离缘撕裂6例(14.3%,14/42),内侧半月板后根部撕裂4例(9.5%,4/42);MRI形态及信号异常在半月板漏诊的效能分析中,半月板形态异常的ROC曲线下面积为0.867,半月板信号异常为0.571。结论:ACL断裂后,内侧半月板撕裂的MRI漏诊并不少见,漏诊部位主要集中于后角关节囊缘及游离缘,半月板形态异常更应该引起警惕。

Objective To improve the MRI diagnostic accuracy of medial meniscus in anterior cruciate ligament(ACL)rupture,and reduce missed diagnosis.Methods The clinical data of 300 patients with ACL rupture treated in the Third People's Hospital of Mianyang city from January 2018 to September 2021 were analyzed retrospectively,including 271 cases of anterior cruciate ligament rupture and medial meniscus tear confirmed by arthroscopy,and compared with preoperative MRI diagnosis,to analyze the causes of missed diagnosis.Results Among the 300 patients with ACL fracture,271 of them were confirmed by arthroscopy to be complicated with medial meniscus tear.MRI diagnosis was significantly different from arthroscopy(χ^(2)=56.71,P<0.05).A total of 271 patients with ACL rupture and meniscus tear were confirmed by arthroscopy,of which 42 cases were missed diagnosis,with a missed diagnosis rate of 15.5%(42/271).Among the missed diagnosis cases,there were 30 cases(71.4%,30/42)of capsular tearing at the posterior corner of the meniscus,6 cases(14.3%,14/42)of free tearing at the medial meniscus,and 4 cases(9.5%,4/42)of posterior root tearing at the medial meniscus.In the efficiency analysis of missed diagnosis of meniscus,the area under ROC curve of abnormal meniscus shape was 0.867,and the abnormal meniscus signal was 0.571.Conclusion In ACL rupture,the missed MRI diagnosis of medial meniscus tear is not rare,which focuses on the capsule margin and free margin.The abnormal shape of meniscus should pay more attention.