距骨骨软骨损伤的影像诊断与评估

Imaging diagnosis and evaluation of osteochondral lesions of talus

目的探讨距骨骨软骨损伤(OLT)的影像诊断,评估检查策略。方法回顾性分析2020年4月—2022年12月本院PAC诊断的79例OLT病例的DR、CT、MRI影像学表现,按照Hepple’s分型系统对其进行准确诊断及分型。对OLT伴发胫、腓骨远端骨软骨病变以及踝关节韧带、肌腱损伤的发病率,病灶位置进行回顾性分析。结果OLT主要位于距骨穹隆内侧中部及穹隆外侧中部,内侧病损面积常较外侧大,以Hepple’sⅡ型和Ⅴ型为主,外侧病变以Ⅲ型为主。OLT伴发胫腓骨远端骨软骨损伤、距腓前韧带损伤发病率并不少见。胫腓骨骨软骨损伤部位与距骨损伤多呈吻形对应。X线对OLT检出率为67.08%,CT对OLT检出率为79.75%,MR对OLT检出率为98.73%。MRI检出率明显高于DR、CT,差异具有统计学意义(P<0.05),CT、DR差异没有统计学意义。结论MRI比DR、CT对OLT检出率高,分期准确,对怀疑OLT病人建议X线检查后常规行MR检查。

Objective To explore the imaging diagnosis of osteochondral lesions of the talus(OLT),and evaluate the test strategy.Methods A retrospective analysis was conducted on the DR,CT,and MRI imaging manifestations of 79 cases of OLT diagnosed in department of PCA of the hospital during April 2020 and December 2022,and accurate diagnosis and classification were performed according to the Hepple's classification system.The incidence of concomitant tibial and fibular distal osteochondral lesions,ankle ligament and tendon injuries,and lesion locations were retrospectively analyzed.Results OLT mainly occurred in the medial and lateral parts of the talar dome,with larger lesion areas on the medial side than on the lateral side,and Hepple's type II and V were the main types on the medial side,while type III was the main type on the lateral side.The incidence of concomitant tibial and fibular distal osteochondral lesions and anterior talofibular ligament injuries was not uncommon,and the location of tibial and fibular osteochondral lesions corresponded to that of the talus in a kissing lesion pattern.The detection rates of OLT by X-ray,CT,and MRI were 67.08%,79.75%,and 98.73%,respectively.The detection rate of MRI was significantly higher than that of DR and CT,and the difference was statistically significant(P<0.05),while there was no statistically significant difference between CT and DR.Conclusions MRI has a higher detection rate for OLT than DR and CT,performs high accurate staging;it is recommended to perform routine MRI examination after X-ray examination for patients with suspected OLT.