膝关节前交叉韧带断裂磁共振成像技术的临床诊断价值研究

目的探讨膝关节前交叉韧带断裂(ACL)磁共振成像技术(MRI)的临床诊断价值。方法选取2018-01—2020-12间在西平县人民医院就诊的疑诊为膝关节ACL的54例膝关节损伤患者。均行MRI检查,以关节镜所见为“金标准”,探讨MRI对膝关节ACL的临床诊断价值。结果以关节镜检查结果为“金标准”,将ACL作为阳性,将非ACL作为阴性。MRI检查对诊断膝关节ACL的灵敏度为92.11%,特异性为93.75%,准确率为92.59%。阳性预测值为97.22%,阴性预测值为83.33%。结论对临床疑诊为膝关节ACL的膝关节损伤患者,MRI检查具有较高的灵敏度、特异性、准确率,以及阳性预测值和阴性预测值。而且具有无创、费用较低和检查方便等优势,可为制订治疗方案提供可靠的影像学资料,并可有效避免过度检查和治疗。     

膝关节前交叉韧带损伤的MRI诊断及分析

[目的]研究MRI在膝关节前交叉韧带(ACL)损伤中的诊断价值,分析MRI失误的原因,探寻提高诊断准确率的方法.[方法]选取符合病例人选标准的127例膝关节前交叉韧带损伤病例,行临床检查、MRI及关节镜检查.以关节镜检查为标准,分析MRI诊断ACL损伤的灵敏度、特异度、准确度、阳性预测值、阴性预测值、Youden指数及Kappa值.[结果]关节镜证实89例患者ACL撕裂,38例正常,ACL撕裂患者中部分撕裂7例,完全撕裂82例.MRI诊断ACL撕裂的灵敏度96.6%,特异度86.8%,准确度93.7%,阳性预测值94.5%,阴性预测值91.7%,Youden指数83.4%,Kappa值0.85.[结论]MRI诊断ACL损伤具有较高的准确度,MRI是诊断ACL撕裂的理想检查方法.     

前交叉韧带近端撕裂的MRI诊断

目的探讨前交叉韧带(ACL)近端撕裂的MRI诊断特点。方法回顾性分析自2014-01—2017-01经关节镜手术探查确诊的12例急性膝关节ACL近端断裂,术前均行膝关节MRI检查,分析其影像学特点。以关节镜探查结果作为评价ACL是否完全断裂的金标准,计算MRI诊断的假阴性率。结果 12例中7例MRI诊断报告为ACL部分损伤,5例诊断ACL未损伤,假阴性率高达41%。12例经关节镜手术探查证实均为ACL近端完全断裂,为股骨髁处完全撕裂,撕裂后靠滑膜组织粘连在原撕裂处或附着于后交叉韧带上,直视下无法判断时用探钩探查发现ACL无张力近侧已经完全撕裂。结论急性ACL近端撕裂容易漏诊,MRI可作为急诊有效检查手段,但需要从矢状位和冠状位MRI图像上全面、仔细评估以降低漏诊率,而关节镜探查结果是确诊ACL完全断裂的金标准。     

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胰十二指肠损伤在临床上较罕见,损伤的早期诊断和治疗与预后密切相关。但胰十二指肠损伤病人临床表现多不典型,早期诊断难度大,影像学检查在其中扮演了重要角色。目前常用的影像学检查手段包括CT、腹部超声、磁共振胰胆管成像(MRCP)及内镜逆行胰胆管造影(ERCP),其中多排CT(MDCT)是首选的影像学检查手段。     

胰腺十二指肠损伤影像学诊断

胰十二指肠损伤在临床上较罕见,损伤的早期诊断和治疗与预后密切相关。但胰十二指肠损伤病人临床表现多不典型,早期诊断难度大,影像学检查在其中扮演了重要角色。目前常用的影像学检查手段包括CT、腹部超声、磁共振胰胆管成像（MRCP）及内镜逆行胰胆管造影（ERCP）,其中多排CT（MDCT）是首选的影像学检查手段。     

MRI在ACL合并伤中对半月板损伤诊断评价

目的通过关节镜检查,评价术前MRI检查在前交叉韧带(ACL)合并伤中半月板损伤的诊断符合率。方法选取2014年1月至2020年6月因外伤致ACL损伤,术前阅读MRI检查,评估ACL损伤患者的半月板损伤情况,并术中关节镜检查确诊半月板损伤部位及损伤类型,进一步评价MRI诊断符合率。结果 MRI检查对内侧半月板损伤的诊断率明显高于外侧半月板损伤的诊断符合率,但差异无明显统计学差异(P0.05)。MRI对内侧半月板前角和外侧半月后角的诊断符合率较低。结论在ACL损伤合并半月板损伤中,MRI对内侧半月板前角和外侧半月后角的诊断符合率较低,因此术前应更加仔细阅读MRI,以免漏诊。     

陈旧性前交叉韧带损伤诊治分析

[目的]探讨临床检查和MRI诊断陈旧性前交叉韧带（anterior cruciate ligament，ACL）损伤的价值。[方法]回顾分析65例陈旧性ACL损伤患者的诊治经过，进行临床检查，其中8例行MRI检查，最后关节镜手术确诊。[结果]53例ACL完全损伤，前抽屉试验、Lachman试验和轴移试验的准确性分别为：79．2％、96．2％和92．5％；12例ACL部分损伤，前抽屉试验、Lachman试验和轴移试验的准确性分别为：16．7％、50．0％和33．3％。MRI诊断ACL损伤的准确性为100％。[结论]临床检查和MRI是诊断陈旧性ACL损伤的有效方法。     

半腱肌腱/股薄肌腱在前交叉韧带重建术中应用

前交叉韧带 (ACL)损伤是较常见的膝部损伤之一。在美国每年新增ACL损伤病例近 10万例 ,且其发生率有逐年增长趋势[1 ] 。ACL损伤后 ,会引起一系列并发损伤 ,关节镜下ACL重建术已被临床广泛采用。该术式虽在临床上取得很好的疗效 ,但仍有高达 10 %～ 2 5 %的失败率[1 ] 。决定手术成功的因素很多 ,但替代物的选择仍是关节镜下ACL重建术的最重要环节之一。目前 ,临床上应用的替代材料有自体替代物、同种异体替代物和人工合成材料三大类。自体材料移植重建ACL仍为首选。现临床常用的自体重建材料有中1 3髌腱 -骨、半腱肌腱 股薄肌腱 (H…     

3D序列MR在膝关节前交叉韧带及半月板损伤中的诊断应用

目的采用3D序列MR技术检查膝关节前交叉韧带(ACL)损伤、半月板损伤患者,评价3D序列MR对膝关节ACL损伤、半月板损伤的临床诊断价值,为临床提供参考。方法选取2019年10月至2020年9月本院及舟山医院收治的因膝关节损伤均行常规MRI、3D序列MR检查和关节镜检查的191例患者作为研究对象。由2名MRI图像诊断经验丰富的放射科医师分析常规MRI及3D序列MR图像,以关节镜结果作为金标准,比较常规MRI及3D序列MR诊断膝关节ACL损伤、半月板损伤的灵敏度、特异度、准确度和Kappa值。结果常规MRI诊断膝关节ACL损伤的灵敏度为88.76%,特异度为81.82%,准确度为87.96%,Kappa值为0.544;3D序列MR诊断膝关节ACL损伤的灵敏度为94.67%,特异度为90.91%,准确度为93.19%,Kappa值为0.717。常规MRI诊断半月板损伤的灵敏度为87.50%,特异度为84.62%,准确度为86.91%,Kappa值为0.642;3D序列MR诊断半月板损伤的灵敏度为91.45%,特异度为89.74%,准确度为91.10%,Kappa值为0.748。结论 3D序列MR技术可提高膝关节ACL损伤、半月板损伤诊断的灵敏度、特异度、准确度和一致性,有助于临床的早期诊断和治疗。     

前交叉韧带损伤:3.0TMR影像与关节镜对照分析

目的分析膝关节前交叉韧带损伤的3．0TMRI特征,并与关节镜手术结果对照。方法回顾性分析来我院行3．0T MR膝关节检查的36例前交叉韧带损伤患者的40个膝关节,全部病例经关节镜检查确诊。应用3．0T MR机（Philips Achieva型）,膝关节专用线圈,进行斜矢状位TSE T1WI、TSE T2WI、PD-SPIR和冠状位、轴位TSE T2WI扫描。前交叉韧带损伤分为完全断裂、撕裂（部分断裂）及胫骨端撕脱。将膝关节前交叉韧带损伤的3．0T MR影像特征与关节镜手术结果进行对照分析。结果前交叉韧带完全断裂MRI直接征象表现为韧带连续性中断,断端肿胀（21／25）,间接征象为交叉韧带过度弯曲、T2WI和PD-SPIR股骨髁间窝外侧骨挫伤;MRI与关节镜诊断完全符合率为84．00％。前交叉韧带撕裂（部分断裂）MRI直接征象为ACL矢状T2WI和PD-SPIR显示形态不规则、部分撕裂,ACL局部肿胀增粗,信号增高,仍可见连续存在的纤维低信号;MRI与关节镜诊断完全符合率为66．67％。前交叉韧带胫骨端撕脱MR检查直接征像为胫骨近端可见T1WI、T2WI低信号撕脱骨片（3／3）,ACL水肿、形态不规则,周围可见出血、积液,MRI与关节镜诊断符合率为100％。结论高场强3．0TMR膝关节诊断的多平面、多序列影像相结合可形成ACL立体影像观,结合临床能够有效诊断ACL损伤。     

Clinical,MRI, and arthroscopic correlation in meniscal and anterior cruciate ligament injuries

The aim of this prospective study was to compare and correlate clinical, magnetic resonance imaging (MRI), and arthroscopic findings in cases of meniscal tear and anterior cruciate ligament (ACL) injuries. MRI scan results and clinical diagnosis are compared against the arthroscopic confirmation of the diagnosis. One hundred and thirty-one patients had suspected traumatic meniscal or anterior cruciate ligament (ACL) injury. Clinical examination had better sensitivity (0.86 vs. 0.76), specificity (0.73 vs. 0.52), predictive values, and diagnostic accuracy in comparison to MRI scan in diagnosis for medial meniscal tears. These parameters showed only marginal difference in lateral meniscal and anterior cruciate ligament injuries. We conclude that carefully performed clinical examination can give equal or better diagnosis of meniscal and ACL injuries in comparison to MRI scan. MRI may be used to rule out such injuries rather than to diagnose them.     

Diagnostics and treatment of posterior cruciate ligament injuries

Over the last few years, the posterior cruciate ligament (PCL) has taken over from the anterior cruciate ligament (ACL) as the new challenge in knee diagnosis and treatment. PCL injuries are much more frequent than previously thought. Despite increasing experience, we are often still confronted with an inappropriate and delayed diagnosis of this injury and its concomitant lesions. Additionally, the outcome of surgical treatment has not yet reached an acceptable rate of satisfaction. Therefore, the goal of this concept review is to give a comprehensive insight into injury mechanisms, diagnostics and treatment regimes based on our experience and data from the international literature. Furthermore, diagnostic problems with respect to clinical examination and imaging techniques are discussed. We also present a differential concept for the perioperative and conservative management of PCL deficient knees in order to adequately address concomitant injuries such as posterolateral rotatory instability and combined ACL injuries, with the aim of further improving results.     

Diagnostik und Therapie von Verletzungen des hinteren Kreuzbandes

Over the last few years, the posterior cruciate ligament (PCL) has taken over from the anterior cruciate ligament (ACL) as the new challenge in knee diagnosis and treatment. PCL injuries are much more frequent than previously thought. Despite increasing experience, we are often still confronted with an inappropriate and delayed diagnosis of this injury and its concomitant lesions. Additionally, the outcome of surgical treatment has not yet reached an acceptable rate of satisfaction. Therefore, the goal of this concept review is to give a comprehensive insight into injury mechanisms, diagnostics and treatment regimes based on our experience and data from the international literature. Furthermore, diagnostic problems with respect to clinical examination and imaging techniques are discussed. We also present a differential concept for the perioperative and conservative management of PCL deficient knees in order to adequately address concomitant injuries such as posterolateral rotatory instability and combined ACL injuries, with the aim of further improving results.     

Post-traumatic hemarthrosis of the knee joint--an indication for arthroscopy

Diagnostic arthroscopy including the use of a probe should be performed if the cause for a haemarthrosis of the knee cannot be established by radiological means. The clinical examination of the recently injured knee must be considered to be unreliable due to pain. In approximately one-third of knee injuries an incorrect or incomplete diagnosis is made. Even if ligamentous injuries can be established, arthroscopy is mandatory, because this is the only sure way in which acute and degenerative meniscal or cartilaginous lesions can be diagnosed. Arthroscopy should be performed under general or spinal anaesthesia to allow the use of a tourniquet and the immediate repair of ligaments if deemed necessary. The experienced arthroscopist needs only a few minutes to obtain information that could influence the approach to the injury and its longterm prognosis. In a series of 1238 arthroscopies 252 (20.3%) were done for haemarthrosis of unknown origin. In 68% of these cases diagnosis could only have been established by arthroscopy. In this series of 252 cases 23% had an isolated complete anterior cruciate ligament (ACL) injury, 28% had anterior-medical instability, 8% had partial ACL lesions, 5% posterior cruciate ligament injuries, 15% medial collateral ligament injuries, 11% had only synovial tears or contusions. 5% of cases had chronic ACL instability, 4% had osteochondral fragments which could not be diagnosed radiologically. A recent traumatic patellar dislocation with a tear of the retinaculum was found in 1.6% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)     

前十字韧带损伤合并内侧半月板ramp损伤

目的探讨前十字韧带损伤合并内侧半月板ramp损伤的发生率、诊断方法、修补术及其临床疗效。方法2002年4月至2005年4月,共进行333例单纯前十字韧带损伤重建术,陈旧性损伤(>3个月)215例,急性损伤(<3个月)118例。合并内侧半月板ramp损伤者89例,其中85例需手术修补。手术取腘绳肌腱、自体或异体骨-髌腱-骨移植物重建前十字韧带,同时应用全内缝合方法,经两个后内入路配合经髁间窝入路,利用缝合钩修补ramp损伤。前十字韧带损伤中,ramp损伤的总发生率为26.7%,其中陈旧性损伤的发生率为30.7%,急性损伤为19.5%。结果可随访者75例(88.2%),随访5～41个月,平均20.2个月。随访时采用主观症状观察、临床查体、二次关节镜手术观察及MR检查。其中二次手术观察25例,MR复查21例。在可随访的75例患者中,所有患者的主观症状及临床查体均呈正常表现;在二次关节镜手术观察的25例中,均全部愈合。在经MR复查的21例中,18例完全愈合,3例部分愈合。结论大约1/3的前十字韧带损伤合并有内侧半月板ramp损伤,陈旧性损伤较新鲜损伤合并ramp损伤的发生率更高。在重建前十字韧带的同时应修补ramp损伤,全内缝合方法是修补ramp损伤的很好方法,可以达到很高的愈合率。     

Meniscal injury: I. Basic science and evaluation

The patient with meniscal injury may present with pain, swelling, or mechanical symptoms and often requires surgical intervention for symptom resolution. Treatment of such injuries relies on understanding the gross and microanatomic features of the meniscus that are important in maintaining meniscal function. The ability of the meniscus to participate in load bearing, shock absorption, joint lubrication, and joint stability depends on the maintenance of its structural integrity. The diagnosis of meniscal injury often can be made by clinical evaluation utilizing the history, physical examination, and plain radiographs. Magnetic resonance imaging can be useful in confirming the diagnosis when clinical findings are inconclusive. Treatment depends on tear pattern, vascularity, and an assessment of tissue quality. Surgical decision making for the treatment of meniscal injury is based on patient factors and understanding of the meniscal structure, function, and pathology.     

膝关节前交叉韧带急性损伤早期关节镜下检查和手术治疗

目的 探索关节镜下早期微创修复与重建膝关节交叉韧带（ＡＬＣ）的方法。方法 对２３例ＡＣＬ急性完全断裂者施行了早期关节镜术。结果 １８例主前诊断相符;３你关节镜下明确诊断,２例发现断裂：观察到内侧副韧带断裂间接与直接损伤征象各２例。ＡＣＬ断裂病理类型：韧带体部断裂２１例,上、下止点撕脱各１例。２１例早期重建ＡＣＬ中,６例在关节镜下完成。结论 ＡＣＬ急性损伤早期施以关节镜手术,创伤小、诊断明确,可观察     

Editorial Commentary: Another Take on the Anterolateral Ligament: High-Grade Are Worse Than Low-Grade Injuries,But the Categorization Is Problematic

The anatomy, function, and existence of the anterolateral ligament (ALL) is still hotly debated and a controversial topic. Currently both basic biomechanical and clinical studies are not providing sufficient and strong evidence to either support or refute that the ALL plays an important role for knee stability. One could argue that stability is provided by the anterolateral complex, including the iliotibial band, Kaplan fibers, and the anterolateral capsule, which may contain a structure called the ALL. Magnetic resonance imaging (MRI) is routinely performed in patients with anterior cruciate ligament (ACL) injury, but unfortunately ALL injuries cannot be reliably diagnosed in patients with concomitant ACL tears. When dividing ALL injuries into high and low grade using preoperative MRI and investigating clinical outcomes after double-bundle ACL reconstruction, patients with high-grade injuries have inferior outcomes and a significantly greater revision rates. However, the limitations of this research reduce the validity of these conclusions: high rate of loss to follow-up above accepted standard, unequal size of their study groups, fragility index of zero, the inaccuracy of diagnosing ALL injuries in the presence of ACL tears on MRI, and the dilemma with randomly classifying high- and low-grade ALL injury based on MRI.     

Diagnosis of acute knee ligament injuries: the value of stress radiography compared with clinical examination, stability under anaesthesia and arthroscopic or operative findings

A consecutive series of 85 stress radiographic examinations was performed in order to evaluate the clinical reliability and use of stress radiography in disclosing acute knee ligament injuries. Eighty-three examinations were performed within one week of the injury. Sagittal stress examination discovered 27% of the 37 anterior cruciate ligament (ACL) tears and all four posterior cruciate tears. Valgus stress detected 56% of the medial collateral tears. The specificity of stress radiography was even reduced by the number of false positive stress results (n = 25) in posterior drawer or valgus-varus examinations. An ACL tear was, however, an isolated or major ligament injury in twenty (80%) of the false positive results. Clinical examination revealed all the medial collateral tears whereas only 40% of the anterior cruciate tears. The most reliable method for diagnosing acute knee injuries where clinical examination has failed in disclosing instability is examination under anaesthesia supplemented by acute arthroscopy.     

膝关节脱位多韧带损伤Ⅰ期修复重建的临床观察

目的:探讨关节镜下Ⅰ期异体肌腱重建并结合关节外微创技术治疗膝关节脱位合并多发韧带损伤的临床疗效。方法:2008年1月至2012年1月共收治48例膝关节脱位患者,排除腘血管损伤,采用关节镜下Ⅰ期重建前后交叉韧带,并结合关节外微创技术修复膝关节韧带损伤。男38例,女10例;年龄20～59岁,平均35.6岁;左膝22例,右膝26例;伤后至手术时间2 d～2周。前交叉韧带(ACL)、后交叉韧带(PCL)、内侧副韧带(MCL)及后外侧复合体(PLC)损伤2例,ACL、PCL及MCL损伤36例,ACL、PCL及PLC损伤10例。合并腓总神经损伤4例。比较术前及末次随访时Lysholm 评分以评价膝关节功能。结果:所有患者获得随访,时间12～30个月,平均(18.2±6.3)个月,患者关节活动度和稳定性明显改善,Lysholm评分由术前40.3±4.1提高为随访时87. 0±6.4.结论:关节镜下应用同种异体肌腱Ⅰ期重建膝关节脱位并多韧带损伤,能较好地恢复关节稳定性,保留关节功能。术前训练指导及术后个体化康复是膝关节功能恢复的关键。