膝关节韧带损伤的MRI诊断

目的:探讨膝关节韧带损伤的MRI表现及诊断价值。方法:36例临床怀疑膝关节损伤的患者于关节镜及手术前行MRI检查,以关节镜结果作为金标准,前瞻性分析膝关节韧带损伤的MRI表现及诊断价值。结果:关节镜证实前交叉韧带损伤21例,其中完全撕裂15例,部分撕裂6例,后交叉韧带损伤12例,正常患者15例。MRI诊断前交叉韧带损伤的敏感度为95.2%,特异度为80%,准确度为88.9%;诊断后交叉韧带损伤的敏感度为100%,特异度为95.8%,准确度为97.2%。结论:MR1是诊断膝关节韧带损伤的理想检查方法,具有较高的临床应用价值。     

Magnetic resonance imaging of the ligaments and menisci of the knee

Although the technique is still developing and the data are preliminary, MRI will likely be the best noninvasive method for evaluating the ligaments and menisci of the knee. It can provide valuable and accurate information, especially in the acutely injured knee. The presence, extent, and exact location of cruciate ligament disruption can be visualized. This is useful in patients in whom the clinical diagnosis is uncertain and provides valuable information in preoperative planning. Equally important is the ability of MRI to provide diagnostic information about associated injuries to the collateral ligaments, capsule, menisci, articular cartilage, and subchondral bone. Proper pulse sequence selection is important. T2-weighted spin-echo sequences are best for visualizing injuries to the ligaments and menisci, and T1-weighted sequences (inversion-recovery or spin-echo with a short TR and a short TE) are more helpful in evaluating cartilaginous and bony abnormalities.     

Advanced MR imaging of the cruciate ligaments

The anterior and posterior cruciate ligaments are crucial stabilizers of the knee. These ligaments are named by the location of their tibial attachments. Each ligament is composed of separate functional bundles that differ in size but are equally important in function. MR imaging is accurate and sensitive, making it the imaging technique of choice for evaluating these ligaments. Acute and chronic injuries involving the cruciate ligaments have typical appearances and associated findings. MR imaging interpretation must take into account atypical injuries and imaging pitfalls. Knowledge of normal ligament reconstruction techniques allows differentiation of the normal postoperative appearance from reconstruction failure and complications. Ligament reconstruction techniques, complications, and appearances are reviewed in this article.     

膝关节韧带损伤的MRI诊断

目的：分析膝关节韧带损伤的MRI表现及诊断价值。资料与方法：回顾性分析22例经手术或关节镜检查证实的膝关节韧带损伤的MRI资料。结果：22例膝关节损伤患者中，共有37条韧带损伤，MRI检出其中的34条，其敏感性为91．9％，准确性为95．5％。交叉韧带损伤的MRI表现为韧带连续性中断，局灶或弥漫性肿胀，信号强度增加及断端移位。侧副韧带损伤的MRI表现为韧带连续性中断和／或韧带肿胀增粗，信号升高。结论：MRI是诊断膝关节韧带损伤的理想的非创伤性检查方法。     

Imaging of the collateral ligament injuries of the knee

The role of routine and advanced imaging techniques after suspected injury to the collateral ligaments of the knee is to augment the findings on physical examination. Although radiographs may disclose avulsion injuries, the limited soft tissue contrast does not permit accurate assessment of the collateral ligaments and associated soft tissue structures. Because of its superior soft tissue contrast and multiplanar capabilities, magnetic resonance (MR) imaging has largely replaced conventional imaging techniques. Using high-contrast pulse sequences, MR imaging permits localization of the site of ligamentous trauma, as well as associated soft tissue injury, including meniscal tears, cruciate ligament tears, and injury to the structures of the posterolateral corner. Although secondary signs of ligamentous injury, including adjacent soft tissue edema and bony contusions, may be helpful in localizing the site of injury, the most important criteria remains direct visualization of the ligament, with focal discontinuity. Using such criteria, accurate preoperative assessment of the injured extremity may be made, thereby aiding in the clinical management of the patient.     

膝关节韧带损伤的MRI诊断

目的 探讨膝关节韧带损伤的MRI表现及诊断价值. 方法 回顾性分析32例经手术或关节镜检查证实的膝关节韧带损伤的MRI资料,所有病例均行常规MRI扫描,对疑有前交叉韧带损伤的患者,加扫斜矢状位T_2WI像,对疑有胫侧副韧带损伤的患者加扫冠状脂肪抑制T_2WI像. 结果 32例膝关节中MR诊断韧带损伤共36条,其中前交叉韧带损伤16条,后交叉韧带损伤14条,胫侧副韧带损伤5条,腓侧副韧带损伤1条.韧带损伤包括韧带完全撕裂和部分撕裂. 结论 MRI 是理想的诊断膝关节韧带损伤的无创性检查方法.     

Management of combined anteriorcruciate ligament/posterior cruciate ligament/posterolateral complex injuries of the knee

The multiple ligament injured knee is a complex problem in orthopedic surgery. These injuries may present as acuteknee dislocations, and careful assessment of the extremity vascular status is essential because of the possibility of arterial and/or venous compromise. These complex injuries require a systematic approach to evaluation and treatment. Physical examination and imaging studies enable the surgeon to make a correct diagnosis and formulate a treatment plan. Arthroscopically assisted combined anterior cruciate ligament/ posterior cruciate ligament (ACL/PCL) reconstruction is a reproducible procedure. Knee stability is improved postoperatively when evaluated with knee ligament rating scales, arthrometer testing, and stress radiographic analysis. Posterolateral complex (PLC) injuries combined with ACL/PCL tears are best treated with primary repair as indicated combined with PCL reconstruction using a post of strong autograft (split biceps tendon, biceps tendon, semitendinosus), or allograft (Achilles tendon, bone-patellar tendon-bone) tissue. Surgical timing depends on the injured ligaments, vascular status of the extremity, reduction stability, and overall patient health. The use of allograft tissue is preferred because of the strength of these large grafts and the absence of donor site morbidity.     

Magnetic resonance imaging in the evaluation of ligament injuries

Magnetic resonance imaging has had a dramatic effect on the means by which we diagnose ligament injuries. Tears resulting from either acute trauma or overuse can be detected noninvasively, directing appropriate therapy be it conservative or surgical. For the elite athlete, earlier diagnosis leads to earlier intervention, or alternatively, a normal MRI examination can result in an earlier return to play. While MRI is accepted for the diagnosis of certain injuries such as complete tears of the cruciate ligaments of the knee, other injuries, such as partial cruciate ligament tears or tears of the intercarpal ligaments of the wrist, remain controversial. Received: 4 August 1998 Revision requested: 1 October 1998 Revision received: 23 October 1998 Accepted: 29 October 1998     

膝关节内侧副韧带薄层断面与MRI解剖及其诊断价值

目的研究膝关节内侧副韧带薄层断面表现及其正常和损伤的MRI表现。方法分析内侧副韧带薄层断面标本解剖特点,对120例正常膝关节内侧副韧带及25例损伤病例MRI表现进行回顾性分析。结果薄层断面清晰显示膝关节内侧副韧带解剖特点,MRI与薄层断面具有很好对应性。MRI能够对内侧副韧带损伤进行准确分级。结论薄层断面与MRI能够清晰显示内侧副韧带的解剖学特点。横轴位MRI分级评价对内侧副韧带损伤的诊断和治疗具有重要价值。     

前交叉韧带损伤的MRI相关征象分析

目的：分析膝关节多种MRI征象对诊断前交叉韧带（ACL）损伤的价值.方法：经关节镜证实的194例患者（包括前ACL正常膝97例、ACL损伤膝97例）,对ACL损伤的相关MRI直接征象和间接征象进行评价.结果：在评价的4个直接征g（ACI,连续性中断、信号缺失、形态异常及走行异常）中,除ACL信号缺失外,其余直接征象对诊断ACL损伤均具有统计学意义,其中韧带连续性中断具有较高的诊断敏感度（83.5%）、特异度（97.9%）及阳性似然比（39.8）.大多数间接征象具有较高的特异性和相对低的敏感性,其中Notch征、骨挫伤、外侧半月板后角裸露征及胫骨前移等征象具有较高的阳性似然比,分别为：＋∞、9.0、55.70和8.0.结论：前交叉韧带损伤的MRI直接征象是其诊断的主要依据;由于其间接征象具有较高的特异性和＋LR,因此可作为前交叉韧带损伤的辅助诊断依据,尤其是直接征象难以确诊的可疑ACL损伤者.     

MRT des Kniegelenks

Since its introduction into clinical use, magnetic resonance imaging (MRI) has become well established in the diagnosis of injuries of the knee joint and has replaced diagnostic arthroscopy as the primary evaluation method. Traumatic lesions of the ligaments, menisci, and articular surfaces are common injuries that can be confidently detected using MRI. This article reviews the basic principles of the examination technique of the knee, the normal MRI anatomy of the internal joint structures, and the typical findings in injuries of the cruciate ligaments, collateral ligaments, and mensci, in traumatic dislocation of the patella, and in acute osteochondral lesions.     

后交叉韧带损伤MRI诊断指标的评价

目的评价后交叉韧带(PCL)损伤各种MRI征象的诊断价值。资料与方法分析32例经关节镜或临床诊断的PCL损伤患者MRI资料,并与57例非PCL损伤病例对照,总结PCL损伤直接和间接征象,依据各征象建立回归模型。结果正常PCL可分为"弓"形、"U"形、和"打结"形3种形态。根据PCL损伤征象建立的回归模型,其诊断的重要程度依次为PCL消失、不连续,PCL信号异常,内侧副韧带损伤,PCL增粗,三角间隙积液以及骨挫伤。结论MRI是诊断PCL损伤的重要手段。PCL损伤各征象对诊断的重要性不同,以此建立的回归模型有较强的预测能力。     

膝关节骨与韧带急性损伤的MRI研究

目的:探讨MRI检查中急性膝关节骨损伤与韧带损伤之间的合并关系以及临床应用价值。方法:38例急性膝部骨损伤病人,行MRI重点观察STIR序列的损伤情况。骨损伤分为显性骨折(X线检查可见)与隐性骨损伤(X线检查未见异常),韧带损伤包括撕裂与完全断裂。结果:38例共45处骨损伤,包括显性骨折28处(73%)、隐性骨损伤(骨挫伤)17处(44%)。84%病例的骨损伤累及胫骨。86%的病例合并多韧带损伤,最常累及内侧副韧带、前交叉韧带与后交又韧带,74%的损伤韧带非邻近骨损伤部位。结论:急性膝部骨损伤最常累及腔骨,常合并多韧带损伤,但韧带损伤多不靠近骨损伤部位。MRI脂肪抑制序列能直观地显示韧带的撕裂与完全断裂,且能发现相当多的隐性骨损伤病例。     

膝关节交叉韧带低场强MRI表现及其损伤诊断

目的 :研究膝关节正常交叉韧带MRI特点和交叉韧带损伤的的MRI表现。方法 :对 2 0 0例正常膝关节交叉韧带的MRI进行回顾性分析 ,对 2 5例临床可疑交叉韧带损伤患者的MRI资料和关节镜检查行对比研究。结果 :正常膝关节矢状位MRI上显示交叉韧带最佳 ,冠状位和横断位作为补充 ,交叉韧带损伤的MRI表现为韧带连续性中断、局灶性或弥漫性肿胀、信号强度增高及断端移位 ;以关节镜检查结果为标准 ,MRI诊断交叉韧带损伤的敏感度为 91.3 % ,特异度为 91.6% ,符合率为 91.4%。结论 :MRI多方位扫描是一种准确诊断交叉韧带损伤的方法 ,矢状位显示交叉韧带最佳。     

Physical examination and imaging of the medial collateral ligament and posteromedial corner of the knee

The medial side is one of the most commonly injured areas of the knee. The anatomy, diagnosis, and treatment of medial collateral ligament and posteromedial corner (PMC) injuries can be challenging. Understanding the mechanism of injury and performing a thorough physical examination and radiographic evaluation is essential. Frequently, there are concomitant meniscal and other ligament injuries associated with medial-side injuries. Correct identification of all injured structures is important, as missed diagnoses can lead to significant disability. Unrecognized PMC injuries have been implicated in anteromedial rotary instability and failed anterior cruciate ligament reconstructions. Valgus stress testing is the cornerstone for the identification of medial-side knee injuries. Coronal sequences from magnetic resonance imaging are the most useful tool to view the medial collateral ligament and posteromedial structures. Stress x-rays and ultrasound may also be helpful. Thorough physical examination and imaging of injuries to the PMC should dictate the appropriate treatment for optimal results.     

低场磁共振GE序列在膝关节侧副韧带损伤诊断中的应用评价

目的：探讨损伤的膝关节侧副韧带在低场MRIGE序列中的表现。方法：对经手术或临床证实的48例共54条损伤的侧副韧带进行回顾性MRI对比观察。结果：54条侧副韧带损伤，单纯胫侧副韧带27条，单纯腓侧副韧带18条，两侧侧副韧带同时损伤10条。Ⅰ级侧副韧带损伤27条；Ⅱ级侧副韧带损伤17条；Ⅲ级侧副韧损伤10条。30例（62．5％）出现并发症，其中前交叉韧带损伤19条。后交叉韧带损伤14条，半月板损伤18个，骨挫伤及骨折11例，关节囊积液30例。结论：GE序列能缩短检查时间，清晰显示膝关节侧副韧带解剖结构，准确诊断侧副韧带损伤并能进行分级，发现多种并发症，宜列为膝关节外伤的常规扫描序列。     

膝关节损伤的MR应用价值

目的 :分析膝关节损伤的MR表现并评价其应用价值。方法 :选择 60例经临床或手术证实的膝关节损伤患者 ,回顾性分析、总结其MR表现。采用 1 .0TMR扫描机 ,常规应用矢状位 ,SET1 W、T2 W ,冠状位T1 W、T2 W成像。结果 :2 9例半月板损伤 ,其中Ⅰ° 1 0例 ,Ⅱ°1 2例 ,Ⅲ°7例 ;前交叉韧带损伤 1 8例 ,撕裂 2 2例 ;后交叉韧带损伤 7例 ,撕裂1例 ;内侧侧副韧带损伤 2 8例 ,撕裂 1 7例 ;外侧侧副韧带损伤 1 2例 ,撕裂 9例 ;韧带损伤表现为韧带不同程度增粗 ,但韧带连续性仍然存在 ,正常低信号内出现不规则高信号影 ,韧带撕裂表现为韧带明显增粗 ,呈弥漫性高信号 ,韧带的连续性部分或完全中断 ;股骨下端或胫骨上端骨质损伤 9例 ;关节积液 54例 ;多种损伤可同时出现。结论 :MR检查可很好显示膝关节损伤的各种表现 ,可作为膝关节损伤检查的重要或首选手段     

膝关节后内侧结构生物力学意义及损伤的MRI表现

目的:分析膝关节后内侧结构的解剖、生物力学特点及临床意义;阐述膝关节后内侧结构的MRI正常及损伤后表现;进行后内侧结构损伤MRl分级.方法:回顾分析87例后内侧结构、以及其他相关损伤的MRI所见.结果:本组87例后内侧结构损伤,Ⅰ级损伤29例,Ⅱ级47例,Ⅲ级11例;合并交叉韧带损伤34例(39%),内侧半月板后角撕裂...     

Anterior cruciate ligament tears for the primary care sports physician: what to know on the field and in the office

Anterior cruciate ligament (ACL) injuries are relatively common and can lead to knee dysfunction. The classic presentation is a non-contact twisting injury with an audible pop and the rapid onset of swelling. Prompt evaluation and diagnosis of ACL injuries are important. Acute treatment consists of cessation of the sporting activity, ice, compression, and elevation with evaluation by a physician familiar with ACL injuries and their management. The diagnosis is made with the use of patient history and physical examination as well as imaging studies. Radiographs may show evidence of a bony injury. MRI confirms the diagnosis and evaluates the knee for concomitant injuries to the cartilage, menisci and other knee ligaments. For active patients, operative treatment is often recommended while less-active patients may not require surgery. The goal of this review is to discuss the diagnosis of an ACL injury and provide clear management strategies for the primary-care sports medicine physician.