膝关节内侧副韧带损伤的MRI诊断价值

目的:探讨MRI对膝关节内侧副韧带损伤的诊断价值。方法:对59例临床拟诊膝关节内侧副韧带损伤的病例进行了MRI检查,分析其MRI表现,并与30例正常膝关节进行对比研究。结果:59例中,临床确诊为内侧副韧带损伤43例;MRI诊断为内侧副韧带损伤的共有37例,其中Ⅰ级损伤9例,Ⅱ级损伤15例,Ⅲ级损伤13例。MRI诊断膝关节内侧副韧带损伤的敏感度与特异性分别为81.4%和87.5%;对于手术治疗的20例Ⅱ、Ⅲ级的病例,MRI诊断的敏感度达100%。结论:MRI能够准确判断膝关节内侧副韧带有无损伤和损伤的程度及并发症,是较为理想的非创伤性检查方法。     

X线与MRI对膝关节内侧副韧带损伤的表现分析

目的探讨膝关节内侧副韧带(MCL)损伤的X线与MRI表现。资料与方法回顾性分析32例临床手术证实的膝关节内侧副韧带损伤患者的双膝关节应力位X线片及MRI影像表现,总结其特征性,分析两者在诊断分级上的差异。结果 32例内侧副韧带损伤的患者中,X线诊断Ⅰ级损伤15例,Ⅱ级损伤8例,Ⅲ级损伤9例。MRI诊断Ⅰ级损伤11例,Ⅱ级损伤12例,Ⅲ级损伤9例。结论 MRI能够较清晰显示内侧副韧带的解剖学特点,膝关节内侧副韧带损伤的X线与MRI分级基本符合,可为临床诊断提供重要信息。     

The value of MRI in the diagnosis of injury of discoid meniscus

目的:探讨MRI对膝关节盘状半月板及其损伤的诊断价值.方法:回顾性分析89例(151个膝关节)盘状半月板及其损伤的MRI、关节镜及手术资料.结果:89例盘状半月板中,88例(150个膝关节)为外侧盘状半月板,1例(1个膝关节)为内侧盘状半月板,表现为半月板增大、增宽、增厚,矢状面上可见≥3个层面前后角相连,冠状面髁闻棘层面半月板宽度>15 mm.本组中81例(138个膝关节)伴半月板损伤,发生率为91.40%,MRI表现为半月板不同程度变性或撕裂.与膝关节镜及手术对照,MRI图像对半月板损伤诊断的特异度为92.31%、敏感度为99.28%,对I～Ⅱ级半月板损伤诊断的符合率为95.00%;对Ⅲ级半月板损伤诊断的符合率为98.98%.结论:MRI能准确判断盘状半月板类型及其损伤的范围和程度,是诊断盘状半月板及其损伤的最佳检查方法.     

膝关节损伤的MRI诊断

目的 探讨膝关节损伤的 MRI表现及临床应用价值.方法 回顾性分析40例经手术或关节镜证实的膝关节损伤患者术前MRI表现.结果 半月板损伤28例,内侧11例,外侧17例,其中撕裂11例;韧带损伤28例,撕裂9例,损伤以前交叉韧带(15例)和内侧副韧带(12例)为主;骨挫伤20例;隐匿性骨折5例.同时发生半月板、韧带和骨损伤3类中两者及以上的复合性损伤32例(80%).关节积液及周围软组织损伤为伴随表现.结论 MRI能准确地显示膝关节损伤的各种表现,是膝关节损伤后非创伤性检查的首选,对临床有重要指导意义.     

MRI对膝关节盘状半月板及其损伤的诊断价值

目的:探讨MRI对膝关节盘状半月板及其损伤的诊断价值。方法:回顾性分析89例(151个膝关节)盘状半月板及其损伤的MRI、关节镜及手术资料。结果:89例盘状半月板中,88例(150个膝关节)为外侧盘状半月板,1例(1个膝关节)为内侧盘状半月板,表现为半月板增大、增宽、增厚,矢状面上可见≥3个层面前后角相连,冠状面髁间棘层面半月板宽度>15mm。本组中81例(138个膝关节)伴半月板损伤,发生率为91.40%,MRI表现为半月板不同程度变性或撕裂。与膝关节镜及手术对照,MRI图像对半月板损伤诊断的特异度为92.31%、敏感度为99.28%;对Ⅰ～Ⅱ级半月板损伤诊断的符合率为95.00%;对Ⅲ级半月板损伤诊断的符合率为98.98%。结论:MRI能准确判断盘状半月板类型及其损伤的范围和程度,是诊断盘状半月板及其损伤的最佳检查方法。     

MRI诊断膝关节骨挫伤临床应用价值

目的:探讨膝关节骨挫伤MRI诊断及鉴别诊断.方法:回顾性分析36例骨挫伤患者MRI资料,观察其骨挫伤以及合并邻近韧带半月板损伤的影像表现.结果:36例患者骨挫伤87处,合并骨折20例共23处,合并韧带损伤31例,合并半月板损伤32例.结论:MRI是诊断膝关节骨挫伤及其邻近结构损伤的有效影像学检查手段,同时骨挫伤MRI诊断对临床诊断和治疗有重要意义.     

磁共振薄层扫描在膝关节半月板嵌顿诊断中的应用价值

目的：分析膝关节半月板嵌顿的磁共振成像（MRI）影像学特征,提高膝关节半月板嵌顿的诊断正确率。方法回顾分析25例经MRI检查及临床治疗或手术证实的病例。结果25例患者中,内侧半月板嵌顿11例,外侧半月板嵌顿14例;半月板前角15例,半月板后角10例;伴有半月板损伤12例,其中Ⅰ级损伤9例,Ⅱ至Ⅲ级损伤3例;伴有同侧副韧带损伤9例。结论 MRI检查能及时准确诊断半月板嵌顿,观察半月板损伤情况,对伴有Ⅱ级以上撕裂伤的半月板,能为临床提供可靠依据。     

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。     

膝关节内侧副韧带损伤的X线与MR分级的对照分析

目的:探讨膝关节内侧副韧带损伤的X线与MR分级的相关性。方法:总结分析24例临床手术及关节镜检查证实的膝关节内侧副韧带损伤患者的双膝关节应力位X线片及MR资料,寻找两者在分级上的相关性。结果:24例内侧副韧带损伤的患者中,X线诊断的Ⅰ级损伤15例,Ⅱ级损伤6例,Ⅲ级损伤3例。MR诊断Ⅰ级损伤11例,Ⅱ级损伤10例,Ⅲ级损伤3例。结论:膝关节内侧副韧带损伤的X线及MR分级是基本符合的。     

低场MRI对膝关节外伤的诊断价值

目的 探讨膝关节外伤后X线、CT检查阴性,低场MRI进一步检查的诊断价值.方法 对36例膝关节外伤,X线、CT检查阴性的低场MRI资料进行分析.结果 单纯性滑膜囊或关节囊积液4 例;半月板撕裂伤14例;后交叉韧带撕裂伤3 例;内侧副韧带撕裂伤5 例;外侧副韧带撕裂伤3 例;骨挫伤5例;正常2例.其中膝关节损伤合并关节积液18例,骨挫伤合并韧带损伤2例,合并半月板损伤3例.结论 低场MRI对显示膝关节外伤优于X线平片及CT检查,可为临床治疗方式提供可靠依据.     

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。     

0.2-Tesla magnetic resonance imaging of internal lesions of the knee joint: a prospective arthroscopically controlled clinical study

The results of magnetic resonance imaging (MRI) were compared with those of arthroscopy in a prospective series of 244 patients. A dedicated system for MRI of limbs and peripheral joints – the 0,2-T Artoscan (Esaote, Italy) – was used for imaging knee joint lesions. T1-weighted spin-echo sagittal images, T2-weighted gradient-echo coronal images, and axial views for lesions of the femoropatellar joint were acquired. Paraxial sagittal and oblique coronal views were obtained for imaging of the cruciate ligaments. This protocol allowed excellent visualization of the cruciate ligaments and medial and lateral meniscus in almost all patients. Compared with arthroscopy performed within 48 h after imaging, the sensitivity, specificity, and accuracy were respectively 93%, 97%, and 95% for tears of the medial meniscus; 82%, 96%, and 93% for tears of the lateral meniscus; 100%, 100%, and 100% for tears of the posterior cruciate ligament; 98%, 98%, and 97% for tears of the anterior cruciate ligament; and 72%, 100%, and 92% for full-thickness articular cartilage lesions. The examination can be performed within 30–45 min at lower cost than diagnostic arthroscopy. MRI with a 0.2-T magnet is a safe and valuable adjunct to the clinical examination of the knee and an aid to efficient preoperative planning. Received: 13 October 1997 Accepted: 3 March 1998     

The use of MRI scan of knee injuries in an emergency department

We present a retrospective study of the number of arthroscopically verified total meniscus and cruciate ligament tears seen in our Emergency department one year before, and one year after introducing magnetic resonance imaging (MRI) as a diagnostic tool. The number of total ruptures of the anterior cruciate ligament increased from 34 (1.7% of total 2003 patients) to 67 (2.9% of total 2277). The number of ruptures of the medial meniscus increased from 42 (2.1%) to 87 (3.8%). The number of ruptures of the lateral meniscus remained unchanged. In the first 12 months after introducing MRI we ordered 513 (23%) scans of the total number of 2277 patients with an acute knee condition. Thirty-nine (8%) of these were described with no pathology, 227 (44%) showed total meniscus or cruciate ligament tears. The remaining 247 (48%) were mainly degenerative or partial injuries. The cost per additional new diagnosis was approximately USD 800. The introduction of MRI has enabled us to identify a larger number of patients with meniscus and cruciate ligament injuries.     

MRI对急性膝关节骨挫伤的临床应用价值

目的：探讨MRI对急性膝关节骨挫伤的临床应用价值。方法：对117例X线平片显示阴性并行MRI检查的外伤性膝关节病例进行回顾性分析,MRI检查时间为外伤后2h．5天,重点观察股骨下端、胫腓骨上端及髌骨的骨质信号,前后交叉韧带、内外侧副韧带、内外侧半月板的完整性和信号情况。结果：急性外伤后骨挫伤的发生率为87．2％（102／117）,合并韧带损伤62例,半月板损伤49例,关节软骨损伤17例,隐性骨折21例。结论：急性膝关节外伤后骨挫伤的发生率较高,MRI能准确显示骨挫伤的部位、范围以及临近结构的损伤,对临床诊断、治疗具有重要意义。     

军事训练膝关节不同应力性损伤的高场MRI表现

目的探讨军事训练膝关节不同应力性损伤的特点、生物力学特征及其高场MRI表现。方法回顾性分析我院2010年12月—2012年12月军事训练膝关节应力性损伤患者的MRI资料共102个膝关节,根据应力性质及应力作用的特点、组织损伤部位及特点,对每一个膝关节的MRI资料进行分析。结果 102个膝关节中,股骨远端38例,胫骨近端42例,前交叉韧带98例,后交叉韧带31例,内侧副韧带34例,外侧副韧带24例,关节腔积液76例,内侧半月板18例,外侧半月板11例,5例为单纯型损伤,97例为复合型损伤。交变应力性损伤时MRI可见骨髓腔内线状、斑片状长T1长T2信号影;拉应力性损伤时MRI可见与骨干平行的软组织异常信号,骨髓腔内片状异常信号,有骨折时骨髓腔锯齿状、斜行或横行的长T1短T2信号影;压应力性损伤时MRI可见胫骨平台的骨髓水肿、压缩骨折、半月板损伤和软组织损伤;剪切应力性损伤时MRI可见交叉韧带、侧副韧带、半月板、股骨髁或胫骨平台的异常信号。结论军事训练膝关节应力性损伤的程度与军事活动的频度、强度和训练科目有关,军事训练膝关节所遭受的应力作用不是单一的,而是几种应力的共同作用,MRI能敏感地发现不同应力所致的组织损伤特点,对膝关节应力性损伤各期的评价和诊断具有明显的优势,能为军事训练应力性损伤的预防和早期干预提供借鉴。     

Evaluation and treatment of chronic medial collateral ligament injuries of the knee

Injuries to the medial collateral ligament (MCL) can occur as isolated injuries or in conjunction with injuries to other structures about the knee. Most grade I and II MCL injuries without meniscal avulsion, alone or in combination with anterior or posterior cruciate ligament injuries, can be treated nonoperatively. Grade III or complete tears also can be treated nonoperatively, but only after careful exclusion of any associated injuries that may require surgical treatment. Treatment recommendations also have been based on the location of the MCL tear and the associated injuries. Surgical treatment may include reconstruction of the anterior and posterior cruciate ligaments with primary repair of the MCL. Chronic medial knee injuries often are associated with concomitant ligament injuries, which also must be treated. Treatment options include nonoperative (bracing, activity modification, and rehabilitation) and operative reconstruction.     

The O'Donoghue triad revisited. Combined knee injuries involving anterior cruciate and medial collateral ligament tears

We identified 60 consecutive patients with combined anterior cruciate and medial collateral ligament (ACL-MCL) disruptions that were incurred during athletic endeavors. Each underwent acute reconstruction of the ACL. The arthroscopic data obtained at the time of reconstructive surgery was reviewed in order to determine the incidence of O'Donoghue's triad (the "unhappy triad"), consisting of ACL, MCL, and medial meniscus tears. Patients were subdivided into two groups for analysis based upon the degree of MCL injury at time of presentation (Group I, 35 patients with a second-degree sprain; Group II, 25 patients with a complete, or third-degree injury). Medial meniscus tears were an uncommon finding. Lateral meniscus tears significantly out-numbered medial meniscus tears in both groups, occurring in 25 (71%) of Group I patients and 8 (32%) of those in Group II. Even chondral fractures of the lateral femoral condyle outnumbered medial meniscus tears [6 (17%) versus 4 (11%)] in patients with a second-degree MCL sprain. Furthermore, when present in Group I patients, tears of the medial meniscus were associated with a concomitant lateral meniscus injury. Group II patients were more likely (60%) than Group I not to have any meniscal abnormality at all. We conclude that the classic O'Donoghue triad is, in fact, an unusual clinical entity among athletes with knee injuries; it might be more accurately described as a triad consisting of ACL, MCL, and lateral meniscus tears. This injury combination appears to be more common when an incomplete, or second-degree, tear of the medial collateral has occurred.(ABSTRACT TRUNCATED AT 250 WORDS)     

膝关节损伤核磁共振成像诊断分析

目的探讨G-SCAN检查对膝关节损伤的诊断价值。方法 120例膝关节损伤,采用G-SCAN（0.25T可旋转式核磁共振成像仪）膝关节表面线圈检查,分别采用自旋回波序列、梯度回波序列、脂肪抑制序列,做矢状位、冠状位及横断位扫描。结果 G-SCAN可以清楚显示膝关节半月板、韧带及骨挫伤。本组120例病例中,半月板损伤95例,其中单纯外侧半月板损伤63例,单纯内侧半月板损伤8例,内、外侧半月板同时损伤24例;韧带损伤85例,其中前交叉韧带损伤68例,后交叉韧带损伤19例,胫侧副韧带损伤65例,腓侧副韧带损伤5例;骨挫伤35例,其中单纯胫骨挫伤22例,单纯股骨挫伤5例,胫骨及股骨同时挫伤8例。结论 G-SCAN是诊断膝关节结构损伤的最佳检查方法之一,可为临床医生选择合适的治疗方法提供依据,具有重要的临床价值。     

关节镜下全内缝合法修补内侧半月板后角损伤

目的:探讨内侧半月板后角损伤的关节镜下全内修补方法及其临床疗效。方法:自2002年4月~2005年4月间在本院进行前交叉韧带损伤合并内侧半月板后角损伤治疗的患者89例。对其中85例患者应用全内缝合方法手术,经两个后内入路配合髁间窝入路,利用缝合钩修补损伤半月板;同时选择绳肌腱、自体或异体骨-腱-骨移植物重建受损前交叉韧带。结果:可随访者75例(84·3%),随访5~41个月,平均20·2个月。随访采用主观症状检查、临床查体、2次关节镜手术复查(25例)及MRI复查(21例)等。随访到的75例患者的主观症状及临床查体结果均正常,其中25例患者经2次关节镜手术复查结果均为全部愈合;经MRI复查的21例患者中,18例完全愈合,3例部分愈合。结论:关节镜下全内缝合方法是修补内侧半月板后角损伤的理想方法,术后疗效好。