多层螺旋CT与MRI在膝关节隐匿性骨折伴半月板及韧带损伤中的诊断比较

目的:探讨多层螺旋CT(multislice spiral CT,MSCT)和MRI对膝关节隐匿性骨折伴半月板及韧带损伤的诊断价值。方法:自2020年1月至2021年3月,经关节镜或手术定性确诊膝关节隐匿性骨折伴半月板及韧带损伤患者63例,男41例,女22例,年龄21~67(44.35±8.77)岁,病程1~6(4.64±1.75) d;体质量指数(body mass index,BMI)(19.85±2.78) kg/m²。收集63例患者的MSCT和MRI检查资料,统计分析相关数据并评价二者的诊断价值。结果:MRI对膝关节隐匿性骨折伴半月板及韧带损伤、关节腔积液、骨髓水肿和关节面损伤的检出率分别为100.00%(63/63),95.24%(60/63),42.86%(27/63)和36.51%(23/63),MSCT的检出率分别为49.21%(31/63),41.27%(26/63),0.00%(0/63)和1.59%(1/63),差异有统计学意义(P<0.05);MRI的诊断灵敏度、特异度和准确度高于MSCT(P<0.05)。结论:MRI对膝关节隐匿性骨折伴半月板及韧带损伤的诊断灵敏度、特异度和准确度明显优于多层螺旋CT,对关节腔、关节面及骨髓等周围组织病变诊断准确性较高,可降低临床误诊风险。

Comparison of multislice spiral CT and MRI in diagnosis of occult fracture of knee joint with meniscus and ligament injury

Objective: To investigate the diagnostic value of multislice spiral CT (MSCT) and MRI in occult fracture of knee joint with meniscus and ligament injury. Methods: From January 2020 to March 2021,63 patients with knee occult fracture with meniscus and ligament injury,including 41 males and 22 females,aged from 21 to 67 years old,with an average of (44.35±8.77) years old,the course of disease ranged from 1 to 6 days,with an average of (4.64±1.75) days,the body mass index (BMI) was (19.85±2.78) kg/m². MSCT and MRI data of 63 patients were collected and statistically analyzed to evaluage their diagnist value. Results: The detection of MRI for occult knee fravtures with meniscus and ligament injury,joint cavity effusion,bone marrow edema,and articular surface injury were 100.00% (63/63),95.24% (60/63),42.86% (27/63) and 36.51% (23/63),respectively. The detection rates of MSCT were 49.21% (31/63),41.27% (26/63),0.00% (0/63) and 1.59% (1/63),respectively, significantly lwver than that of MRI (P<0.05). The diagnostic sensitivity,specificity and accuracy of MRI were significantly higher than those of MSCT(P<0.05). Conclusion: The sensitivity,specificity and accuracy of magnetic resonance imaging in the diagnosis of occult fracture of knee joint with meniscus and ligament injury are significantly better than that of MSCT. MRI has higher accuracy in the diagnosis of peripheral tissue diseases such as joint cavity,articular surface and bone marrow,and can reduce the risk of clinical misdiagnosis.