半月板损伤MRI表现与关节镜下表现的对比研究

目的探讨MRI对半月板损伤的诊断价值,进一步明确MRI信号对手术指证的参考意义。方法采集MRI诊断的97例（141个）损伤半月板的相关资料,以关节镜下半月板损伤表现为诊断＂金标准＂,应用SPSS 17.0软件对结果进行统计学分析。采用Kappa值检验MRI对半月板损伤诊断的有效性,然后用Х^2检验分析MRI对内、外侧半月板损伤诊断价值的差异。根据MRI的损伤信号表现分成三组,A组：MRI表现为Ⅰ级信号的半月板;B组：MRI表现为Ⅱ级信号的半月板;C组：MRI表现为Ⅲ级信号的半月板。应用Х^2检验分析各组需要手术处理的损伤半月板数量的差异。结果 （1）MRI诊断半月板撕裂有较好的有效性（K=0.58）,且对于内、外侧半月板撕裂的诊断无统计学差异;（2）不同信号间需行手术处理的半月板数比较具有统计学差异（Х^2=62.357,P〈0.05）。两组间比较：A组和B组无统计学差异（Х^2=5.332,P〉0.02）;C组分别和A、B组相比,均有有统计学差异（Х^2=33.930,P〈0.01）、（Х^2=47.781,P〈0.01）。结论 MRI是诊断半月板撕裂伤的一种比较有效的手段,MRI表现可以作为手术指证的参考,但应结合临床症状和体征综合考虑。

Comparative study on MRI and arthroscopic images of meniscus injury

To investigate the diagnostic value of magnetic resonance imaging（MRI） in meniscus injury and its value for surgical indications.Methods The data of 97 patients included 114 cases of meniscus injury which were diagnosed by MRI were collected.The arthroscopic findings were used as the gold standard,and all the comparison data were analysed by SPSS 17.0.Kappa test was used to analyze the validity of MRI findings,the difference between the medial meniscus and the lateral meniscus was examined by Х^2test.According to the MRI signal,all the cases were divided into three groups：group A,the meniscus showed MRI signal level Ⅰ;group B,MRI signal level Ⅱ;group C,MRI signal level Ⅲ.The number of the injured meniscus which needed surgical treatment in the three groups was analyzed by Х^2test.Results（1） As for the difference in the diagnositic effectiveness of MRI between the medial and lateral meniscal tears,there was no statistical significance.（2） The number of the cases needed arthroscopy among the three group had significant differences（Х^2= 62.357,P〈0.05）.Comparing each group,the numbers of the cases needed arthroscopy of group A and group B had no significant differences（Х^2= 5.332,P〉0.02）.The numbers of the cases needed surgery of group A and group C had significant differences（Х^2= 33.930,P〈0.01）,so were those of group B and group C（Х^2= 47.781,P〈0.01）.Conclusion MRI is an effective method in the diagnosis of the meniscus injury of the knee joint.MRI shows a good reference for surgery.However,the clinical symptoms and signs should be taken into account.