膝横韧带和板股前、后韧带的MRI观测及其在外侧半月板“假撕裂征”诊断中的应用

目的 探讨膝横韧带(TLK)和板股前、后韧带(aMFL、pMFL)的MRI影像解剖学特征,及其对鉴别膝关节外侧半月板真假撕裂的价值。方法 回顾性分析2014年8月―2015年8月在广西医科大学第三附属医院关节外科行膝关节MRI检查,且关节镜排除半月板真性撕裂的101例患者的影像资料,其中男60例,女41例,平均年龄42(18~75)岁。行MR多序列、多平面扫描,观测TLK、aMFL、pMFL的出现率、中点径、走行方式及“假撕裂征”出现率等,应用χ²检验对“假撕裂征”出现率行性别及侧别间比较。结果 TLK的出现率为67.3%(68/101),横断面多呈卵圆形、圆形,其平均中点矢状径(1.88±0.35)mm、冠状径(1.79±0.60)mm,于外侧半月板前角“假撕裂征”出现率为2.9%(2/68)。aMFL、pMFL的出现率分别为13.9%(14/101)、77.2%(78/101),横断面呈卵圆形、扁平形及不规则形等多种形状;aMFL平均中点矢状径(1.53±0.39)mm、冠状径(2.8±0.92)mm,pMFL平均中点矢状径(2.04±1.03) mm、冠状径(3.10±1.08)mm;板股韧带于外侧半月板后角“假撕裂征”出现率为18.5%(17/92)。外侧半月板“假撕裂征”出现率在性别、侧别间差异均无统计学意义(P值均﹥0.05)。结论 在膝关节MRI检查中,外侧半月板有时显示“假撕裂征”;通过对TLK及aMFL、pMFL进行影像形态学研究,根据其在MRI上的形态、走行及外侧半月板假撕裂的方向、位置,可鉴别外侧半月板后角撕裂的真假属性,从而减少不必要的手术治疗。

MRI study of the transverse ligament of knee,anterior and posterior meniscofemoral ligament and the application in the diagnosis of " pseudotears sign " of lateral meniscus

Objective To investigate the anatomic features of the MRI of the transverse ligament of knee(TLK) , anterior meniscofemoral ligament(aMFL) and posterior meniscofemoral ligament(pMFL) of the knee, and the value of identifying the true and false tear of the lateral meniscus of the knee joint. Methods One hundred and one patients with knee joint surgery in the Department of Orthopedics of the Third Affiliated Hospital of Guangxi Medical University from August 2014 to August 2015 were retrospectively analyzed, and all of patients with meniscus true tear were excluded. There were 60 males and 41 females with an average age of 42 (18-75) years. Multiple sequence and plane of MR scan were performed to observe the display rates of the TLK, aMFL and pMFL, the mid-point, the way of walking and the appearance of pseudo-tears sign of them. Chi square test was used on the gender and sides of the pseudo-tears sign rate.Results The TLK was presented in 67.3%(68/101), the cross section more presentation oval-like and circular-like, the average of the mid-point of the sagittal diameter was (1.88±0.35)mm, coronary diameter was (1.79±0.60)mm, the pseudo-tears sign displayed in the anterior horn of the lateral meniscus was presented in 2.9%(2/68). The aMFL and pMFL was presented in 13.9%(14/101) and 77.2%(78/101), respectively, the cross section of the aMFL were oval-like, flat-like and irregular-like, the average of the mid-point of the aMFL of the sagittal diameter was (1.53±0.39)mm, coronary diameter was (2.8±0.92)mm, the average of the mid-point of pMFL of the sagittal diameter was (2.0±1.03)mm, coronary diameter was (3.10±1.08)mm, the pseudo-tears sign displayed in the posterior horn of the lateral meniscus was presented in 18.5%(17/92). There was no significant difference in the pseudo-tears sign of the lateral meniscus in different genders and sides(all P values﹥0.05). Conclusions In the MRI examination of the knee joint, pseudo-tears sign is sometimes displayed in the lateral meniscus, and these three ligaments studied in this way can improve the recognition of them, based on the anatomy and position of these ligaments, and the direction and location of pseudo-tears, the pseudo-tears can be distinguished from the true tear of posterior horn of the lateral meniscus so as to reduce the unnecessary surgical treatment.