共查询到20条相似文献,搜索用时 15 毫秒
1.
MR imaging of meniscal bucket-handle tears: a review of signs and their relation to arthroscopic classification 总被引:4,自引:0,他引:4
Our objective was to review the MR imaging signs of meniscal bucket-handle tears and assess the relevance of these signs
to the arthroscopic classification of displaced meniscal tears. Forty-five menisci in 42 patients who had a diagnosis of bucket-handle
tear either on MR imaging or on subsequent arthroscopy (in which Dandy's classification of meniscal tears was used) were retrospectively
analyzed for MR imaging findings of double posterior cruciate ligament (PCL), fragment within the intercondylar notch, absent
bow tie, flipped meniscus, double-anterior horn, and disproportional posterior horn signs. Arthroscopy, which was considered
as the gold standard, revealed 41 bucket-handle tears (either diagnosed or not diagnosed by MR imaging) in 38 patients (33
males, 5 females). There was a stastistically significant male preponderance for the occurrence of meniscal bucket-handle
tears. Overall, sensitivity and positive predictive value of MR imaging for the detection of meniscal bucket-handle tears
were calculated as 90%. Common MR imaging signs of meniscal bucket-handle tears in arthroscopically proven cases of such tears
were the fragment in the notch and absent bow tie signs (98% frequency for each). Double-PCL, flipped meniscus, double-anterior
horn, and disproportional posterior horn signs, however, were less common (32, 29, 29, and 27%, respectively). An arthroscopically
proven bucket-handle tear was found in all patients who displayed at least three of the six MR imaging signs of meniscal bucket-handle
tears. The presence of three or more MR imaging signs of meniscal bucket-handle tears is highly suggestive of this condition.
Electronic Publication 相似文献
2.
膝关节半月板撕裂的MRI(与手术,关节镜对照研究) 总被引:9,自引:0,他引:9
目的:研究半月板内信号接触关节面的特定型式与半月板撕裂的关系。材料和方法:分析了98例临床怀疑半月板撕裂病人的膝关节MR资料,并与手术或关节镜检查结果进行对照研究。结果:信号接触关节面的半月板发生撕裂的机率明显高于不接触和可能接触的半月板(P<001)。信号可能接触关节面的半月板与不接触的半月板发生撕裂的机率无显著性差异(P>005)。当一层以上图像显示半月板内信号接触关节面时,发生半月板撕裂的机率在90%以上;而只有一层图像显示半月板内信号接触关节面时,发生半月板撕裂的机率在内侧半月板为50%,外侧半月板为33%。半月板撕裂最好发的部位是半月板的后角。结论:当半月板内信号与关节面无接触或可能接触时,发生半月板撕裂的可能性均较小;当只有一层图像显示半月板内信号接触关节面时,诊断为半月板可能撕裂较妥,当一层以上图像显示信号接触关节面时,诊断为月板撕裂较可靠 相似文献
3.
MRI评价膝关节半月板的桶柄状撕裂 总被引:21,自引:1,他引:20
目的 明确5种MRI征象对膝关节半月板桶柄状撕裂的诊断价值。方法 回顾135例患者139个经关节镜证实的膝关节MR图像,其中19个存在半月板桶柄状撕裂。在均不告知关节镜结果的条件下,由2名有经验的放射医生对所有图像进行独立读片,差异协商解决。每个膝关节均记录如下5种MRI征象:双后交叉韧带征(双PCL征)、半月板翻转征、空领结征、碎块内移征和外周残半月板征。分别计算每种征象诊断半月板桶柄状撕裂的敏感度、特异度、阳性预测值、阴性预测值和准确度。结果 5种征象的诊断敏感度分布于52.6%和89.5%之间,特异度分布于83.3%和98.3%之间,阳性预测值分布于42.9%和88.2%之间,阴性预测值分布:于92.7%和98.3%之间,准确度分布于82.7%和96.4%之间。“碎块内移征”和“外周残半月板征”的诊断敏感度最高,“双PCL征”的诊断特异度和阳性预测值最高,而“碎块内移征”具有最高的阴性预测值和诊断准确度。结论 半月板桶柄状撕裂在MRI上可以有多种表现,各种征象对诊断的能力有所不同。 相似文献
4.
Michael Makdissi Karl O. Eriksson Hayden G. Morris David A. Young 《Knee surgery, sports traumatology, arthroscopy》2006,14(10):1012-1016
Magnetic resonance imaging (MRI) is the most widely used non-invasive test for assessing intra-articular injuries of the knee. It has been suggested that a negative MRI can be useful in avoiding the need for diagnostic arthroscopy in cases where clinical examination is equivocal. However, the sensitivity and specificity of MRI is not 100%, particularly for tears of the lateral meniscus. Furthermore, a false negative MRI scan may result in premature return to play in athletes, resulting in increased risk of further damage to a torn meniscus. To illustrate this issue, we present a case series of eight elite athletes who all presented with mechanical knee symptoms and where MRI scans revealed no significant intra-articular pathology. Five of the athletes were allowed to return to sport on the basis of a negative MRI. All patients were subsequently found to have a bucket-handle tear of their lateral meniscus at arthroscopy. Two independent, experienced musculoskeletal radiologists were asked to review the MRI films without being given any clinical history of the cases. Although injuries to the popliteus tendon were noted in two of the athletes who had sustained a recent acute injury to their knee, no meniscal tears were identified. Thus arthroscopy remains the gold standard for the assessment and management of high-demand patients with a clinical suspicion of meniscal pathology. 相似文献
5.
The presence or absence of a meniscal tear was established in 340 out of 475 consecutive patients who had double contrast knee arthrograms. The accuracy in these 340 cases was 95% for both the medial and lateral menisci although the specificity for lateral tears was only 0.64. Analysis of the pattern of arthrographic abnormalities revealed that both medial and lateral tears usually involved the posterior horn of the meniscus. Posterior horn abnormalities rarely caused a false positive diagnosis of a meniscal tear. In contrast, isolated blunting of the anterior horn of either the lateral or medial meniscus was an unreliable sign of a tear and accounted for many of the false positive diagnoses. It is concluded that careful attention to the posterior horn of each meniscus is essential for accurate arthrographic diagnosis of a meniscal tear. 相似文献
6.
Arthroscopic diagnosis was used to determine the incidence of the most frequent injuries to the knee’s internal structures
associated with ACL tear as well as ones without ACL tear. The most frequent finding associated with a recent ACL tear was
the LM tear (72.7%). There is a statistically significant incidence of recent LM tear in knees with a recent ACL tear compared
with recently injured knees without an ACL tear (P < 0.001). A statistically significant incidence of longitudinal LM tear was found in knees with a recent ACL tear compared
with recently injured knees without an ACL tear (P < 0.001). Longitudinal tears were present in 63.6% of the knees with a recent ACL tear or in 87.5% of all knees with a recent
LM tear. No statistically significant difference was found in the incidence of LM tear in the knees with a recent ACL tear
compared to the incidence of LM tear in knees with an old ACL tear (P > 0.05). The posterior horn was most frequently injured (71.5% vs 64.0%). A significant difference between the findings in
the various patient groups studied supports the hypothesis that longitudinal LM tears in an ACL-deficient knee do not involve
secondary meniscal pathology but that their onset derives from a primary recent injury. Most probably, the recent LM lesion
does not evolve in meniscal length and depth. This hypothesis needs thorough investigation.
Received: 25 May 1996 Accepted: 7 April 1997 相似文献
7.
Objective To determine the frequency of medial meniscal extrusion (MME) versus “medial meniscal intrusion” in the setting of bucket
handle tears. Images were evaluated for previously reported risk factors for MME, including: medial meniscal root tear, radial
tear, degenerative joint disease and joint effusion.
Methods Forty-one consecutive cases of bucket handle tear of the medial meniscus were reviewed by consensus by two musculoskeletal
radiologists. Imaging was performed using a 1.5 GE Signa MR unit. Patient age, gender, medial meniscal root integrity, MME,
medial meniscal intrusion, degenerative joint disease, effusion and anterior cruciate ligament (ACL) tear were recorded.
Results Thirteen females and 27 males (age 12–62 years, median=30 years) were affected; one had bucket handle tear of each knee. Effusion
was small in 13, moderate in 9 and large in 18. Degenerative joint disease was mild in three, moderate in two and severe in
one. 26 ACL tears included three partial and three chronic. Medial meniscal root tear was complete in one case and partial
thickness in two. None of the 40 cases with an intact or partially torn medial meniscal root demonstrated MME. MME of 3.1 mm
was seen in the only full-thickness medial meniscal root tear, along with chronic ACL tear, moderate degenerative joint disease
and large effusion. Medial meniscal intrusion of the central bucket handle fragment into the intercondylar notch was present
in all 41 cases.
Conclusion Given an intact medial meniscal root in the setting of a “pure” bucket handle tear, there is no MME. 相似文献
8.
Simultaneous bucket handle tear of both medial and lateral menisci of a knee with chronic anterior cruciate ligament deficiency 总被引:1,自引:1,他引:0
Ozgur Cetik Meric Cirpar Fatih Eksioglu Murad Uslu 《Knee surgery, sports traumatology, arthroscopy》2006,14(4):356-359
Bucket handle meniscus tears constitute about 10% of all meniscal tears. Bucket handle tears of medial meniscus is three times more than lateral meniscus. Most of these tears are associated with anterior cruciate ligament (ACL) deficiency. Lateral meniscus lesions are more common with acute ACL deficiency, where medial meniscus lesions are more associated with chronic ACL deficiency. We identified bucket handle tears of each meniscus of a 30-year-old male patient while performing diagnostic arthroscopy during ACL reconstruction procedure. We present an ACL deficient knee with bucket handle tears of medial and lateral meniscus of the same knee and discuss the treatment. 相似文献
9.
膝关节半月板撕裂的磁共振诊断:附61例关节镜对照分析 总被引:2,自引:0,他引:2
目的:比较分析半月板撕裂的MRI表现和关节镜所见,明确半月板撕裂MRI成像的作用和价值。材料和方法:对一组61例(68膝)MRI资料的影像学特征与关节镜所见作对照分析,MRI半月板内异常高信号影的判断采用Lotysch提出的分级标准。结果:MRI对半月板损伤的诊断敏感性为95%,特异性为88%,关节镜符合率为92%。MR的Ⅲ级信号与关节镜所见半月板撕裂具有高度相关性,其中Ⅲ级信号仅见于一层和见于一层以上者分别与半月板撕裂的对应关系有显著差别。病变信号发生部位及其与半月板特定表面的关系对诊断结果无影响。结论:MRI对膝关节半月板撕裂的诊断极有价值,半月板内Ⅲ级信号是诊断半月板撕裂的可靠征象,而当Ⅲ级信号影仅见于一层时,诊断须慎重。 相似文献
10.
MRI对膝关节半月板撕裂诊断价值的Meta分析 总被引:3,自引:0,他引:3
目的通过Meta分析的方法评价MRI对膝关节半月板撕裂的临床诊断价值。方法搜集1998至2004年国内外公开发表的以关节镜检查结果为诊断金标准的关于MRI诊断膝关节半月板撕裂的英文、中文文献,按照Meta分析的要求和诊断试验公认的质量标准对所有的纳入研究进行质量评估,并提取各纳入研究的特征信息。采用SAS8.0软件,检验异质性,根据异质性结果选择相应的效应模型,计算出汇总敏感度和特异度,以诊断试验Meta分析特有的综合受试者工作特性曲线(SROC)分析方法定性、定量地评价该诊断方法的准确性。结果符合纳入标准的文献共11篇,汇总的诊断指标和SROC分析均显示,MRI对内、外侧半月板撕裂的诊断均有较高的准确度,表示诊断试验准确度的TPR^*分别为0.90、0.86,二者差异无统计学意义(Z=0.11,P〉0.05)。亚组分析显示,磁场强度的高低所致诊断准确性之间的差异无统计学意义(内、外侧Z值分别为1.59、0.43,双侧P值均〉0.05)。结论汇总目前关于MRI诊断内、外侧半月板撕裂的研究显示,MRI是一种准确性较高的无创性检查方法,目前尚无确切证据表明高磁场强度对半月板撕裂具有较高的诊断准确性。 相似文献
11.
目的 :探讨膝关节半月板损伤MRI和关节镜下的不同表现及其对半月板损伤的诊断意义。方法 :回顾性分析 10 2个半月板损伤的MRI表现和关节镜下图像。根据MRI信号改变将半月板损伤分为Ⅰ级、Ⅱ级、Ⅲ级 ,并与关节镜下所见对比 ,分别加以研究。结果 :根据MRI信号强度改变 ,10 2个膝关节中Ⅰ级损伤 3 4个 ,Ⅱ级损伤 2 7个 ,Ⅲ级损伤 41个。与关节镜检结果对比 ,MRI诊断半月板撕裂的敏感度 90 .0 % ,特异度 91.9% ,符合率 91.2 %。结论 :MRI在半月板损伤的诊断中具有极高价值 ,对指导患者的治疗具有重要的临床意义。 相似文献
12.
MRI对膝关节半月板桶柄样撕裂的诊断价值 总被引:7,自引:0,他引:7
目的 评价MRI诊断膝关节半月板桶柄样撕裂的应用价值。方法 经关节镜证实的 2 1例的桶柄样撕裂患者及 11例非桶柄样撕裂患者。采用百胜公司的关节专用磁共振成像系统进行扫描。观察以下 4种MRI征象 ,双前角征 ,双后交叉韧带征 ,髁间碎片征及领结消失征。结果 3 2例患者中 ,出现双前角征的有 10例 ,双后交叉韧带征 5例 ,髁间碎片征 2 0例 ,领结消失征 2 5例。结论 MRI是诊断半月板桶柄样撕裂的有效手段 ,内侧半月板桶柄样撕裂的敏感性及特异性较外侧高 ,髁间碎片征是诊断内侧半月板桶柄样撕裂最有价值的征象 相似文献
13.
目的:了解关节镜下使用FasT-Fix系统进行半月板缝合的临床疗效与MRI造影下的愈合情况。方法:2006年4月至2007年7月,17例患者、18侧损伤半月板在我所应用Fast-Fix系统进行了关节镜下全内的半月板缝合,所有患者同时进行了交叉韧带重建,于术后平均11个月进行临床随访,依照Barrett标准评价半月板缝合的临床愈合情况,并对随访患者进行IKDC、Lysholm和Tegner评分。所有18侧半月板应用MRI造影评价半月板愈合情况。结果:18侧缝合的半月板有17侧得到了临床愈合,临床愈合率为94.4%。平均IKDC评分由术前的46.4分提高至术后的75.2分,平均Lysholm评分由术前的44.8分提高至术后的80.6分,平均Tegner评分由术前的2.5分提高至术后的5.4分。MRI造影显示18侧半月板中13侧为完全愈合,2侧为部分层厚不愈合,3侧为全层厚不愈合,总愈合率为83.3%,完全愈合率为72.2%。结论:应用Fast-Fix系统进行半月板缝合具有很好的临床效果,MRI造影显示有较高的愈合率。 相似文献
14.
Russell M. Nord MD Natalie Badowski MD Christopher Elkins PhD Marcus Alley PhD Alex H.S Harris PhD Jason L. Dragoo MD 《Journal of magnetic resonance imaging : JMRI》2013,37(1):201-207
Purpose:
To determine the best positioning and the resulting fluid flow patterns inside the knee during arthroscopy, reducing the surgical morbidity associated with the arthroscopic irrigation and debridement of a septic knee joint.Materials and Methods:
Three‐dimensional MRI, using an MRI‐compatible human cadaveric knee arthroscopic model, generated fluid flow diagrams and velocity vector data. This was analyzed for six different arthroscopic configurations and at six different locations within the knee joint.Results:
At any one static arthroscopic position, fluid flow velocity differed at the various locations in the knee, often with statistically significantly greater flow at one location over another. In general, flow was greatest at the location at which the inflow cannula terminated and preferentially flowed directly to the outflow cannula location, neglecting spaces in the knee that were not on this direct path. Three‐portal arthroscopy provided no benefit over two‐portal arthroscopy.Conclusion:
To maximize arthroscopic lavage throughout all compartments in the knee, the arthroscopist must individually enter each space in the knee. Static arthroscopy in the setting of knee sepsis may lead to inadequate flow in certain areas of the knee and may lead to treatment failure. Three‐portal arthroscopy does not improve lavage efficiency. J. Magn. Reson. Imaging 2013;37:201–207. © 2012 Wiley Periodicals, Inc. 相似文献15.
16.
Degenerative joint disease on MRI and physical activity: a clinical study of the knee joint in 320 patients 总被引:1,自引:0,他引:1
We examined 320 patients with MRI and arthroscopy after an acute trauma to evaluate MRI in diagnosis of degenerative joint
disease of the knee in relation to sports activity and clinical data. Lesions of cartilage and menisci on MRI were registered
by two radiologists in consensus without knowledge of arthroscopy. Arthroscopy demonstrated grade-1 to grade-4 lesions of
cartilage on 729 of 1920 joint surfaces of 320 knees, and MRI diagnosed 14 % of grade-1, 32 % of grade-2, 94 % of grade-3,
and 100 % of grade-4 lesions. Arthroscopy explored 1280 meniscal areas and showed degenerations in 10 %, tears in 11.4 %,
and complex lesions in 9.2 %. Magnetic resonance imaging was in agreement with arthroscopy in 81 % showing more degenerations
but less tears of menisci than arthroscopy. Using a global system for grading the total damage of the knee joint into none,
mild, moderate, or severe changes, agreement between arthroscopy and MRI was found in 82 %. Magnetic resonance imaging and
arthroscopy showed coherently that degree of degenerative joint changes was significantly correlated to patient age or previous
knee trauma. Patients over 40 years had moderate to severe changes on MRI in 45 % and patients under 30 years in only 22 %.
Knee joints with a history of trauma without complete structural or functional reconstitution showed marked changes on MRI
in 57 %, whereas stable joints without such alterations had degenerative changes in only 26 %. There was no correlation of
degenerative disease to gender, weight, type, frequency, and intensity of sports activity. Therefore, MRI is an effective
non-invasive imaging method for exact localization and quantification of chronic joint changes of cartilage and menisci that
recommends MRI for monitoring in sports medicine.
Received: 28 July 1997; Revision received: 9 February 1998; Accepted: 20 March 1998 相似文献
17.
膝关节半月板损伤的MRI诊断 总被引:4,自引:0,他引:4
目的 回顾性研究膝关节半月板不同程度损伤的MRI表现。方法 对手术或临床证实的20例共31个损伤的半月板进行回顾性MRI分析。结果 在20例40个半月板中有31个损伤的半月板,其中单纯内侧损伤4个,单纯外侧损伤3个,两侧半月板同时损伤12例24个。将31个损伤的半月板按Stoller的4级分法分类,其中0级0个,Ⅰ级7个,Ⅱ级11个,Ⅲ级13个。17例出现并发症,其中半月板囊肿1例,内侧副韧带损伤3例,外侧副韧带损伤1例,前后交叉韧带同时损伤2例,内外侧副韧带前后十字交叉韧带同时损伤2例,骨折3例,关节囊积液17例。结论 MRI是一种无创伤性的能准确诊断半月板损伤并进行分级,还能发现多种并发症的成像方法。 相似文献
18.
0.2-Tesla magnetic resonance imaging of internal lesions of the knee joint: a prospective arthroscopically controlled clinical study 总被引:3,自引:0,他引:3
K.-A. Riel M. Reinisch B. Kersting-Sommerhoff N. Hof T. Merl 《Knee surgery, sports traumatology, arthroscopy》1999,7(1):37-41
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 相似文献
19.
20.
Algorithm for establishing the indication for knee arthroscopy in children: a comparison of adolescent and preadolescent children 总被引:4,自引:1,他引:3
The aim of this study was to select children with pathological lesions of the intra-articular structures from children with
identical complaints but with no pathological intra-articular changes. The younger the child, the more difficult it is to
make the diagnosis, and the expected distribution of pathology changes increasingly. This is particularly stressed in children
aged younger than 13 years. Synovial inflammatory alterations are more frequent, and osteochondral and chondral fractures
appear to be more problematic than meniscal and cruciate ligament lesions. Before establishing the indication for knee arthroscopy
it is mandatory to implement the algorithm of diagnostic and conservative therapeutic procedures. The indication for knee
arthroscopy is considered in cases when complaints persist after conservative treatment, a lesion of intra-articular segments
is suspected, and the pathological condition is deemed arthroscopically treatable. Arthroscopy before conservative treatment
is justified only in acute cases.
Received: 21 April 1999/Accepted: 25 November 1999 相似文献