骨挫伤与膝关节附属结构损伤关系的MRI评价

目的　探讨骨挫伤与膝关节附属结构损伤的关系。方法　回顾性分析了 5 8例膝关节骨挫伤病人的影像学资料 ;记录患者的年龄 ,骨挫伤病灶的部位、病灶数、MRI表现、关节附属结构损伤的部位及类型。结果　膝关节骨挫伤好发于青少年 (3 1.0 % ,18/ 5 8) ;80 % (8/ 10 )的股骨外侧髁及胫骨外侧平台的骨挫伤伴有前交叉韧带撕裂 ;侧副韧带损伤中有 45 % (9/ 2 0 )伴有同侧的骨挫伤 ,5 0 % (10 / 2 0 )对侧有骨挫伤 ;64 .9% (2 4/ 3 7)的骨挫伤发生于半月板撕裂的同侧 ,对侧为 13 .5 % (5 / 3 7) ,内、外侧半月板同时累及2 1.6% (8/ 3 7)。关节软骨损伤均伴有软骨下的骨挫伤。结论　青少年膝关节外伤后关节疼痛 ,行MRI检查可发现相关的关节损伤。膝关节的骨挫伤是前交叉韧带撕裂、半月板撕裂及关节软骨损伤的重要间接征象。     

膝关节外伤性骨挫伤的MR诊断及临床意义

目的评价MRI对骨挫伤的诊断价值和临床意义。方法选取145例x线平片未显示股骨和胫骨骨折但MRI显示有外伤性骨髓水肿的膝关节外伤患者，MR检查时间为外伤后1-3d，采用膝关节专用线圈，快速SE（FSE）序列，T，WI、T2WI、质子密度加权成像（PDWI）＋脂肪抑制，行冠状面、矢状面、横断面、斜矢状面扫描，层厚3min，层间距0．5mm。根据骨髓水肿的分布，将膝关节外伤性骨挫伤分成5类：轴向旋转性损伤、夹击损伤、仪表盘式损伤、过伸型损伤和髌骨外侧脱位。其中48例行关节镜检查。结果145例中MRI显示轴向旋转性损伤43例，夹击损伤53例，仪表盘式损伤40例，过伸型损伤9例。骨髓水肿在PDWI或T2WI脂肪抑制序列上为片状地图样高信号，在T1WI上为低信号，边界不清。48例行关节镜检查，发现前交叉韧带撕裂11例，后交叉韧带撕裂13例，半月板撕裂22例，5例MRI诊断半月板撕裂而关节镜未能显示，MRI诊断与关节镜诊断结果符合率为89．6％。结论MRI可以准确显示膝关节骨挫伤的部位和范围及膝关节附属结构的损伤，推断其受伤机制，对临床诊断、治疗具有重要意义，应作为常规检查方法应用。     

膝关节对吻性骨挫伤在急性前交叉韧带损伤中的临床意义

目的探讨急性膝关节损伤出现股骨外侧髁与胫骨外侧平台后缘对吻性骨挫伤时与前交叉韧带(ACL)损伤的关系及其临床意义。方法分析50例膝关节损伤伴有股骨外侧髁与胫骨外侧平台后缘对吻性骨挫伤的MRI图像,分析股骨外侧髁与胫骨外侧平台后缘对吻性骨挫伤与前交叉韧带损伤之间的关系。结果在50例有股骨外侧髁与胫骨外侧平台后缘对吻性骨挫伤的膝关节损伤患者中,前交叉韧带损伤50例,其中断裂38例,损伤率达100%,断裂率达76%。结论在急性膝关节外伤时,股骨外侧髁与胫骨外侧平台后缘对吻性骨挫伤的出现对前交叉韧带损伤的诊断及临床诊治有重要意义。     

半月板桶柄样撕裂的MRI表现

目的 探讨半月板桶柄样撕裂的MRI征象. 资料与方法 对经关节镜证实的半月板桶柄样撕裂56例(58侧)患者的MRI表现进行研究. 结果 领结残破征21膝,空领结征28膝,双前交叉韧带征6膝,双后交叉韧带征19膝,双半月板前角征11膝,前角异常肥大征5膝,双半月板后角征16膝,后角异常肥大7膝,后角残破征19膝,厚饼征6膝,半月板分离移位征53膝.合并膝关节囊积液58膝、股骨(或胫骨)挫伤36膝、内侧副韧带损伤6膝、前交叉韧带损伤5膝、后交叉韧带损伤9膝、关节软骨损伤13膝、骨梗死2膝. 结论 空(残)领结征、后角残破征、双后交叉韧带征及半月板分离移位征提示半月板桶柄样撕裂.     

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。     

探讨半月板边缘部垂直撕裂与前交叉韧带损伤的关系

目的 探讨半月板边缘部垂直撕裂对诊断前交叉韧带(ACL)损伤的价值.方法 回顾性分析经关节镜证实的149例半月板撕裂的膝关节MRI结果,判断半月板撕裂的形态、位置以及前交叉韧带的情况.结果 149例半月板撕裂膝关节中,34个膝关节共36个半月板撕裂(其中2个膝关节内、外侧半月板同时撕裂),MRI显示为半月板边缘部垂直撕裂类型,其中29个膝关节同时伴有前交叉韧带损伤.其余115个膝关节,MRI显示为其他半月板撕裂类型,其中49例膝关节同时伴有前交叉韧带损伤.膝关节半月板边缘部垂直撕裂类型与其他的半月板撕裂类型比较,其合并前交叉韧带损伤的发生率分别为85.3%及42.6%,两者间具有显著性差异(χ2=19.2,P＜0.01).半月板边缘部垂直撕裂提示膝关节前交叉韧带损伤的敏感性、特异性和阳性似然比分别为37.2%、93.0%和5.3.结论半月板边缘部垂直撕裂大部分合并有ACL损伤.     

膝关节损伤磁共振成像诊断及临床价值

在临床工作中,外伤致膝关节损伤很常见,传统的影像学方法难以做出十分准确的诊断,而磁共振成像(MRI)因其能够多方位成像、软组织分辨率高及无创伤性等特点,在对膝关节损伤的诊断中显示出巨大优势,已成为膝关节损伤理想的检查方法。本文就膝关节的半月板损伤、韧带撕裂、骨挫伤及骨、软骨骨折的MRI诊断和临床价值综述如下。1膝关节的正常解剖及MR表现1.1半月板半月板为位于胫骨平台和股骨内外髁透明软骨之间的半月状纤维软骨盘,外缘肥厚,与关节囊相连,内缘薄而锐利,游离于关节腔。内侧半月板较大呈“C”形,外侧半月较小呈“O”形。通常将…     

膝部骨挫伤的MRI评估

目的：进一步认识膝部骨挫伤的ＭＲＩ表现以及与其他结构损伤的关系。材料和方法：回顾性分析膝部外伤后６周内行ＭＲＩ检查的５８例连续性资料，骨挫伤与其他结构损伤诊断由两位骨关节放射专家一致认可，采用相关分析法确定二者有无关系。根据损伤机理，就其挫伤部位推断其他哪些结构可能出现损伤。并将２１例骨挫伤ＭＲＩ表现与退变对照比较。结果：骨挫伤与其他结构损伤有关系（ＯＲ＝５．１５），扭伤为骨挫伤最常见的原因，胫骨平台后外侧与股骨外髁中部骨挫伤多见，常伴有前交叉韧带及内侧副韧带撕裂，软骨、内侧半月板损伤及创伤性滑膜炎。其次为胫骨平台内侧与股骨内髁挫伤，多伴有外侧副韧带撕裂、软骨、内侧半月板损伤及创伤性滑膜炎。根据病变部位、形态及Ｔ２Ｗ信号特点等，结合临床可与膝关节退变鉴别。结论：根据骨挫伤的ＭＲＩ表现可引导发现相关隐匿性损伤，避免误诊与漏诊     

骨挫伤的MRI表现及意义

目的:探讨骨挫伤的MRI表现及意义。方法:回顾性分析两年内1 050名患者中的86例骨挫伤病例的MRI表现。结果:骨挫伤常伴有其他结构损伤,以股骨及胫骨外侧髁骨挫伤最多见,其次为股骨及胫骨内侧髁骨挫伤;常伴有前后交叉韧带、内外侧副韧带、内外侧半月板损伤及创伤性滑膜炎。结论:MRI对骨挫伤及其他结构损伤的发现有重要的临床意义。     

Partial and complete tear of the anterior cruciate ligament

PURPOSE: To analyze MR direct and indirect signs for knees with anterior cruciate ligament (ACL) partial or complete tear. MATERIAL AND METHODS: According to documented MR direct and indirect signs for ACL tear, we retrospectively reviewed the incidence of those signs in 15 partial ACL tear and 17 complete ACL tear patients. The findings were also compared with duration of injury (less or more than 6 weeks, as acute or chronic stages). RESULTS: A residual straight and tight ACL fiber in at least one pulse sequence was more frequently detected in partial ACL tears. The empty notch sign, a wavy contour of ACL, bone contusion at lateral compartment and lateral meniscus posterior horn tear were significantly more frequently seen in complete tear cases. The posterior cruciate ligament angle in chronic complete ACL tear cases (109 degrees +/-20 degrees ) had a tendency to be less than in chronic partial ACL tear cases (119+/-18 degrees ). CONCLUSION: The empty notch sign, a wavy ACL, bone contusion, and posterior horn of lateral meniscus tears are suggestive of a complete ACL tear. A residual straight and tight ACL fiber seen in at least one image section is a helpful sign to diagnosis of partial ACL tear. In the acute ACL injury stage, a focal increase of the ACL signal intensity is more suggestive of a partial ACL tear.     

Bone contusions of the posterior lip of the medial tibial plateau (contrecoup injury) and associated internal derangements of the knee at MR imaging.

PURPOSE: To determine if there are any predictable patterns of internal derangement associated with a bone contusion of the posterior lip of the medial tibial plateau at magnetic resonance (MR) imaging and to offer a biomechanical explanation for the findings. MATERIALS AND METHODS: A retrospective review of 215 consecutive MR examinations for knee trauma was conducted to identify contusions of the posterior lip of the medial tibial plateau. Any additional contusions and internal derangements were documented in the cases with these contusions. Medical charts and arthroscopic results, when available, were reviewed for mechanisms of injury. RESULTS: The specific medial tibial contusion was demonstrated in 25 of 215 (12%) knee MR examinations. Associated anterior cruciate ligament (ACL) tears were found in 25 of the 25 (100%) examinations. Injury to the meniscocapsular junction (14 of 25) or a peripheral tear of the posterior horn of the medial meniscus (10 of 25) occurred in a combined 96% of the cases. Lateral compartment contusions were noted in 24 (96%) cases. Pivot, twisting, or valgus forces were reported mechanisms of injury. CONCLUSION: Contusions involving the posterior lip of the medial tibial plateau may result from a contrecoup impaction injury directly following an ACL tear, as the knee reduces. These contusions are almost always associated with a far peripheral meniscal tear or with a meniscocapsular junction injury affecting the posterior horn of the medial meniscus.     

Anomalous insertion of the medial meniscus into the anterior cruciate ligament: the MR appearance

The aim of this study was to determine the characteristic MR findings of the anomalous insertion of the medial meniscus (AIMM) into the anterior cruciate ligament (ACL), and to document potential pitfalls in its interpretation. We reviewed 1326 consecutive knee arthroscopic studies to identify patients with an AIMM. 30 knees of 26 patients (4 females, 22 males; average age, 31.3 years; range, 14-50 years) were included in this study. We evaluated the presence of an AIMM and analysed the MR findings, including the ACL attachment sites of the AIMMs, the absence of the transverse ligament, meniscal tears and a discoid meniscus. AIMMs were detected by MR imaging in 16 knees of 18 patients (60%, 18/30). The AIMMs showed a linear band with low signal intensity on T2 weighted sagittal images running parallel to the ACL. The AIMMs were inserted into the lower portion of the ACL in eight knees, the middle portion in five knees, and the intercondylar notch in five knees. Meniscal tears (10 medial, 10 lateral) were found in 20 knees of 16 patients. Six knees of five patients showed a discoid meniscus. 15 knees of 14 patients showed no transverse ligament on MR imaging. An AIMM has the potential to be misinterpreted as a meniscal tear, ACL tear or infrapatellar plica on knee MR imaging. Familiarity with the characteristic MR findings can aid in the detection of an AIMM into the ACL.     

MR imaging of anterior cruciate ligament tears: is there a gender gap?

Objective Clinically, females receive anterior cruciate ligament (ACL) tears more commonly than males. We explored whether gender differences exist in MR imaging patterns of ACL tears.Design and patients At 1.5T, two observers evaluated MR examinations of 84 consecutive age-matched patients (42 males, 42 females, aged 16–39) with ACL tears, for mechanism of injury, extent and type of tear, the presence of secondary signs and associated osseous, meniscal and ligamentous injuries.Results The most common mechanism of injury for both females and males was the pivot shift mechanism (67 and 60%, respectively). Females were more commonly imaged in the acute stage of tear than males (98 and 67%, respectively, p=0.001) and more commonly possessed the typical posterolateral tibial bone contusion pattern (88 and 62%, respectively, p=0.0131). Males exhibited a deeper femoral notch sign (2.7 and 2.0 mm, p=0.007) and medial meniscal, lateral collateral ligament and posterior cruciate ligament injuries more commonly than females (48 and 24%, p=0.009, 30 and 7%, p=0.035, 17 and 0%, p=0.035). There was no significant difference between genders for the presence of other secondary signs and contusion patterns, associated lateral meniscal tears, presence of O'Donoghue's triad or associated medial collateral ligament injuries.Conclusion Gender differences in MR imaging patterns of ACL tears exist: females are more commonly imaged in the acute stage and more commonly possess posterolateral tibial bone contusions; males have a more severe presentation than females, associated with more severe lateral femoral condyle and soft tissue injuries.     

前交叉韧带撕裂的MRI诊断

目的:研究膝关节前交叉韧带撕裂的MRI表现。方法:回顾分析30例经关节镜证实的前交叉韧带撕裂MR图像及40例完好的ACL,分析其直接及间接征象的特征。结果:在评价的直接征象中,ACL不连续和ACL走行异常均具有相对高的诊断敏感性、特异性;在评价的间接征象中,后交叉韧带角、Blumensaat角、后交叉韧带指数、半月板后移征、“对吻性”骨挫伤、胫骨前移位等6个征象具有相对高的特异性,后交叉韧带角、Blumensaat角具有较高的敏感性。结论:ACL损伤的直接征象为诊断主要依据,ACL损伤的间接征象具有辅助诊断意义。     

Occult fracture patterns of the knee associated with anterior cruciate ligament tears: assessment with MR imaging.

One hundred consecutive magnetic resonance (MR) images of the knee in patients with acute complete anterior cruciate ligament (ACL) tears were reviewed to evaluate the prevalence and patterns of associated occult fractures. Eighty-nine occult fractures were identified in 56 knees. All occult fractures were in the posterior aspect of the lateral tibial plateau. Of these, occult fractures were isolated in 24 cases (43%) and were in combination with fractures in the middle aspect of the lateral femoral condyle in 26 (46%), with fractures in the posterior aspect of the medial tibial plateau in four (7%), and with fractures involving all three areas in one (2%). Disruption of the ACL under valgus stress leads to anterior translation of the tibia and relative external rotation of the femur. This allows impaction of the posterior portion of the lateral tibial plateau against the middle of the lateral femoral condyle and accounts for the unique pattern of occult fractures associated with ACL tears. An occult fracture of the posterior lateral tibial plateau with or without an associated fracture in the lateral femoral condyle ("kissing contusion") is a relatively frequent finding in acute ACL tears and, when present, is highly suggestive of such an associated tear.     

MR evaluation of the "arcuate" sign of posterolateral knee instability

OBJECTIVE: The purpose of this study was to evaluate associated knee injuries using MR imaging in patients with the "arcuate" sign, a term referring to avulsion fracture of the proximal fibula on conventional radiographs. MATERIAL AND METHODS: MR imaging of 18 cases (17 patients, both knees in one patient) with the arcuate sign on conventional radiographs was retrospectively interpreted to evaluate the associated meniscal, ligamentous, and bony injuries. In 12 cases, MR findings were correlated with surgical results. RESULTS: In all cases, avulsed bony fragments from the proximal pole of the fibula were attached to the fibular collateral ligament, the biceps femoris tendon, or both. Tear of the posterolateral capsule was seen in 12 cases (67%). Injury of the cruciate ligaments was noted in 16 cases (89%): injury to both the anterior cruciate ligament and posterior cruciate ligament was seen in nine cases (50%), injury to only the anterior cruciate ligament was seen in four, and injury to the posterior cruciate ligament only was noted in three. Bone bruises or gross fractures were seen in all cases: bone bruises on the anteromedial femoral condyle were noted in nine cases (50%) and were seen on the anteromedial tibial condyle in five cases (28%). Tear of the medial meniscus was seen in five cases (28%) and tear of the lateral meniscus in four cases (22%). Injury to the popliteus was seen in six cases (33%). Joint effusion was associated in all cases. CONCLUSION: MR imaging is useful for evaluation of associated soft-tissue injuries in patients with the arcuate sign on conventional radiographs. Avulsion injury to the proximal fibula is an important indicator of the internal derangement of the knee and for predicting the mechanism of an injury with varus stress. Cruciate ligament tear and bone bruises on the anteromedial condyle of the femur and tibia are common associated findings.     

急性前交叉韧带断裂合并膝关节骨挫伤的临床研究

目的 :总结前交叉韧带急性断裂时骨挫伤的不同类型和分布 ,探讨骨挫伤与关节软骨损伤的关系。方法 :回顾性研究 37例前交叉韧带急性断裂合并膝关节骨挫伤患者的影像学和临床资料 ,分析前交叉韧带急性断裂时骨挫伤的MRI不同表现类型、分布以及关节镜下软骨损伤的情况。结果 :MRI显示本组病例骨挫伤共 5 7处 ,其中Ⅰ型 1 4处 (2 4 .6 %) ,Ⅱ型 32处 (5 6 .1 %) ,Ⅲ型 3处(5 .3%) ,Ⅳ型 6处 (1 0 .5 %) ,Ⅴ型 2处 (3.5 %)。共 5 4处 (94 .7%)骨挫伤位于外侧间室 ,其中股骨外髁骨挫伤 31处 ,胫骨外侧平台骨挫伤 2 3处。经关节镜下手术发现 9处 (1 5 .8%)骨挫伤部位有软骨损伤表现。结论 :急性前交叉韧带断裂时 ,骨挫伤通常发生在外侧间室 ,尤其集中在外侧股骨髁前部以及外侧胫骨平台后部。关节镜下软骨损伤与骨挫伤并非一一对应的关系。