膝关节骨性关节炎的MRI诊断进展

MRI 能够在三维上评估软骨的形态和成分,这对发现膝关节骨性关节炎（OA）的自然病程至关重要。形态学分析可以是半定量或定量分析。随着MRI技术的不断发展,成分分析如软骨的延迟增强MRI成像、T2map、钠谱和自旋锁定成像技术（T1ρ）已经日趋成熟,可以定量的评估组织的微观结构并且能够先于形态学检测软骨的变化。成分分析有助于膝关节OA的早期检出、更好地指导临床进行早期干预,延缓OA的病程发展以及挺高患者的生存质量。     

Physical functions associated with health-related quality of life in older adults diagnosed with knee osteoarthritis

[Purpose] The present study aimed to identify the physical functions associated with health-related quality of life in older adults with knee osteoarthritis. [Participants and Methods] A total of 132 participants were included in this study in two groups: the knee osteoarthritis group (n=66) and the control group (n=66). We compared the results of the Medical Outcomes Study 36-Item Short-Form Health Survey with the physical function measures related to health-related quality of life. In the knee osteoarthritis group, we examined the relationship between the degree of knee pain and health-related quality of life. [Results] The knee osteoarthritis group showed a significantly shorter one-leg standing time, lower maximum walking speed, and significantly longer time to complete the Sit-to-Stand-5 and Timed Up and Go tests than the control group. The knee osteoarthritis group had significantly lower 36-Item Short-Form Health Survey scores than the control group on seven subscales and significantly lower scores for physical component summary and role or social component summary. In the knee osteoarthritis group, physical component summary and role or social component summary were correlated with Sit-to-Stand-5, Timed Up and Go, and maximum walking speed. We observed a correlation between physical component summary and knee pain on joint loading. [Conclusion] In older adults with knee osteoarthritis, rehabilitation approaches aimed at achieving a smooth transition from sitting to standing may increase social participation and improve health-related quality of life.     

等速离心肌力训练治疗膝关节骨关节炎的研究

运动Ｃｙｂｅｘ－６０００型等还肌力测试和训练系统对２０例膝关节骨关节炎患者进行 量等速离心肌力训练，观察训练对患膝肌力、疼痛及下肢功能的影响。结果表明：经过４周的训练，患膝 伸肌群各项测试指标均有不同程度提高，疼痛明显缓解，下肢功能显著改善。说明亚极量等速离心训练对膝关节骨关节炎２的近期疗效是明显的。     

Muscle mass and composition of the hip, thigh and abdominal muscles in women with and without hip osteoarthritis

The objective of this study was to compare muscle mass and composition between individuals with and without hip osteoarthritis. Twenty-four women with hip osteoarthritis (OA group) and 16 healthy women (healthy group) participated in this study. Muscle thickness (MT) and echo intensity (EI) were measured as indices of muscle mass and composition, respectively, using ultrasound imaging. Seven muscles were examined: gluteus maximus, gluteus medius, quadriceps femoris, rectus abdominis, external oblique, internal oblique and transversus abdominis. MT of only quadriceps femoris in the OA group was significantly thinner than that in the healthy group. EIs of gluteus medius, quadriceps femoris and rectus abdominis were significantly higher in the OA group than those in the healthy group. Thus, actual contractile tissue of gluteus medius and rectus abdominis substantially decreased, although muscle mass was similar, whereas both quantitative and qualitative changes occurred in quadriceps femoris in patients with hip OA.     

MRI评估膝关节骨性关节炎病变

膝关节骨性关节炎（OA）是以软骨病变、半月板损伤、骨髓病变、滑膜炎、骨赘及韧带损伤等为主要病理特征的退行性关节病。MRI可清晰显示关节软骨及半月板等软组织，直观了解膝关节解剖结构或病变类型，根据OA进展及病理类型选择特异度及敏感度较高的方法，可于膝关节软组织及周围组织发生形态学变化前早期诊断OA。本研究对MRI评估膝关节OA病变中的应用进展进行综述。     

Effect of magnetic knee wrap on quadriceps strength in patients with symptomatic knee osteoarthritis

Chen C-Y, Chen C-L, Hsu SC-C, Chou S-W, Wang K-C. Effect of magnetic knee wrap on quadriceps strength in patients with symptomatic knee osteoarthritis.

Objective

To determine the effects of magnetic knee wrap on isokinetic quadriceps strength in patients with painful knee osteoarthritis (OA).

Design

Randomized, double-blinded, placebo-controlled and before-after trial.

Setting

Rehabilitation clinic in a tertiary hospital.

Participants

Eligible patients (N=50) (mean age ± SD, 66.0±8.6y) with mild to moderate knee OA were recruited from the outpatient department and 37 (74%) completed the trial. Only 3 (6%) withdrew due to study-related adverse effects.

Interventions

Wearing the active (n=24) or sham (n=26) magnetic knee wrap for 12 weeks.

Main Outcome Measures

The primary outcome measure was isokinetic quadriceps strength. Secondary outcome measures included the Health Assessment Questionnaire Disability Index (HAQ-DI) and the Health Assessment Questionnaire (HAQ) Pain Scale.

Results

Using intention-to-treat analyses, the peak isokinetic quadriceps strength increased significantly in the treated leg at 30°/s (P=.007) and 60°/s (P=.022) after wearing the magnetic knee wrap. Compared with baseline, the median strength increase for the treated leg in the study group significantly exceeded that in the control group at week 4 (.05Nm/kg vs −.09Nm/kg at 60°/s, P=.038) and week 12 (30°/s, .09Nm/kg vs .04Nm/kg, P=.044; 60°/s, .17Nm/kg vs .02Nm/kg, P=.031). The HAQ-DI and HAQ Pain Scales improved significantly in both groups. Compared with baseline, the improvement at week 12 in terms of the HAQ-DI in the study group significantly exceeded that in the control group.

Conclusions

Magnetic knee wrap may significantly facilitate isokinetic quadriceps strength in patients with mild to moderate knee OA.     

MRI误诊膝关节腔内凝血块为游离体1例

患者男,34岁,无明显诱因出现右膝关节疼痛4天;查体发现右膝关节肿胀,浮髌实验阳性,诊断为关节腔积液,行关节腔穿刺,抽出血性液体约80ml。MRI示关节腔内髌骨水平内侧卵圆形异常信号,边界清晰,约2.0cm×1.0cm×0.7cm,T1WI呈稍低信号(图1A),T2WI呈等、高混杂信号(图1B),周围可见关节腔积液,考虑为游离体。1周后行手术治疗,于右膝关节髌骨水平外侧切口打开关节腔,未     

中国女子柔道运动员膝关节损伤:3.0T MR影像分析

目的 通过分析中国女子柔道运动员膝关节损伤的3.0T MR影像学改变,探讨优秀女子柔道运动员膝关节损伤特征.方法 本研究收集10例女子柔道运动员膝关节损伤的病例,平均年龄22岁,平均接受柔道训练8年.全部病例均行3T MR膝关节检查,应用膝关节专用线圈,行斜矢状位T1WI,T2WI,质子密度抑脂序列,和横断面、冠状面T2wI序列扫描,回顾性分析膝关节损伤情况.结果 ①半月板损伤8例(8/10)内侧半月板后角Ⅲ度损伤,8例(8/10)外侧半月板前角Ⅲ度损伤,5例(5/10)外侧半月板后角Ⅲ度损伤;②韧带损伤2例(2/10)前交叉韧带断裂,7例(7/10)内侧副韧带Ⅱ度损伤,2例(2/10)内侧副韧带Ⅲ度断裂损伤;3例(3/10)外侧副韧带断裂,3例(3/10)胭肌腱断裂;1例(1/10)髌韧带断裂,3例髌腱炎(3/10);③软骨损伤8例(8/10)髌骨软骨Ⅲ度损伤,1例(1/10)髌骨软骨Ⅳ度损伤;④骨质改变3例(3/10)骨折分别位于髌骨上极、胫骨平台塌陷骨折、胫骨前交义韧带止点骨折,4例(4/10)骨挫伤;⑤关节积液10例(10/10)均表现为关节囊内的长T1长T2信号影,其中1例(1/10)患者为关节积血.结论 3.0T MRI能够最佳地显示女子柔道运动员膝关节多发运动损伤、急慢性损伤,十分有益于指导柔道运动员膝关节功能保护和损伤康复、治疗.     

Neck muscles cross-sectional area in adolescents with and without headache – MRI study

Background: Cervical musculature may play an important role in the genesis of tension‐type headache. However, there are no reports on a possible association between the morphometrical features of the neck flexion and extension muscles and adolescence headache. Aim: To examine differences in neck flexion and extension muscles cross‐sectional area (CSA) in adolescents with and without headache. Methods: A population‐based sample of 17‐year‐old adolescents with migraine (N=19), tension‐type headache (N=24) and healthy controls without headache (N=22) was examined. CSA of the neck muscles was measured from axial T1‐weighted magnetic resonance images (MRI). Results: Boys with tension‐type headache showed significantly smaller CSA of right sternocleidomastoid muscle than boys with migraine and girls with tension‐type headache showed significantly smaller CSA of combined right sternocleidomastoid and scalenus muscles than girls with migraine. In addition, boys with migraine had significantly larger CSA of both right sternocleidomastoid and combined right sternocleidomastoid and scalenus muscles, and left semispinalis capitis muscle and combined left semispinalis and splenius muscles than boys without headache. In boys and girls no other significant differences were observed in the CSA of neck flexion or extension muscles. Conclusions: This preliminary work demonstrates that both girls and boys with tension‐type headache and migraine have differences in the size of neck flexion muscles, especially unilaterally. In boys, unilaterally increased size of neck flexion and extension muscles is associated with migraine. These findings, if confirmed in further studies, may have important diagnostic and therapeutic implications for rehabilitation of adolescents with headache.     

肌骨超声及MRI对膝关节退行性骨关节炎的诊断价值

目的  评估肌骨超声及MRI对膝关节退行性骨关节炎（KOA）的诊断价值。方法  选择2017年1月~2019年12月在我院接受治疗并全部接受关节镜检查的单侧KOA患者126例为研究对象。对所有纳入研究的患者行超声检查、MRI检查及关节镜检查,对肌骨超声图像及MRI图像行质量评价。以关节镜检查结果为金标准,分别评估超声、MRI检查对关节积液、滑膜增生、髌上囊积液、关节软骨损害、骨质增生、半月板损伤、韧带损伤等病变的诊断价值。结果  126例患者成功接受肌骨超声、MRI及关节镜检查。以关节镜结果为金标准,超声检查及MRI检查在KOA患者滑膜增生、髌上囊积液、半月板损害、韧带损伤、肌腱断裂及腘窝囊肿的检出中与关节镜结果一致性好（超声Kappa值：0.81、0.85、0.79、0.79、1.00、1.00,MRI Kappa值：0.76、0.93、0.86、0.89、1.00、1.00,Kappa值均 > 0.75）;在KOA滑膜增生和骨质增生的诊断中,超声检查的诊断效能好于MRI检查（AUC=0.978、0.972,P < 0.05）;在关节积液、髌上囊积液、关节软骨损害、韧带损伤的诊断中,MRI检查的诊断效能好于超声检查（AUC=0.991、0.995、0.969、0.961,P < 0.05）;在韧带损伤的诊断中,超声检查与MRI检查的诊断效能差异无统计学意义（P > 0.05）;126例患者中,超声检查认为有57例患者存在关节间隙狭窄,平均关节间隙为3.54±0.53 mm,MRI检查认为有52例患者存在关节间隙狭窄,平均关节间隙为3.62±0.61 mm,两者测量差值无统计学意义（P > 0.05）。结论  肌骨超声及MRI检查能较好的识别膝关节退行性骨关节炎病变特征,具有较高的临床运用价值。     

Living experiences of middle-aged adults with early knee osteoarthritis in prediagnostic phase

Purpose: The aim of this study was to understand the living experiences of middle-aged Taiwanese adults with early knee osteoarthritis (OA). Methods: A qualitative research design was used in this study. Participants (n?=?17) were recruited by purposive sampling from orthopedic clinics at two medical centers in northern Taiwan. Data were collected through in-depth interviews from July to December 2010. The data were transcribed verbatim and summarized by content analysis. Results: The results indicated that the lived experiences could be grouped into 4 main themes: awareness; surmise of causes; acquisition of strategies; and the search for confirmative diagnosis. Conclusions: This study found that patients’ knowledge is insufficient for recognition of the presence of early OA. There is a need for clinicians to integrate knowledge of OA into the health education system and to develop interventions for early knee osteoarthritic patients. Patients’ disease cognition must be promoted so that their ability to process early symptoms of this disease will improve.

Implications for Rehabilitation

• Awareness, surmise of causes, and acquisition of strategies are repetitive circles. Patients pursue the true cause for their knee joint disease and seek confirmative diagnosis when the symptoms do not improve or when they became worse.

• The information patients have is insufficient to know the presence of degenerative osteoarthritis disease.

• There is a need for clinical practitioners to integrate knowledge of osteoarthritis into the health education system to increase awareness and to develop appropriate interventions for patients with early knee OA.

     

正常成年人膝关节的MR测量及其成像

目的通过对正常成年人膝关节MRI的半月板及韧带的测量,为膝关节损伤性疾病的诊断提供参考值.方法 53例正常对照组成人膝关节MRI检查资料,选择矢状位及冠状位PDWI成像序列,分别测量正常成年人半月板、前、后交叉韧带、内、外侧副韧带、胫骨平台的有关数据,并与解剖文献的大体测量结果进行比较.其中13例同时做了矢状位及冠状位的T2WI及PDWI压脂序列扫描,分析、比较压脂序列对显示半月板及韧带的优势.结果半月板的MR测量值较大体解剖测量值大,外侧半月板后角较半月板的其余部分厚.内侧半月板体部横径与胫骨平台宽径及体重呈线性相关.前交叉韧带与Blumensaat线的夹角小于15°,后交叉韧带的角度约为(120.89±5.63)°.结论膝关节的MR测量值较大体解剖测量值更能反映活体的真实情况,为临床膝关节损伤性疾病的诊断提供正常参考值,外侧半月板后角较前角及内侧半月板厚;内侧半月板体部横径与胫骨平台宽径及体重间可建立多元线性回归方程,体重对内侧半月板体部横径的作用稍大于胫骨平台的作用;MR特别是T2WI及PDWI压脂序列对显示膝关节结构具有较高的价值.     

GE1.5T430s MR频率饱和法与水脂分离法膝关节抑制脂肪图像比较分析

目的：传统抑脂方式都存在着各自的局限性,图像质量整体受限,本研究通过比较分析频率选择脂肪预饱和（Fat Saturation,Fatsat）法和水脂分离（Smartfat）法两种脂肪抑制序列在GE 1.5T optima 430 s关节磁共振上抑脂效果的成像质量、检查时间,以获得最佳的脂肪抑制序列图像.材料与方法：本研究应用GE l.5T 430s MR完成30个健康志愿者（男15,女15）膝关节脂肪抑制序列的检查.将同一患者分别用Fatsat法和Smartfat法扫描,即Fatsat T1WI、Fatsat T2WI、Fatsat PD和SmartfatT1WI、Smartfat T2WI、Smartfat PD,由2位经验丰富的影像科医生分别对两种脂肪抑制图像上的韧带、软骨、肌肉、半月板和图像均匀性的显示进行评价（将清晰列为3分,欠清晰为2分,模糊为1分）.采用t检验比较分析两种抑脂方法的抑脂效果图像质量、检查时间.采用Kappa检验评价2位阅片者间的诊断一致性.结果：30例志愿者两种检查方法均成功.Fatsat T1WI为（7.5±0.98）分,Smartfat T1WI为（12.2±1.51）分,Fatsat T2WI为（8.4±0.43）分,Smartfat T2WI为（15.1±0.75）分,Fatsat PD为（8.7±0.21）分,Smartfat PD为（12.3±0.81）分,差异有统计学意义.2位阅片者间的诊断一致性很好（Kappa值＞0.75）.结论：Smartfat法抑脂效果图像质量要大幅度优于Fatsat法,且检查时间相对较短.     

低场磁共振对膝关节骨挫伤的诊断价值

目的探讨低场MRI对膝关节骨挫伤的诊断价值。方法对64例膝关节骨挫伤的MRI影像学表现进行回顾性分析。结果本组64例，MRI检查在T1WI呈不规则斑片状、地图状及长条状低信号；T2WI呈不规则高信号。结论低场MRI能清楚的显示膝关节骨挫伤的病变特点及严重程度，MRI检查是诊断骨挫伤的首选方法。     

膝部隐性骨折的MRI诊断(35例报告)

目的 探讨膝部隐性骨折的MRI表现，评价MRI检查的诊断价值。方法 35例膝部外伤病例在外伤后7天内行MRI检查，检查序列包括T1WI、T2WI与T2^*WI。结果 35例共49处膝部隐性骨折。FSE T2WI与FE T2^*WI序列对病变检出率较高，分别为100％及93．88％。隐性骨折以胫骨上端与股骨下端最多见。21例合并膝部韧带损伤。12例有膝部损伤其他征象。结论 MRI能敏感显示膝部隐性骨折及合并的其他表现，对于疑为膝部隐性骨折的病例应列为首选检查。     

Volume and mobility of the infrapatellar fat pad during quasi-static knee extension after manual therapy in patients with knee osteoarthritis: a randomized control trial study

[Purpose] This study aimed to determine whether the volume and mobility of the infrapatellar fat pad (IPFP) change as a result of manual release or stretching during quasi-static knee extension in patients with knee osteoarthritis (KOA). [Participants and Methods] Fourteen patients with KOA were allocated to one of two groups: the manual release (R) and stretching (S, control) groups. They all underwent 12 treatment sessions in in a space of four weeks. We created 3D models of the IPFP, tibia, patella, and patellar tendon using sagittal MRI scans with the knee at 30° or 0°. We compared the differences in (1) the distance of anterior movement of the anterior surface of the IPFP (IPFP movement) and (2) the volume of the IPFP, between the R and S groups, using the 3D models. [Results] Neither group showed any anterior movement of the IPFP during quasi-static knee extension at pre-intervention; however, both groups showed significant anterior movement of the IPFP at post-intervention. IPFP movement decreased in the S group, meanwhile it increased in the R group at post-intervention. [Conclusion] Anterior movement of the IPFP was more increased by manual release than by stretching since the latter may have shortened the distance between the patella and tibial tuberosity at 0° and 30° flexion.     

MR在诊断膝关节周围骨隐匿性损伤中的价值

目的评价膝关节周围骨质隐匿性损伤MRI诊断价值。方法31例外伤患者共33个膝关节均行X线平片检查及MR快速自旋回波(FSE)T1WI、FSET2WI、快速梯度回波(FFE)T2WI、频率选择及反转脉冲抑脂序列(SPIR)T2WI、SPIRPDWI以及三维水激励快速梯度回波T1WI软骨成像(3D/WATSc/FFE/T1WI)序列扫描。结果31例患者中33个膝关节周围骨均发现异常,其中骨挫伤20例,隐匿性骨折8例,关节软骨或骨软骨骨折5例。T2W/SPIR对骨挫伤显示清楚,呈大片状高信号;PDW/SPIR能清晰显示隐匿性骨折线,呈锐利的细线状、条带状高信号;3D/WATSc/FFE/T1WI显示软骨骨折最佳。结论MRI能准确显示并诊断外伤后膝关节周围骨隐匿性病灶,不同的扫描序列对不同类型的隐匿性病灶显示各有优势,应结合使用。     

低场磁共振诊断膝关节骨挫伤的价值(附45例分析)

目的探讨低场MRI对膝关节骨挫伤的诊断价值。方法对45例膝关节骨挫伤的MRI表现进行回顾性分析。结果本组45例X线平片均未见异常,MRI检查45例T1WI呈低信号,T2WI呈高信号,在STIR上病灶与正常骨组织的对比度更高,MRI能有效显示不同部位骨挫伤的病变部位、范围及形态。结论低场MRI能清楚的显示膝关节骨挫伤的病变特点及严重程度,MRI是检查本病的最佳方法,临床工作中注意骨挫伤的存在,将为及时的诊治提供有益的帮助。     

重建前交叉韧带移植物生长的MR信号改变初步研究

目的探讨术后生长良好的重建前交叉韧带(ACL)移植物MR信号改变过程。方法选取48例ACL重建患者,Lysholm平均积分由术前54分升至术后83.5分,总结其术后4～22个月重建ACL移植物的MR信号改变。扫描序列包括SE T_1WI、GE T_2WI和STIR序列。结果 4～9个月内大部分重建ACL信号增高,术后12～22个月大部分重建ACL信号降低,与正常韧带相仿。结论生长良好的重建ACL移植物,术后MR信号呈现由高到低的变化过程,1年后信号与正常韧带相仿。