超声评估膝关节软骨退行性变的应用价值

目的：采用高频超声探查拟行关节镜手术及关节置换术的膝关节，评估超声对软骨退行性变的诊断效能。方法：选择2004-02／08在中山大学第三附属医院行膝关节镜手术患者36例37个膝关节及关节置换术患者4例4个膝关节。男13例，女27例，年龄8-75岁，病程1个月～20年。分别对每个膝关节的5个关节面，共计205个关节面的软骨进行高频超声探查，并将超声表现与关节镜结果及手术切除标本对照。结果：40例41个膝关节，均进入结果分析。超声诊断膝关节软骨退行性变的敏感性、特异性、准确性分别为64．9％，92．0％，76．5％。膝关节软骨退行性变超声表现为软骨表面毛糙、变薄或消失、局部隆起，回声改变和软骨下骨质改变等征象。结论：超声评估膝关节软骨退行性变具有一定的敏感性和较高的特异性．可作为诊断膝关节软骨退行性变的重要筛查手段。     

超声评估膝关节软骨退行性变的应用价值

目的:采用高频超声探查拟行关节镜手术及关节置换术的膝关节,评估超声对软骨退行性变的诊断效能。方法:选择2004-02/08在中山大学第三附属医院行膝关节镜手术患者36例37个膝关节及关节置换术患者4例4个膝关节。男13例,女27例,年龄8～75岁,病程1个月～20年。分别对每个膝关节的5个关节面,共计205个关节面的软骨进行高频超声探查,并将超声表现与关节镜结果及手术切除标本对照。结果:40例41个膝关节,均进入结果分析。超声诊断膝关节软骨退行性变的敏感性、特异性、准确性分别为64.9%,92.0%,76.5%。膝关节软骨退行性变超声表现为软骨表面毛糙、变薄或消失、局部隆起,回声改变和软骨下骨质改变等征象。结论:超声评估膝关节软骨退行性变具有一定的敏感性和较高的特异性,可作为诊断膝关节软骨退行性变的重要筛查手段。     

软骨延迟增强磁共振成像诊断膝关节软骨早期退行性变

目的 探讨dGEMRIC用于诊断膝关节软骨早期退变的可行性和价值.方法 OA组30例退变膝关节患者经肘静脉注射马根维显后步行10 min使对比剂尽量弥散至关节软骨内,注射后2 h接受dGEMRIC扫描;对照组27个正常膝关节.于T1时间图中选取感兴趣区(ROI)测量T1值,对照组同时测量软骨浅深层的T1值.对照组与OA组、对照组浅层与深层的T1值行独立样本t检验.结果 OA组的T1值为(359.10±41.64)ms,对照组为(426.42±39.81)ms,差异有统计学意义 (t=-6.223, P<0.05);对照组髌骨软骨浅层T1值为(411.39±41.50)ms,深层为(468.40±45.05)ms,差异有统计学意义 (t=-4.838, P<0.05).另于OA组5例患者的软骨T1时间图中发现低信号区.结论 dGEMRIC通过定量分析关节软骨中GAG含量的变化来判断关节软骨是否有组织成分的丢失,是可用于诊断关节软骨早期退变的有潜力的方法 .     

超声、MRI评价不同分期膝关节软骨退行性变的比较

目的比较超声、MRI评价不同分期膝关节软骨退行性变与手术分期的相关性。方法选择40例患者41个拟行关节镜手术或关节置换术的膝关节,术前采用超声观察股骨内髁、股骨外髁、股骨滑车正中沟、滑车内侧斜面和滑车外侧斜面,共计205个关节面。其中11个膝关节接受了MRI检查。评价2种影像学手段判断膝关节软骨退变的分期与手术分期的相关性。结果超声、MRI评判软骨退变的分期与手术分期的相关系数分别为0.703（P〈0.05）、0.778（P〈0.05）。结论超声、MRI评判膝关节软骨退变的分期与手术分期均有较好的相关性,能反映出病变的严重程度,有助于估计病情、指导治疗。     

膝关节软骨的MR应用研究进展

膝关节软骨在维持正常关节活动中起着重要作用,但它的耐受力较弱,年龄的增长、外伤及各种关节疾患均可导致软骨发生病理改变。X线、CT检查均不能显示软骨的外形和轮廓,亦不能显示软骨内部的病理改变,只能通过膝关节间隙的变窄、关节周围骨质增生等间接征象,     

X线平片与MR影像诊断膝关节退行性骨关节病的价值分析

目的:探讨X线平片与MR影像诊断膝关节退行性骨关节病的价值分析。方法:在本研究中,我们筛选本人所在医院从2018年1月至2020年12月期间医治的88例患有膝关节退行性骨关节病的患者作为研究对象。所有患者都接受了X线平片和MR影像的诊断,其中以关节镜检查结果为最可靠的评判标准。我们将比较这两种诊断方式的准确性。结果:对关节面不平整、间隙狭窄、软骨下囊变、骨赘等诊断的准确率进行比较,结果显示没有显著差异(P>0.05);对关节软骨的变化、软组织的肿胀以及关节内的积液情况、半月板变性等诊断的准确率,X线平片比MR影像低(P<0.05);敏感性、特异性、准确性X线平片诊断均比MR影像诊断低(P<0.05)。结论:X线平片与MR影像诊断膝关节退行性骨关节病,MR影像诊断结果更为准确,适用于早期膝关节退行性骨关节病的诊断,效果更理想,值得广泛推广。     

T_(1p) MRI对膝关节软骨退行性变的临床应用价值

目的探讨T1p对膝关节软骨退行性变的临床应用价值。方法 20例OA患者的患侧膝关节行T1p、T2 mapping序列扫描,以T2 mapping序列作为对比,测量髌骨、股骨软骨的T1p、T2值,与20例正常组比较;同时计算各部分软骨的T1p、T2值Z-score的置信区间、Z-score的相关性(Pearson相关)及了解其分布情况。结果 OA组髌骨、股骨软骨T1P值分别为(50.01±4.23)ms、(53.80±4.38)ms,较正常组(45.12±0.92)ma、(45.42±0.84)ms高,两组间比较差异有统计学意义(t=5.077,P0.001;t=8.446,P0.001)。OA组与正常组软骨的T_1 p、T_2值之间具有相关性[OA组相关系数为0.548±0.170,置信区问为(0.396,0.812),正常组相关系数为(0.455±0.163),置信区间为(0.246,0.789)]。结论 OA患者中关节软骨T1p值升高,且T1p与T2值两者的变化具有一定的相关性。T1p与T2 mapping能互补的诊断关节软骨早期退变,两技术可作为临床诊断的检查方法。     

T1ρMRI对膝关节软骨退行性变的临床应用价值

目的：探讨T1ρ对膝关节软骨退行性变的临床应用价值。方法20例OA患者的患侧膝关节行T1ρ、T2 mapping序列扫描,以T2 mapping序列作为对比,测量髌骨、股骨软骨的T1ρ、T2值,与20例正常组比较;同时计算各部分软骨的T1ρ、T2值Z-score 的置信区间、Z-score的相关性（Pearson相关）及了解其分布情况。结果 OA组髌骨、股骨软骨T1ρ值分别为（50.01±4.23）ms、（53.80±4.38）ms,较正常组（45.12±0.92）ms、（45.42±0.84）ms高,两组间比较差异有统计学意义（t＝5.077,P＜0.001;t＝8.446,P＜0.001）。OA组与正常组软骨的T1ρ、T2值之间具有相关性[OA组相关系数为0.548±0.170,置信区间为（0.396,0.812）,正常组相关系数为（0.455±0.163）,置信区间为（0.246,0.789）]。结论 OA患者中关节软骨T1ρ值升高,且T1ρ与T2值两者的变化具有一定的相关性。T1ρ与T2 mapping能互补的诊断关节软骨早期退变,两技术可作为临床诊断的检查方法。     

X线平片和MR检查在膝关节外伤诊断中的应用价值

目的分析膝关节损伤的X线平片和MR表现并评价其应用价值。方法对26例膝关节外伤患者分别行X线平片和MR检查,分析比较其表现。结果本组26例,MR显示7例隐性骨折;10例骨髓水肿;13例半月板损伤;18例韧带损伤;21例关节腔积液。X线诊断骨折19例,其余7例未见明显异常。结论MR对膝关节损伤的诊断具有重要的临床意义,可为制定正确的治疗方案提供客观而详细的依据。     

膝关节软骨MR成像序列对比研究

目的：通过20名青年志愿者膝关节MRI检查来探讨显示膝关节软骨的最佳序列。方法：利用3D-FS-SPGR、FS-GRE、FS-FSE序列测量软骨、软骨下骨、肌肉及滑液的信噪比（SNR）、信噪比效率,并测量软骨与其他组织的对比噪声比（CNR）。结果：①SNR：除滑液在3D-FS-SPGR序列与FS-GRE序列间无统计学差异外,其他组织在三种序列间存在统计学差异。3D-FS-SPGR序列软骨SNR最高。②信噪比效率：除肌肉在3D-FS-SPGR序列与FS-GRE序列间无统计学差异外,其他组织在三种序列间存在统计学差异。软骨下骨在FS-FSE序列上SNR效率最低,在FS-GRE序列上SNR效率最高。③对比噪声比：除软骨/肌肉在3D-FS-SPGR序列与FS-FSE序列间无统计学差异外,其他组织间对比噪声比在三种序列间存在统计学差异。软骨与周围组织的CNR最高。结论：3D-FS-SPGR序列是显示关节软骨的最佳序列。     

超声诊断膝关节软骨退行性变的影响因素分析

目的 分析超声诊断膝关节软骨退行性变(退变)的一些影响因素.方法 选择行膝关节镜手术患者36例37个膝关节及关节置换术患者4例4个膝关节,共41个膝关节.术前1周行超声检查,超声诊断结果与关节镜或大体标本肉眼所见结果对比.对超声误诊、漏诊病例进行回顾性分析.结果 本组234处病灶,超声诊断真阳性病灶87处,假阳性病灶8处,假阴性病灶47处,真阴性病灶92处,诊断敏感性、特异性、准确性分别为64.9%、92.0%、76.5%.超声对软骨退变的分期与关节镜分期相关(r=0.703,P<0.01),但有59处病灶(59/234,25.2%)两者分期不符.影响超声诊断准确性的因素主要包括(1)病变部位,(2)病变程度,(3)临床治疗过程,(4)一些与超声成像原理有关的一般性影响因素.结论 超声检测膝关节软骨退变操作较复杂,影响因素也多.正确认识这些因素,有助于更好地理解声像图,避免漏诊误诊.     

3.0T 三维扰相梯度回波序列对膝关节软骨损伤的诊断价值

【目的】通过对比膝关节常规 MRI 序列,探讨三维扰相梯度回波序列(3D-FSPGR)对膝关节软骨损伤的诊断价值。【方法】对本院收治45例膝关节疼痛患者分别应用3.0T 3D-FSPGR 序列和常规2D 序列成像进行扫描。对不同序列图像分析,并以膝关节镜检查结果为“金标准”,比较3D-FSPGR 序列和常规2D 序列在诊断膝关节软骨损伤的敏感度、特异度和准确度。【结果】45例患者,共65侧膝关节,总共分析260个部分的软骨,关节镜结果显示0级的57个,1~4级的203个,3D-FSPGR 序列诊断的敏感性、特异性及准确性均显著高于2D 常规序列诊断,差异具有统计学意义(P <0.05)。【结论】3D-FSPGR 序列在诊断膝关节软骨损伤上要优于常规2D 序列,具有较高的临床应用价值。     

磁共振T1WI加脂肪抑制扫描序列在膝关节半月板及关节软骨成像中的应用价值

目的 探讨T1WI加脂肪抑制序列在显示半月板及关节软骨的价值。方法 50例膝关节MRI检查的患者行矢状位T1WI常规自旋回波序列；质子密度加权快速自旋回波序列；T2加权梯度回波序列和SET1WI加脂肪抑制序列。分别将SET1WI加脂肪抑制序列与其他三种序列的影像进行比较。结果 矢状位T1加脂肪抑制序列清晰显示半月板结构达84％，其他三种序列仅为0.24％和30％；T1加脂肪抑制序列清晰显示关节软骨结构达94％，另三种序列为30％，16％，50％。结论 T1WI加脂肪抑制序列在半月板及关节软骨结构方面比其他三种序列更清晰，可作为膝关节检查的常规序列。     

超声评价不同分期的膝关节软骨退行性变

目的探讨超声诊断膝关节软骨退行性变分期的临床价值。方法超声探查40例患者的41个拟行关节镜手术或关节置换术膝关节，均观察其股骨内髁、股骨外髁、股骨滑车正中沟、滑车内侧斜面和滑车外侧斜面，共计205个关节面。超声结果与手术所见对照。结果超声诊断膝关节软骨退行性变（退变）的敏感性、特异性、准确性分别为64．9％、92．0％、76．5％。但对Ⅰ、Ⅱ期的诊断敏感性（46．7％）远远低于Ⅲ、Ⅳ期（75．7％）。结论超声评价膝关节软骨退变具有一定的敏感性和较高的特异性，可作为诊断该病的重要筛查手段。     

不同MR扫描序列对髌股关节软骨病变的评价

目的　评价SE序列、FSE序列、二维SPGR序列及三维脂肪抑制SPGR序列对髌股关节软骨病变的诊断价值。方法　 5例尸体膝关节 ,关节腔内注射 40ml生理盐水。所有髌股关节均作常规自旋回波 (SE)序列T1WI、快速自旋回波(FSE)序列T2 WI和PDWI、二维毁损梯度回波 (2DSPGR)序列以及三维脂肪抑制毁损梯度回波 (3DFS SPGR)序列轴位扫描。计算每种序列诊断髌股关节软骨病变的敏感性、特异性和总符合率。结果　在 3DFS SPGR序列正常髌股关节软骨表现为三层结构 ,其诊断髌股关节软骨病变的敏感性、特异性和总符合率分别为 92 %、86%和 90 %。结论　在髌股关节软骨病变的诊断中 ,3DFS SPGR序列的特异性及敏感性较SE、FSE和 2DSPGR序列要高 ,是观察关节软骨结构的最佳方法。     

Ultrasound Arthroscopy of Human Knee Cartilage and Subchondral Bone in Vivo

Arthroscopic ultrasound imaging enables quantitative evaluation of articular cartilage. However, the potential of this technique for evaluation of subchondral bone has not been investigated in vivo. In this study, we address this issue in clinical arthroscopy of the human knee (n = 11) by determining quantitative ultrasound (9 MHz) reflection and backscattering parameters for cartilage and subchondral bone. Furthermore, in each knee, seven anatomical sites were graded using the International Cartilage Repair Society (ICRS) system based on (i) conventional arthroscopy and (ii) ultrasound images acquired in arthroscopy with a miniature transducer. Ultrasound enabled visualization of articular cartilage and subchondral bone. ICRS grades based on ultrasound images were higher (p < 0.05) than those based on conventional arthroscopy. The higher ultrasound-based ICRS grades were expected as ultrasound reveals additional information on, for example, the relative depth of the lesion. In line with previous literature, ultrasound reflection and scattering in cartilage varied significantly (p < 0.05) along the ICRS scale. However, no significant correlation between ultrasound parameters and structure or density of subchondral bone could be demonstrated. To conclude, arthroscopic ultrasound imaging had a significant effect on clinical grading of cartilage, and it was found to provide quantitative information on cartilage. The lack of correlation between the ultrasound parameters and bone properties may be related to lesser bone change or excessive attenuation in overlying cartilage and insufficient power of the applied miniature transducer.     

膝关节滑膜病变的高频超声与关节镜对照研究

目的通过与关节镜结果检查对照,评价高频超声对膝关节滑膜病变的诊断价值.方法 68例临床病例,应用高频超声前瞻性观察 72个膝关节滑膜情况,并与关节镜检查结果对照,找出膝关节滑膜疾病的图像特征;并采用双盲法对高频彩超的诊断能力进行评价.结果高频超声诊断膝关节滑膜病变的敏感性为 93.3%、特异性为 90.9%,准确性为 91.7%,阳性预测值为 98.2%及阴性预测值为 71.4%.结论高频超声在术前常规筛选滑膜疾病方面是一种很有价值的影像学方法.     

Comparative Effectiveness of Platelet-Rich Plasma Injections for Treating Knee Joint Cartilage Degenerative Pathology: A Systematic Review and Meta-Analysis

Objective

To explore the effectiveness of platelet-rich plasma (PRP) in treating cartilage degenerative pathology in knee joints.

Data Sources

Electronic databases, including PubMed and Scopus, were searched from the earliest record to September 2013.

Study Selection

We included single-arm prospective studies, quasi-experimental studies, and randomized controlled trials that used PRP to treat knee chondral degenerative lesions. Eight single-arm studies, 3 quasi-experimental studies, and 5 randomized controlled trials were identified, comprising 1543 participants.

Data Extraction

We determined effect sizes for the selected studies by extracting changes in functional scales after the interventions and compared the PRP group pooled values with the pretreatment baseline and the groups receiving placebo or hyaluronic acid (HA) injections.

Data Synthesis

PRP injections in patients with knee degenerative pathology showed continual efficacy for 12 months compared with their pretreatment condition. The effectiveness of PRP was likely better and more prolonged than that of HA. Injection doses ≤2, the use of a single-spinning approach, and lack of additional activators led to an uncertainty in the treatment effects. Patients with lower degrees of cartilage degeneration achieved superior outcomes as opposed to those affected by advanced osteoarthritis.

Conclusions

PRP application improves function from basal evaluations in patients with knee joint cartilage degenerative pathology and tends to be more effective than HA administration. Discrepancy in the degenerative severity modifies the treatment responses, leading to participants with lower degrees of degeneration benefiting more from PRP injections.     

Comprehensively Assessing the Acute Femoral Cartilage Response and Recovery after Walking and Drop-Landing: An Ultrasonographic Study

We compared the acute response and recovery of ultrasonography (US) cartilage outcomes (i.e., thickness, cross-sectional area, and echo intensity) between walking, drop-landing and control conditions in 43 young adults with no history of lower extremity injury. A femoral cartilage US assessment was performed before and after each condition to determine the acute cartilage response and recovery at 15, 30 and 45?min. Percentage change scores from pre- to all post-time points were used for analysis. Acute cartilage response and recovery were analyzed with a 3?×?4 (condition?×?time) repeated-measures analysis of variance. Greater deformation of the medial and lateral femoral cartilage was observed immediately after both the walking and drop-landing conditions compared with the control condition. Cartilage deformation after the drop-landing condition required longer time to recover compared with the walking condition. The femoral cartilage deformation was not accompanied by concurrent alterations in cartilage echo intensity.