半月板损伤的磁共振诊断与关节镜结果对照分析

【目的】进一步了解磁共振成像(MRI)对膝关节半月板损伤的诊断价值。【方法】对76(膝)例临床拟诊半月板损伤的MRI和关节镜检查结果作对照分析。【结果】76膝MRI确诊半月板损伤．关节镜发现半月板撕裂61个膝关节．与MRI诊断半月板Ⅲ级信号59个膝关节的结果相近。【结论】MRI对膝关节半月板损伤诊断极有价值,特别是半月板内Ⅲ级信号是诊断半月板撕裂的可靠征象。     

膝关节半月板损伤磁共振成像诊断与关节镜检查对比研究

目的探讨MRI在膝关节半月板损伤诊断中的应用价值。方法回顾性分析70例同时接受MRI和关节镜检查的膝关节损伤患者的病历资料。共涉及86个膝关节,左膝27例,右膝40例,双膝同时发病19例。所有患者均有外伤史,主要表现为膝关节疼痛、肿胀、功能受限及绞锁。结果按照Stoller等半月板损伤MRI分级标准,0级8膝,Ⅰ级2膝,Ⅱ级16膝,Ⅲ级60膝。经关节镜检查,MRI检查诊断为0级的8膝膝关节中有2膝为外侧半月板边缘撕裂;MRI检查诊断为Ⅱ级和Ⅲ级半月板损伤的膝关节中分别有1膝经关节检查证实其异常高信号为滑膜增生而非半月板损伤。经Kappa检验,MRI检查和关节镜诊断半月板损伤结果的一致性较好（Kappa=0．724,P=0．000）。MRI诊断半月板损伤的敏感度为97．44％,特异度为75％,准确率为95．35％。结论MRI检查和关节镜诊断半月板损伤结果的一致性良好,敏感度和准确率高,安全无创,应作为临床诊断半月板损伤的首选方法。     

关节镜与MRI诊断膝半月板损伤的对比研究

目的探讨膝关节半月板损伤MRI检查对指导关节镜下诊断及手术治疗的意义。方法 231例(245膝)经膝关节MRI诊断为膝关节半月板损伤病例,包括退变性及外伤性半月板损伤,按半月板损伤MRI诊断标准进行分级,将结果与关节镜下探查结果进行对比。结果 MRI诊断Ⅰ级损伤25膝(退变组19膝,外伤组6膝),关节镜检查退变性损伤19膝均未见半月板破损;Ⅱ级损伤133膝(退变组72膝,外伤组61膝),关节镜检查退变性损伤68膝半月板破裂,外伤性损伤48膝半月板破裂;Ⅲ级损伤87膝(退变组48膝,外伤组39膝),关节镜检查退变性损伤42膝半月板破裂,外伤性损伤31膝半月板破裂。以关节镜检查为标准,计算MRI诊断准确率,Ⅰ级损伤:退变组为0;Ⅱ级损伤:退变组为94.4%,外伤组为78.7%;Ⅲ级损伤:退变组为87.5%,外伤组为79.5%。MRI诊断总体准确率79.1%。结论 MRI是膝关节镜术前的重要检查,结合临床症状及体征,对指导半月板损伤手术治疗有重要作用。     

膝关节半月板损伤磁共振成像诊断与关节镜检查对比研究

目的:对比分析研究膝关节半月板损伤磁共振成像诊断与关节镜检查的应用价值。方法:资料选取本院2016年4月1日-2017年1月15日收治的60例膝关节半月板损伤患者作为研究对象,均行MRI扫描及关节镜检查,观察MRI及关节镜检查的膝关节半月板损伤情况及诊断结果,比较两种检查技术的诊断准确性。结果:本组60例患者,经关节镜检查显示:98个正常,68个半月板撕裂;诊断阳性106例,阴性60例;经MRI检查显示:0级65个,Ⅰ级11个,Ⅱ级14个,Ⅲ级76个;诊断阳性101例,阴性65例。MRI诊断准确性95.18%与关节镜诊断准确性90.96%比较无统计学意义(P0.05)。结论:MRI检查在膝关节半月板损伤中的应用价值高,可对膝关节半月板损伤情况作出准确检查,与关节镜检查相比,其诊断结果清楚且确诊率较高,可提供可靠的诊断依据,是一种理想的诊断方法。     

MRI检查对半月板损伤类型的评价

背景:MRI诊断半月板损伤的准确性可达80%～100%,但在临床上也存在一定程度的假阳性和假阴性.目的:通过半月板损伤的MRI检查及关节镜,探讨半月板不同损伤类型的不同MRI表现.方法:选择2003-01/2008-12因膝关节损伤行术前MRI检查患者212例,由放射科及骨科的高级职称医师共同阅片,预测半月板损伤及其损伤形态.由主任医师行关节镜探查,以术中所发现的半月板损伤作为诊断的金标准,对比两者准确性,统计MRI诊断的准确性.结果与结论:212例患者(230个膝关节)中MRI检查可疑半月板损伤215膝,由关节镜探查术证实半月板损伤213膝,MRI检查对半月板损伤诊断的敏感度为93.5%,特异度为64 7%,准确度为93.0%.发现MRI诊断半月板桶柄样损伤的敏感度较高,对半月板轻微撕裂伤易出现漏诊,对外侧半月板损伤诊断的假阳性较多.临床实际操作时,若半月板损伤表现为Ⅲ级信号、损伤后移位或有关节囊分离等情况,则提示半月板不稳定,应给予关节镜探查或进一步的手术治疗以免遗漏.     

膝关节半月板损伤MRI表现与关节镜下表现的临床对照

目的：探讨MRI对半月板损伤的诊断价值及其对临床治疗的指导意义。材料与方法：回顾性分析158个半月板损伤的MRI表现和关节镜表现。根据MRI信号改变将半月板损伤分为Ⅰ、Ⅱ、Ⅲ级,并与关节镜下表现进行对比。结果：本组70例患者的79膝、158个半月板中,MRI检查明确诊断Ⅲ级信号提示半月板撕裂43个,经关节镜证实半月板撕裂39个,其余4个半月板关节镜下肉眼未见明显撕裂;经MR／检查未证实撕裂而关节镜下见撕裂8个,其中有4个MR／检查信号介于Ⅱ～Ⅲ级之间,提示可能撕裂;经MR／检查与关节镜证实无撕裂107个,其中9个MRI检查信号介于Ⅱ～Ⅲ级之间。MRI对半月板损伤诊断的准确度为92．4％。结论：MR]是诊断半月板撕裂元创性的极有价值的诊断方法,是膝关节镜术前的重要检查,半月板内MRIⅢ级高信号影是半月板撕裂的可靠指征。     

磁共振成像对膝关节半月板损伤的诊断价值

目的 探讨MRI对膝关节半月板损伤的诊断价值。方法 分析52个膝关节104个半月板病变的MRI表现，并与关节镜检查结果对照。结果 MRI可准确显示不同程度的半月板损伤，对半月板撕裂的诊断与关节镜检查诊断符合率为91．1％，并能发现半月板的早期退变。结论 MRI是诊断半月板损伤准确、无创的方法，为临床诊断提供确切、可靠的依据。     

半月板损伤在MRI与关节镜下表现的比较研究

关节镜检查是诊断膝关节半月板损伤的金标准,磁共振(MRI)以其无创及对组织的高分辨率、对损伤的高敏感性和特异性等特点己成为继关节镜检查后诊断膝关节半月板损伤的又一重要手段,对提高半月板损伤的诊断率,避免不必要的关节镜手术具有重要的临床意义.作者自2006年1月至2009年6月,对在本院同时行MRI检查及关节镜治疗,且至少临床、MRI或关节镜之一诊断为半月板损伤共67例(72膝)患者的资料进行回顾性对照分析.现报道如下.     

MRI在半月板损伤中的应用价值

目的:探讨膝关节半月板损伤的MRI诊断价值.方法:回顾性分析108例患者113例膝关节半月板损伤的MRI表现,并按Mink和Fischer方法进行分级.结果:113个膝关节中Ⅰ级损伤15个,Ⅱ级损伤29个,Ⅲ级损伤69个(经关节镜证实),其中14个为盘状半月板.结论:MRI对于膝关节半月板损伤的诊断具有很高的价值及临床意义,可以清晰地显示半月板的形态和位置及其信号的改变,为临床治疗提供可靠的依据,是目前诊断半月板损伤最好的检查方法.     

军事训练致膝关节半月板损伤的MRI诊断分析

目的探讨军事训练致膝关节半月板损伤的MRI表现及诊断价值。方法回顾性分析经MRI检查的52例军事训练伤的临床资料,重点分析MRI征象。结果 MRI检查诊断为半月板损伤87个,其中Ⅰ级损伤17个,Ⅱ级损伤38个,Ⅲ级损伤32个。经临床或关节镜探查术证实半月板损伤84个,MRI检查对半月板损伤诊断的准确率为96.6%。结论 MRI可以清晰地显示半月板损伤的部位、类型及程度,对半月板损伤有很高的诊断价值。     

Is there a role for sonography in the diagnosis of tears of the knee menisci?

PURPOSE: The aim of this study was to investigate the usefulness of sonography in diagnosing tears of the knee menisci. METHODS: In this retrospective study, we reviewed the sonographic examinations of the knees of 321 patients diagnosed with a torn meniscus on the basis of clinical findings. Of the 321 knees imaged, 216 were also examined using MRI or CT. Arthroscopic meniscectomy was performed on 126 knees. RESULTS: MRI or CT did not confirm 48% (71 cases) of the positive sonographic diagnoses (ie, false positives) and 72% (50 cases) of the negative sonographic diagnoses (ie, false negatives). Thus, the sonographic diagnosis was correct in 95 cases (44%) and incorrect in 121 cases (56%), yielding low rates of sensitivity (60%) and specificity (21%). Among the 126 cases in which arthroscopic meniscectomy was performed, arthroscopy confirmed 100% of the MRI or CT diagnoses of meniscal tears. CONCLUSIONS: Our results indicate that sonography is not accurate enough to be used as the only imaging modality for diagnosing tears of the knee menisci.     

The value of sonography with micro convex probes in diagnosing meniscal tears compared with arthroscopy.

OBJECTIVE: Meniscal tears are common in knee injuries. Sonography has been used in the knee to evaluate meniscal tears. Linear probes with high resolution have been used, and the overall accuracy of sonography has been more than 70% in many studies. In this study, we used a 6.5-MHz micro convex probe to evaluate meniscal tears, and the results were compared with arthroscopic findings. METHODS: Four hundred six knee joints with knee pain and a clinical indication for arthroscopy were examined from the popliteal fossa with the 6.5-MHz micro convex probe. Those patients with positive sonographic findings who had an arthroscopic examination (100 patients) were included in our study, and the results were compared. The results were statistically analyzed by the Fisher exact test. RESULTS: One hundred knees with sonographic examinations underwent arthroscopic evaluation. Three age groups were included in the study (20-30, 30-40, and >40 years). Comparison of the results between the two methods showed sensitivity of 100% and specificity of 95% for sonography in detecting meniscal tears. The positive predictive value for the medial meniscus was 95%, and the negative predictive value was 100%; these values for the lateral meniscus were 93% and 100%, respectively. CONCLUSIONS: Meniscal tears are common in all age groups. The use of sonography allows rapid, low-cost, and noninvasive exploration of meniscal tears as a first-line diagnostic method. We recommend high-resolution micro convex probes, which better fit the anatomic concavity of the popliteal fossa, as efficient investigation tools.     

半月板周缘垂直撕裂与前交叉韧带损伤相关性的MRI研究

目的：探讨半月板周缘垂直撕裂与前交叉韧带损伤（ACL）的相关性。方法：对178例经关节镜证实,诊断为半月板撕裂的膝关MRI进行回顾性研究,对半月板撕裂的部位和裂口方向及ACL的情况进行诊断分析。并比较半月板周缘垂直撕裂患者和其他类型半月板撕裂患者ACL的发生率。结果：178例患者中有22例被证实为半月板周缘垂直撕裂,其中18例合并急性或慢性ACL,占81．8％,另4例前交叉韧带完整。在156例其他类型半月板撕裂患者中,13例合并急性或慢性ACL,占8．3％。两者比较具有统计学意义（P〈0．001）。结论：半月板周缘垂直撕裂与急性或慢性前ACL密切相关。膝关节MRI图像上,半月板周缘垂直撕裂可作为ACL的辅助诊断依据之一,可以提高诊断ACL的准确率。     

Meniscal injuries: A critical review

Although once perceived as an unimportant vestigial structure, the menisci of the knee are now known to be a common source of knee pain and disability. The medial meniscus is more vulnerable to injury to due to its intimate attachment to the medial collateral ligament. The moveable lateral meniscus is less prone to tear except when the ACL is injured. The medial and lateral menisci are usually injured as a result of sudden knee flexion with a component of knee internal or external rotation. However, older patients may present without a specific mechanism of injury as their meniscal injuries are often due to degenerative processes. Most meniscal injuries can be diagnosed with a thorough physical examination utilizing the McMurray, Apley, and ``bounce home' maneuvers. Joint line tenderness and the presence of a knee effusion aid in the diagnosis. Magnetic Resonance Imaging (MRI) has become the test of choice in confirming injury. MRI also defines the type, location, and severity of meniscal injury. Some meniscal injuries, particularly peripheral, well-vascularized tears, may be more prone to healing with nonsurgical management. Typical initial management includes reduction of swelling and pain. Rehabilitation stresses tri-planar functional retraining. The final phases of rehabilitation incorporate a functional progression to sports or work specific activities. Arthroscopic knee surgery has become a prevalent treatment method for bucket handle tears and non-vascularized meniscal injuries. Meniscal repair is currently preferred over partial menisectomy to avoid premature osteoarthritis. In sum, clinicians can return patients with meniscal pain to a high level of function with appropriate recognition of injury and functional rehabilitation.     

MR在膝关节外伤中的诊断价值

本文对20例膝关节外伤的MR检查作了研究，其中9例施行了关节手术，并与常规X线检查进行了对照，MR显示半月板撕裂及前十字韧带撕裂的正确率均为90％。对膝关节不完全骨折、骨挫伤及软骨骨折的显示，明显优于常规X线检查。     

磁共振膝关节腔造影应用于半月板撕裂的诊断

目的:探讨膝关节腔MRI造影对常规MRI检查所发现的不典型半月板撕裂有无进一步的诊断和鉴别诊断价值。 资料和方法:34例行常规MRI发现半月板病变(可疑撕裂)后附加MRI关节腔造影,手术和关节镜检查发现18例23个半月板撕裂。 结果:关节腔MRI造影诊断半月板撕裂的敏感性、特异性和准确性均高于常规MRI检查,尤其以特异性的提高更为显著。各级医师之间对半月板撕裂常规MRI诊断的准确率差距显著大于关节腔MRI造影。 结论:膝关节腔MRI造影可进一步提高半月板撕裂磁共振检查的准确率。     

Evaluation of acute traumatic hemarthrosis of the knee joint

Acute hemarthrosis of the knee usually results from a significant injury. Preoperative assessment, examination under anesthesia, and arthroscopic examination were conducted on patients with a total of 132 acutely injured knees associated with hemarthrosis and minimal clinical laxity to determine the presence and extent of injury to ligamentous and/or intra-articular structures. Partial or complete tear of the anterior cruciate ligament was found in 101 (77%) of the knees. Peripheral meniscal tears were responsible for the hemarthrosis in 17 cases (13%), and osteochondral fractures were found in 11 cases (8%). Injury to the anterior cruciate ligament was frequently associated with concomitant injury to other structures: meniscal tears (61%), ligament/capsular injury (40%), and hyaline chondral damage (16%). Patients' responses to preoperative anterior drawer, pivot shift, and Lachman tests were within normal limits in 18%, 29%, and 73% of cases, respectively. Patients under anesthesia responded to the anterior drawer and pivot shift tests normally 50% and 74% of the time. The Lachman test, performed under anesthesia, was 98% accurate in predicting anterior cruciate injury. Experience gained in evaluating posttraumatic hemarthrosis of the knee suggests clinical examination alone may not demonstrate the severity of many of these injuries. Arthroscopy, although not necessary to determine competence of the anterior cruciate ligament, is invaluable in determining the existence of other injuries with or without an associated anterior cruciate ligament tear.     

半月板囊肿的关节镜治疗

目的:探讨半月板囊肿的临床、MRI、关节镜手术治疗。方法:2004年～2008年我院共完成18例膝关节半月板囊肿的关节镜手术,3例行单纯囊肿切除,13例行囊肿切除及半月板部分切除、全切,2例行囊肿切除半月板缝合。术前、术后均采用Lysholm评分,对膝关节功能进行评估。结果:18例患者均得到随访,术前Lysholm的评分(70.5±8.6),术后提高到(93.2±4.7),术前、术后有显著差异。结论:半月板囊肿是一种少见的膝关节疾患,MRI检查是主要诊断依据,采用关节镜手术治疗创伤小、疗效佳,是首选治疗方法。     

膝关节半月板囊肿的MRI诊断价值

目的:评价膝关节半月板囊肿的MRI诊断价值。材料与方法:回顾性分析23例经关节镜或手术病理证实的膝关节半月板囊肿的MRI表现,探讨其发生的部位、形态、信号特点及与半月板的毗邻关系。结果:23例半月板囊肿中,外侧半月板囊肿18例(78.3%),内侧半月板囊肿5例(21.7%),合并半月板损伤19例(82.6%)。囊肿多呈类圆形或分叶状,T1WI呈等或稍低信号,T2WI及PDWI脂肪抑制呈高信号。典型表现呈"吹气球征"。结论:半月板囊肿好发于外侧且多与半月板损伤有关,MRI对半月板囊肿的诊断具有较高的临床价值。     

Magnetic resonance imaging in the evaluation of knee injuries

To better define the role of magnetic resonance imaging (MRI) in the evaluation of knee injuries, we analyzed 10 recently published articles comparing MRI and arthroscopy in the detection of meniscal and anterior cruciate ligament tears. Sensitivity (SN), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) for medial meniscus (MM) tears, lateral meniscus (LM) tears, and anterior cruciate ligament (ACL) tears were either obtained or calculated from data contained in each article. The medians of measurements for MM tears were 97% SN, 89% SP, 88% PPV, and 96% NPV. Measurement medians for LM tears were 85% SN, 94% SP, 86% PPV, and 95% NPV. ACL tear measurement medians were 100% SN, 96% SP, 80% PPV, and 98% NPV. High NPVs were found in several studies, many of which were 100%. The high NPV of MR imaging suggests that diagnostic arthroscopic surgery is not necessary in the evaluation of patients with negative MRI studies. The superior sensitivity of MRI in detecting frank posterior horn tears, intrasubstance meniscal tears, and significant incidental findings also suggests that screening MRI scans can facilitate preoperative planning.