膝关节及其附属结构损伤的低场强MRI诊断

目的评价低场强MRI对膝关节及其附属结构损伤的诊断价值。方法对96例因膝关节损伤进行MRI扫描的影像资料作回顾性分析,根据X线检查结果分为膝关节有骨折和无骨折两组。结果 34例X线平片显示有关节骨折的病例,髌骨骨折14例,伴13处附属结构损伤;胫骨骨折9例,伴18处附属结构损伤;股骨骨折6例,伴7处附属结构损伤;多发骨折5例,伴18处附属结构损伤。多发骨折和胫骨平台骨折所致的附属结构损伤以多结构为主。62例X线平片显示无膝关节骨折的病例,MRI显示半月板损伤43例,韧带损伤42例,关节软骨损伤9例。两组经χ2检验,差异有统计学意义（P〈0.05）。结论低场强MRI对不同类型的膝关节及其附属结构的损伤具有良好的诊断价值,膝关节多发骨折引起的附属结构损伤最为严重。     

膝关节损伤的MRI研究

目的 研究膝关节损伤的机制及其MRI表现。方法 搜集从1999年至2003年间经MRI诊断的膝关节损伤患者106例，并复习相关文献。结果 106例患者中有96例半月板损伤，其中Ⅲ度损伤即半月板撕裂共17例。前交叉韧带损伤19例，其中断裂8例；后交叉韧带损伤13例，其中断裂2例；前、后交叉韧带同时损伤7例；内侧副韧带损伤3例，外侧副韧带损伤8例；股骨骨折6例，胫骨平台骨折9例，胫骨髁间嵴骨折3例，髌骨骨折2例，隐性骨折8例，关节内软骨骨折13例。结论 MRI检查可以准确显示膝关节损伤的各种病理改变，对指导手术治疗具有极其重要的临床价值。     

胫骨平台骨折的X线及MRI诊断价值分析

目的:探讨X线及MRI在胫骨平台骨折中的临床应用价值。方法:胫骨平台骨折患者42例。所有患者均行X线及MRI检查。根据暴力作用的大小和方向不同,将胫骨平台骨折分6型,比较平片与MRI诊断结果,分析骨折合并膝关节其他损伤的MRI表现。结果:X线片与MRI分别诊断平台骨折38例及42例,诊断符合率分别为88.1%、100%。所有Ⅱ型和Ⅵ型骨折X线片诊断与MRI相符,其他类型骨折的诊断及分型MRI优于X线片。同时MRI诊断骨挫伤24例,半月板损伤13例,韧带损伤34例,关节面软骨损伤31例,关节囊积液或积血28例。结论:X线片对移位塌陷明显、骨折严重的病例大部分能明确诊断,仍应作为常规应用,MRI是术前全面综合评估胫骨平台骨折及软组织损伤的有效方法。     

膝关节隐性骨折及合并其它损伤的MR诊断价值

目的 探讨膝关节隐形骨折及合并其它损伤的MRI诊断价值.方法 68例膝关节外伤患者均行X线和MRI检查.结果 68例X线平片均未见骨折征象.MRI检查发现膝部隐形骨折83处,以股骨内外髁、胫骨上端多见,发生75处,骨折线多为线形、树枝状等;32例合并膝部韧带损伤;22例合并半月板损伤;60例合并膝关节腔内积液.结论 对于临床症状明显而X线检查未见异常的膝关节外伤患者,MR检查应作为首选的进一步检查方法.     

膝关节损伤的MRI诊断

目的 探讨膝关节损伤的 MRI表现及临床应用价值.方法 回顾性分析40例经手术或关节镜证实的膝关节损伤患者术前MRI表现.结果 半月板损伤28例,内侧11例,外侧17例,其中撕裂11例;韧带损伤28例,撕裂9例,损伤以前交叉韧带(15例)和内侧副韧带(12例)为主;骨挫伤20例;隐匿性骨折5例.同时发生半月板、韧带和骨损伤3类中两者及以上的复合性损伤32例(80%).关节积液及周围软组织损伤为伴随表现.结论 MRI能准确地显示膝关节损伤的各种表现,是膝关节损伤后非创伤性检查的首选,对临床有重要指导意义.     

膝关节半月板撕裂的MRI诊断

目的 探讨膝关节半月板撕裂的MRI诊断价值.方法 收集并分析经关节镜证实的60例膝关节半月板撕裂的MRI表现,并参考Stoller分级方法,提出半月板损伤的4级分法.结果 60例65个半月板撕裂中,内侧撕裂15个,外侧撕裂40个,两侧同时撕裂5例10个.合并外侧盘状半月板15个.MRI诊断准确率为90.8%.39例出现合并症,伴随病变有韧带撕裂,骨挫伤,关节积液,骨折,半月板囊肿等.结论 MRI能够准确诊断半月板撕裂,还能发现多种合并症.     

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。     

膝关节运动性骨挫伤的MRI诊断

目的探讨膝关节运动性骨挫伤的MRI特征及诊断价值。方法选取近年X线平片未见膝关节骨折,而MRI检查显示膝关节骨髓有异常改变32例进行回顾性分析。结果 32例患者骨挫伤45处,合并韧带损伤12处,半月板损伤5例,软骨损伤2例。根据骨挫伤MR表现分为3型:Ⅰ型(14例),为邻近膝关节骨骺或干骺端松质骨内斑片状、地图状异常信号改变,边缘模糊。Ⅱ型(5例),除与I型表现相似外合并骨皮质连续性中断。Ⅲ型(13型),为紧靠皮质下局灶性的异常信号区。结论 MRI能揭示膝关节骨挫伤的病理改变,准确显示膝关节骨挫伤的部位和范围及有无其它附属结构的损伤,是膝关节骨挫伤的最佳检查手段。     

低场MRI在膝关节隐匿性骨折中的应用探讨

膝关节损伤很常见,往往容易被临床忽视,错过治疗时机,给患者带来不可逆转的疼痛、骨软骨缺损及退行性骨关节病等后遗症.传统X线平片及CT可以发现显性骨折及关节脱位,但对隐匿性骨折及合并的关节内其他结构损伤不能显示.MRI具有良好的组织和空间分辨力,能够发现骨及关节囊内结构的损伤,使膝关节损伤的检查更加完善.膝关节损伤MRI检查以高场MRI研究报道较多,而低场MRI研究报道较少.本文收集了71例资料完整的膝关节隐匿性骨折患者的低场MRI检查结果,探讨其MRI表现,以期提高对膝关节隐匿性骨折的低场MRI认识.     

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。     

Impingement fracture of the anteromedial tibial margin: a radiographic sign of combined posterolateral complex and posterior cruciate ligament disruption

Marginal fractures of the tibial plateau are associated with a high incidence of soft tissue injuries to the stabilising structures of the knee joint. Injuries to the anterior cruciate ligament are associated with the Segond fracture and impingement fractures of the posteromedial tibial plateau. Recognition of these fractures aids diagnosis of these injuries. Marginal fractures of the tibial plateau associated with posterior cruciate ligament injuries are less common, though recently a ”reverse” Segond fracture has been recognised. We describe a fracture of the anteromedial tibial plateau associated with complete disruption of the posterior cruciate ligament and posterolateral complex. Received: 12 June 2000 Revision requested: 17 July 2000 Revision received: 23 October 2000 Accepted: 26 October 2000     

军事训练膝关节不同应力性损伤的高场MRI表现

目的探讨军事训练膝关节不同应力性损伤的特点、生物力学特征及其高场MRI表现。方法回顾性分析我院2010年12月—2012年12月军事训练膝关节应力性损伤患者的MRI资料共102个膝关节,根据应力性质及应力作用的特点、组织损伤部位及特点,对每一个膝关节的MRI资料进行分析。结果 102个膝关节中,股骨远端38例,胫骨近端42例,前交叉韧带98例,后交叉韧带31例,内侧副韧带34例,外侧副韧带24例,关节腔积液76例,内侧半月板18例,外侧半月板11例,5例为单纯型损伤,97例为复合型损伤。交变应力性损伤时MRI可见骨髓腔内线状、斑片状长T1长T2信号影;拉应力性损伤时MRI可见与骨干平行的软组织异常信号,骨髓腔内片状异常信号,有骨折时骨髓腔锯齿状、斜行或横行的长T1短T2信号影;压应力性损伤时MRI可见胫骨平台的骨髓水肿、压缩骨折、半月板损伤和软组织损伤;剪切应力性损伤时MRI可见交叉韧带、侧副韧带、半月板、股骨髁或胫骨平台的异常信号。结论军事训练膝关节应力性损伤的程度与军事活动的频度、强度和训练科目有关,军事训练膝关节所遭受的应力作用不是单一的,而是几种应力的共同作用,MRI能敏感地发现不同应力所致的组织损伤特点,对膝关节应力性损伤各期的评价和诊断具有明显的优势,能为军事训练应力性损伤的预防和早期干预提供借鉴。     

Anterior rim tibial plateau fractures and posterolateral corner knee injury

The aim of this study was to review MRI findings of clinically suspected posterolateral corner knee injuries and their associated internal derangements. Sixteen knees in 15 patients who had evidence of a posterolateral corner knee injury on the physical exam underwent MRI to evaluate the posterolateral corner of the knee and to look for associated injuries. Two musculoskeletal radiologists reviewed the scans. Surgery was performed on 10 of the knees. Tibial plateau fractures were present in 6 knees; 5 of the fractures were anteromedial rim tibial plateau fractures. The popliteus muscle was injured in 13 knees and the biceps femoris in 6 knees. The lateral collateral ligament was ruptured in 12 knees. The posterior cruciate ligament was completely ruptured in 7 knees and avulsed from its tibial attachment in 1 knee. Eleven knees had a complete anterior cruciate ligament rupture. The anterior cruciate ligament was edematous without complete disruption of all fibers in 3 knees. There was excellent correlation between the MRI results and operative results in regard to the presence of a posterolateral corner injury of the knee (9 of the 10 knees had a posterolateral corner injury). In our study MRI readily detected posterolateral corner injuries. Posterolateral corner injuries of the knee are frequently associated with a variety of significant injuries, including cruciate ligament tears, meniscus tears, and fractures. Fractures of the peripheral anteromedial tibial plateau are not common; however, given their relatively common occurrence in this study, they may be an indicator of a posterolateral corner injury to the knee.     

膝关节韧带损伤与胫骨平台骨折Schatzker及AO分型的相关性分析

目的分析膝关节韧带损伤与胫骨平台骨折Schatzker分型及AO分型的相关性。方法选取2018年1月至2019年6月厦门大学附属福州第二医院骨科收治的28例胫骨平台骨折合并膝关节韧带损伤患者作为研究对象,根据Schatzker分型及AO分型系统对胫骨平台骨折进行分型,同时判定前交叉韧带(anterior cruciate ligament,ACL)、后交叉韧带(posterior cruciate ligament,PCL)、内侧副韧带(medial collateral ligament,MCL)及后外侧角(posterior lateral corner,PLC)的损伤情况,并采用Spearman相关系数分析膝关节韧带损伤与胫骨平台骨折Schatzker分型及AO分型的相关性。结果Schatzker分型与AO分型(仅以关节外、部分关节内和完全关节内3种类型计算)对应分析结果显示,两者具有显著相关性(P=0.000)。Schatzker分型及AO分型与韧带损伤类型Spearman相关分析结果显示,Schatzker分型及AO分型与ACL、MCL及PLC损伤均呈显著相关性(r=-0.465、-0.639、0.756,P=0.013、0.000、0.000;r=-0.588、-0.420、0.532,P=0.001、0.026、0.004),但若AO分型以关节外、部分关节内和完全关节内3种类型计算,则仅与ACL损伤呈显著相关性(r=-0.465,P=0.013)。结论膝关节损伤时膝关节相关韧带之间有一定协同作用,故胫骨平台骨折多合并膝关节韧带损伤,且随着Schatzker分型与AO分型等级的增高,ACL、MCL及PLC损伤的可能性均增大。     

The degree of articular depression as a predictor of soft-tissue injuries in tibial plateau fracture

Purpose

Magnetic resonance imaging (MRI) provides sufficient information with regard to specific soft-tissue injuries in the knee, but it is not generally used to evaluate acute tibial plateau fractures. The aim of the present study was to determine whether the amount of tibial plateau fracture depression on multi-detector computed tomography (MDCT) scans correlates with the incidence of associated soft-tissue injuries on MRI.

Methods

A total of 54 consecutive patients with a mean age of 51.2 years (SD = 18.3) were included in this retrospective study. All patients were admitted to the emergency department of a university clinic with acute tibial plateau fracture. The amount of articular depression was assessed from MDCT scans. Magnetic resonance images were evaluated for crucial and collateral ligament injury, meniscal tears, and patellar retinaculum lesions.

Results

Logistic regression revealed a significant impact of increasing tibial plateau fracture depression on the incidence of meniscus lateralis tears (P = 0.025) and anterior cruciate ligament lesions (P = 0.018). Analysis of covariance demonstrated a significant correlation between the amount of articular depression and absolute number of soft-tissue injuries (P = 0.001).

Conclusions

Articular depression is a potential predictor of specific meniscal and ligamentous injuries in acute tibial plateau fracture. Magnetic resonance imaging is generally recommended with respect to associated soft-tissue injuries, especially in cases with distinct tibial plateau fracture depression on multi-detector computed tomography scans.

Level of evidence

Case series, Level IV.     

AO解剖钢板治疗严重胫骨平台骨折

目的 探讨应用AO解剖钢板治疗严重胫骨平台骨折的临床疗效.方法 对45例严重胫骨平台骨折的治疗情况进行回顾性分析.全部患者均采用AO解剖钢板内固定,同时根据伤情进行植骨,处理合并的半月板、副韧带和血管损伤;并采用HSS膝关节功能评分系统评估术后膝关节功能.结果 本组患者随访40例.骨折愈合时间为3～5个月;术后1年膝关节功能评定:优21例,良12例,可5例,差2例,优良率为82.5%.结论 采用AO解剖钢板治疗严重胫骨平台骨折,既能实现关节面的解剖复位,又能早期功能锻炼,可获得较为满意的治疗效果.     

前后联合切口入路治疗累及后柱的复杂胫骨平台骨折疗效分析

目的探讨前后联合切口入路治疗累及后柱的复杂胫骨平台骨折的临床疗效。方法回顾性分析惠州市中心人民医院创伤骨科2012年1月~2014年1月收治的累及后柱的复杂胫骨平台骨折患者22例,其中男性14例,女性8例;年龄20~70岁,平均49.7岁。致伤原因:道路交通伤15例,坠落伤7例。平台前外侧骨折6例,前内侧骨折11例,前内、前外广泛骨折5例。受伤至手术时间3~14d,平均6.5d。22例均采取前内侧或前外侧联合后内侧倒"L"型切口入路+支撑钢板内固定术治疗,分析患者的临床资料、手术时间、术中出血量、住院时间、术中并发症(切口感染、内固定松动或断裂情况)、骨折愈合时间(以X线片下骨折线消失为准)以及术后12个月膝关节美国特种外科医院(HSS)评分。结果所有患者手术顺利,手术时间(173.4±40.3)min,术中出血量(187.5±53.1)mL,术后住院时间(16.3±4.6)d,骨折愈合时间(31.2±7.5)周。术中及术后无严重手术相关并发症。所有患者获得随访,平均随访时间(15.3±4.9)个月;术后12个月时膝关节HSS评分为(84.6±17.3),优良率为81.8%(18/22),两侧膝关节活动度差异无统计学意义(P0.05)。结论对于累及后柱的复杂胫骨平台骨折,前内侧或前外侧联合后内侧倒"L"型切口入路对组织损伤小,骨折端暴露充分,利于直视下复位内固定,对膝关节远期影响较小。     

Combined osteochondral fracture of the posterolateral tibial plateau and Segond fracture with anterior cruciate ligament injury in a skeletally immature patient

A case of a 14-year-old boy with a rare injury—an osteochondral fracture of the posterolateral tibial plateau associated with the anterior cruciate ligament (ACL) rapture, and Segond fracture characterized by an avulsion fracture of the lateral tibial plateau—is reported. This case was noteworthy because it involved a rare combination of ACL injuries. This injury was thought to be caused by the impaction between the posterior aspect of the lateral tibial plateau and the lateral femoral condyle during internal rotational displacement of the knee joint at the time of injury, because the osteochondral fracture of the posterolateral tibial plateau matched the site where the bone bruise was observed.     

Bildgebungsstrategie bei Kniegelenkverletzungen

Injuries of the knees are common. The Ottawa knee rule provides decisional support to determine whether radiographs are indicated or not. With the use of ultrasound it is possible to detect defects of the extensor ligaments and the anterior cruciate ligament. Furthermore, it is possible to detect indirect signs of an intra-articular fracture, e.g. lipohemarthrosis. In complex fractures, e.g. tibial plateau fractures, further diagnostic procedures with multislice computed tomography (CT) are needed for accurate classification and preoperative planning. Multislice CT with CT angiography enables three-dimensional reconstruction of the knee and non-invasive vascular imaging for detection of vascular injury. Magnetic resonance imaging (MRI) is the gold standard for detection of occult fractures and injuries of the ligaments and menisci. Higher field strengths can be used to improve the diagnostics of cartilage lesions. Virtual MR arthrography is superior to conventional MRI for detection of cartilage lesions especially after meniscus surgery.