踝关节距骨骨软骨损伤的影像学及关节镜下表现

目的分析踝关节距骨骨软骨损伤的影像学特点,包括病灶位置、病灶大小等形态学数据及MRI分期,并根据关节镜下表现进行分级,分析MRI分期与关节镜分级之间的关系。方法 2006年7月至2008年6月,35例距骨骨软骨损伤患者术前进行踝关节正侧位X线检查及MRI检查,分别根据BerdntHarty标准及Hepple's标准进行分期,在PACS系统上应用测量软件工具分析MRI图像,确定病灶位置、测量其前后径、左右径及深度。所有患病的踝关节均进行关节镜探查,并进行病灶分级。分析MRI分期与关节镜下分级之间的相关性。结果 35例患者的平均年龄为29.1岁(16～44岁),其中男30例,女5例。通过X线发现13例距骨骨软骨损伤,根据BerdntHarty分期:6例为Ⅰ期,3例为Ⅱ期,3例为Ⅲ期,1例为Ⅳ期;6例病灶位于外侧,7例位于内侧。MRI检查共发现38处距骨骨软骨损伤(3例患者均有两处病灶),根据Hepple分期:Ⅰ期1例,Ⅱ期17例,Ⅲ期7例,Ⅳ期2例,Ⅴ期11例。14例病灶位于外侧,24例位于内侧;按照9宫格分区法,55.3%的病灶位于4区(内侧中部),23.7%位于6区(外侧中部)。内侧组病灶大小为:前后径(9.0±2.5)mm、左右径(11.2±2.9)mm、深度(8.4±4.0)mm;外侧组病灶大小为:前后径(7.8±3.2)mm、左右径(10.9±3.2)mm、深度(7.9±4.2)mm。两组病灶大小的差异无统计学意义。关节镜探查共发现38处距骨骨软骨损伤(A级1例、B级1例、C级4例、D级27例、E级3例、F级2例)。MRI分期与关节镜下分级之间无相关性(r=0.12,P=0.474)。结论距骨骨软骨损伤主要位于距骨内侧中部及外侧中部,内侧病损以Hepple's Ⅱ期和Ⅴ期为主,外侧病变以Ⅲ期为主;内外侧病灶的大小差异无统计学意义。内外侧病变的关节镜下表现均以D级为主。Hepple'sMRI影像学分期与关节镜下分级无对应关系。

Imaging and arthroscopic findings of the osteochondral lesions of the talus

Objective To analyze the imaging and arthroscopic characteristics of the corosteochondral lesions of the talus,and to evaluate the correlation between MRI and arthroscopy in staging the lesions.Methods Imaging data（including location,size） and arthroscopic findings of 35 ankles were reviewed.The location,diameter and depth of the lesions were recorded by PACS system.A nine-zone anatomical grid system on the talar dome was used for an accurate depiction of lesion location.MRI Hepple＇s staging and arthroscopic staging（according to Cheng Ferkel） were evaluated.Results 38 lesions were identified by MRI and arthroscopy.The medial talar dome was more frequently involved（n = 24,63.2%） than the lateral dome（n = 14,36.8%）.According to nine-zone system,zone 4（medial and mid zone） was most frequently involved（n = 21,55.3%）,and zone 6（lateral and mid zone） was the second frequently involved（n = 9,23.7%） zone.There was no differences in surface area and depth between the medial and lateral talar dome lesions.Correlation between MRI and arthroscopic staging was not found.Conclusions Medial-midst and lateral-midst talar dome lesions were more common.According to this study,Hepple＇s stage Ⅱ and Ⅴ are most frequently found in medial lesions,while stage Ⅲ is in lateral group.Stage D is most frequent according to arthroscopy.MRI staging does not correspond to arthroscopic staging.