踝关节软骨损伤三种MRI序列的诊断价值和关节镜治疗疗效观察

目的评价三种MRI序列诊断踝关节软骨损伤的价值和观察踝关节镜治疗的疗效。方法对快速自旋回波T2加权像（FSE—T2WI）、快速自旋回波质子加权像（FSE—PDWI）和脂肪抑制三维稳态旋进快速成像（FS-3D—FISP）序列检查提示软骨损伤的34例（34踝）患者，先接受3～6周的保守治疗，效果欠佳的31例再行踝关节镜手术，对术前和术后1周、3周、3个月、6个月的踝关节功能进行比较。结果随访6～54个月，平均26个月，与术前相比，术后1周踝关节功能评分无明显变化，而术后3周、3个月、6个月优良率明显提高（均P〈0.05）。FS-3D—FISP的Kappa值达到0.7622，与关节镜所见一致性高，明显优于FSE—PDWI和FSE—T2WI（P〈0.01）。结论踝关节镜治疗踝关节软骨损伤具有疗效佳、创伤小、恢复快、并发症少等优点，术前FS-3D—FISP序列MRI的准确定位和分级可使术前准备更加充分，诊断更加明确。

The diagnostic value of three types of MRI sequences and the clinical outcomes of arthroscopy in ankle cartilage lesion

Objective To assess the diagnostic value of three types of MRI sequences arid to observe the clinical outcomes of arthroscopy in ankle cartilage lesion. Methods Ankle cartilage lesions were confirmed by FSE-T2WI, FSE-PDWI and FS-3D-FISP MRI sequences in 34 patients. Among them 31 patients, who failed in 3-6 week conservative treatment, underwent arthroscopic surgery. The ankle joint function was compared before and 1 week, 3 weeks, 3 months and 6 months after operation. Results The patients were followed up for 6-54 months （average 26 months）. There was no significant difference between preoperative and 1-week postoperative ankle function scores; but scores in 3 weeks, 3 months and 6 months of operation were higher than that of before operation （P 〈 0.05）, The FS-3D-FISP sequence was well consistent with the result of arthroscopy, Kappa value （0.7590） was higher than that of other two sequences （P 〈 0.01）. Conclusion Arthroscopic treatment of the ankle articular cartilage lesion shows excellent efficacy, minimally trauma and rapid recovery and fewer complications. Preoperative FS-3D-FISP sequence of MRI reveals accurate preoperative localization and classification of the cartilage lesions.