膝关节前外侧韧带的超声影像特征及损伤的诊断分析

目的分析正常及损伤的膝关节前外侧韧带在超声中的影像学表现。 方法选取2018年1月至2019年7月在重庆医科大学附属第三医院的20例磁共振成像确诊的单膝急性前交叉韧带（ACL）损伤患者的双膝关节前外侧韧带（ALL）进行超声检查，获得高分辨率超声图像后对图像进行评估。Cohen的Kappa系数用于评估观察者之间的一致性。通过受试者工作特性曲线（ROC）获得ALL损伤的厚度阈值。 结果在正常膝关节的超声影像中，ALL近股骨外侧髁附着处90%（18/20，Kappa=0.85）可显示，ALL胫骨平台插入处100% （20/20，Kappa=1）可显示，ALL半月板插入处无法显示（0/20，Kappa=1）。在合并ACL损伤的膝关节中，ALL损伤的发生率为45%（9/20，Kappa=0.80），其中胫骨平台插入处损伤有9例（Kappa=1），近股骨外侧髁附着处损伤有2例（Kappa=0.79）。ROC曲线法分析结果表明，超声下ALL近股骨外侧髁附着处厚度大于0.65 mm考虑为韧带损伤（敏感度100%，特异度40%），ALL胫骨平台插入处厚度大于1.25 mm考虑为韧带损伤（敏感度88%，特异度93%）。 结论ALL损伤常与ACL撕裂伴随发生，并且损伤多发生在胫骨平台插入处，超声是检查ALL简单、快速的方法。

Ultrasonographic features and injured diagnosis

ObjectiveTo analyze the ultrasonographic findings of normal and injured anterolateral ligament (ALL). MethodsThe ALLs of 20 patients with acute unilateral anterior cruciate ligament (ACL) injuries, as diagnosed by MRI, were examined by ultrasonography and MRI. The injuries were evaluated after obtaining high-resolution images. The Cohen's Kappa coefficient was used to evaluate consistency between observers. The threshold of thickness for ALL injury was obtained by receiver operating characteristic (ROC) curve analysis. ResultsIn the normal knee joints, the incidence of ALL in proximal femoral condyle attachment was 90% (18/20, Kappa=0.85) and the incidence of ALL in tibial plateau insertion was 100% (20/20, Kappa=1). The insertion of the meniscus of ALL cannot be displayed (0/20, Kappa=1). In knee joints with ACL injury, the incidence of ALL injury, as diagnosed by ultrasound, was 45% (9/20, Kappa=0.80), including nine cases with insertion tibial plateau injuries (Kappa=1) and two cases with lateral condyle of the femur attachment injuries (Kappa=0.79). The results of ROC curve analysis showed that a lateral femoral condyle attachment ALL thicker than 0.65 mm as measured by ultrasound was considered to be an injury (sensitivity: 100%; specificity: 40%), whereas an tibial plateau insertion ALL thicker than 1.25 mm was considered to be an injury (sensitivity: 88%; specificity: 93%). ConclusionALL injury is often accompanied by ACL tear, and the injury usually occurs at the insertion of the tibial plateau. Ultrasound is a simple and rapid method for the examination of ALL.