摘要
目的探讨MRI对半月板损伤的诊断及其指导制定关节镜下手术方案的可行性。方法将157个(147例)膝关节分为两组,骨性关节炎(osteoarthritis,OA)组107膝,运动创伤(sportinjury,SI)组50膝。所有病例均行MR检查,152膝行关节镜下手术,按半月板损伤MRI诊断标准进行分级诊断,并将结果与关节镜下表现进行对比。结果OA组中MRI诊断Ⅰ级21膝,Ⅱ级34膝,Ⅲ级40膝,Ⅳ级12膝,各级诊断的准确率分别为100%(21/21)、91.2%(31/34)、92.5%(37/40)和100%(12/12),OA组总诊断准确率为94.39%;关节镜下行半月板修整15膝,部分切除及成形术25膝,次全切除4膝,全切8膝,未处理55膝。SI组中MRI诊断Ⅰ级5膝,Ⅱ级4膝,Ⅲ级26膝,Ⅳ级15膝,ⅡⅣ级诊断的准确率分别为75%(3/4)、92.3%(24/26)和93.3%(14/15),SI组ⅡⅣ级总诊断准确率为91.11%;行关节镜下半月板修整2膝,半月板部分切除及成形21膝,半月板次全切5膝,半月板全切9膝,半月板修补2膝,未处理6膝。结论MRI诊断Ⅰ级的半月板损伤可不必手术;Ⅱ级损伤必要时可行关节镜探查;Ⅲ级损伤可行部分切除或成形术,关节囊缘撕裂可行半月板修补术;Ⅳ级损伤应行半月板次全切除或全切术。
Objective MRI was a powerful technique for evaluation of the meniscus injury.However,meniscal injuries were the most common reason for arthroscopy of the knee.The research was to reveal the relationship between the classification on MRI and the morphological changes of the meniscus injury under the arthroscopy in order to indicate the surgical procedures according to the MRI degree of meniscus in-juries.Methods From October2000to December2001,157knees of152cases with meniscus tears were analyzed retrospectively,who were classified into the osteoarthritis group and sport injury group depending on the causes of injury.There were107knees in osteoarthritis group,50knees in sport injury group.All cases were made MRI examination with T 1 and T 2 sequences,and152of them underwent arthroscopic oper-ation.According to the different signal intensity,changes of contour and edge of meniscus,juried meniscus were divided into four degrees,referring to the standard described by Stoller.The conditions of torn menis-cus were observe and recorded while performing arthroscopy in order to compare with that on MRI.Results The MRI classification in osteoarthritis group,there were gradeⅠin21knees,gradeⅡin34knees,gradeⅢin40knees,and gradeⅣin12knees;Depending on the exploration in arthroscopy,the accurate rate of diagnosis of MRI for meniscus injury was100%(21/21)for gradeⅠ,91.2%(31/34)for gradeⅡ,92.5%(37/40)for gradeⅢand100%(12/12)for gradeⅣ.The patients with gradeⅢand gradeⅣinjury of the meniscus all underwent the operation of arthroscopy.The MRI classification in sport injury group,there were gradeⅠin5knees,gradeⅡin4knees,gradeⅢin26knees,and gradeⅣin15knees.The accurate rate of diagnosis of MRI was75%(3/4)for gradeⅡ,92.3%(24/26)for gradeⅢand93.3%(14/15)for gradeⅣ.Conclusion In the meniscus tears,gradeⅠinjury on MRI is not indicated to surgical treatment,gradeⅡcan be explored in arthroscopy or observed when it is in need based on clinical symptoms.GradeⅢand gradeⅣof meniscus injury necessitate partial meniscectomy or meniscoplasty.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2003年第7期403-407,共5页
Chinese Journal of Orthopaedics
