CAJ | 학술논문

目的研究前交叉韧带(ACL)断裂的MRI表现,探讨其直接征象和间接征象的产生机制及诊断价值.方法本组男37例,女3例;年龄16～49岁,平均33岁.急性期断裂28例,慢性期断裂12例,均经关节镜检查和手术证实.采用1.5 T西门子MRI扫描仪,SE或TSE序列T1、12、质子压脂、medic和横断位、矢状位、冠状位多方位成像.组织3名高年资医师进行回顾分析,对ACL断裂的MRI直接征象和间接征象进行统计分析.结果 ACL断裂4|D例中完全性断裂35例,部分断裂5例.急性期断裂的28例直接征象分别为信号中断或不连续24例(86%),信号不均匀18例(64%),韧带肿胀增厚10例(36%);而慢性期断裂的12例分别韧带增厚11例(92%),信号中断或不连续9例(75%),信号不均匀7例(58%),其中韧带增厚征象主要见于慢性期的ACL断裂(P＜0.01).完全性断裂的35例中,28例(80%)发生在中段,上端、下端发生率低;5例部分断裂均发生在前内侧束.ACL断裂的间接征象中,后交叉韧带(PCL)"7"字变形34例(85%);半月板外露26例,其中外侧半月板外露16例(62%);骨损伤15例,其中胫骨撕裂骨折8例(53%);关节间隙增宽9例,其中78%属于慢性断裂;胫骨前移23例(57%).本组40例中,术前正确诊断37例,正确率为92%;3例部分断裂术前未能诊断,漏诊率为8%.结论根据ACL断裂的直接征象和间接征象,结合外伤史,术前诊断比较容易.
목적 연구전교차인대(ACL)단렬적MRI표현,탐토기직접정상화간접정상적산생궤제급진단개치.방법 본조남37례,녀3례;년령16～49세,평균33세.급성기단렬28례,만성기단렬12례,균경관절경검사화수술증실.채용1.5 T서문자MRI소묘의,SE혹TSE서렬T1、12、질자압지、medic화횡단위、시상위、관상위다방위성상.조직3명고년자의사진행회고분석,대ACL단렬적MRI직접정상화간접정상진행통계분석.결과 ACL단렬4|D례중완전성단렬35례,부분단렬5례.급성기단렬적28례직접정상분별위신호중단혹불련속24례(86%),신호불균균18례(64%),인대종창증후10례(36%);이만성기단렬적12례분별인대증후11례(92%),신호중단혹불련속9례(75%),신호불균균7례(58%),기중인대증후정상주요견우만성기적ACL단렬(P＜0.01).완전성단렬적35례중,28례(80%)발생재중단,상단、하단발생솔저;5례부분단렬균발생재전내측속.ACL단렬적간접정상중,후교차인대(PCL)"7"자변형34례(85%);반월판외로26례,기중외측반월판외로16례(62%);골손상15례,기중경골시렬골절8례(53%);관절간극증관9례,기중78%속우만성단렬;경골전이23례(57%).본조40례중,술전정학진단37례,정학솔위92%;3례부분단렬술전미능진단,루진솔위8%.결론 근거ACL단렬적직접정상화간접정상,결합외상사,술전진단비교용역.
Objective To investigate the direct and indirect MRI manifestations of anterior cruciate ligament(ACL)tears and discuss its mechanism and diagnostic value.Methods The study involved 40 patients with ACL tears including 37 males and three females at age range of 16-49 years(mean age of 33 years).Arthroscopy and operation confirmed 28 patients at acute phase of ACL tears,12 at chronic phase of ACL tears,35 with complete ACL tears and five with partial ACL tears.All patients were examined on 1.5T Siemens MRI scanner,with SE,TSE or Medic sequence in multiple directions.The direct and indirect MRI manifestations of ACL tears were retrospectively and statistically analyzed by employing three experienced doctors.Results Among 28 patients with acute tears,the direct MRI signs included signal interruption or non-consecutive(86%),uneven signal(64%)and swelling and thickening ligament(36%).While in 12 patients with chronic teats,the MRI signs manifested swelling ligament(92%),signal interruption or non-consecutive(75%)and uneven signal(58%).The sign of thickening ligament was mainly seen at chronic phase of ACL tears(P ＜0.01).Of 35 patients with complete ACL tears,80% occurred in the middle part of ACL,with low incidence of upper and lower parts.All five patients with partial ACL tears occurred in the anteriomedialis bundle.The indirect MRI signs of ACL tears included 7-shaped deformity of posterior cruciate ligament(PCL)(34 patients,85%),meniscus exposure(26 patients)including 16 with lateral meniscus exposure(62%),bone injury(15 patients)including segond fracture(8 patients,53%),widened joint space(9 patients)including 78% at chronic phase,and tibia antelocation(23 patients,57%).Among 40 patients,37 patients were diagnosed correctly preoperatively,with accuracy rate of 92%.While three patients with partial ACL tears were missed diagnosis preoperatively,with inaccuracy rate of 8%.Conclusion ACL tear is relatively easy to identify preoperatively according to direct and indirect MRI signs in combination with trauma history.