中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
14期
6322-6328
,共7页
孙百胜%郑雷%纪丙军%姜辉%何伟华%李永亮
孫百勝%鄭雷%紀丙軍%薑輝%何偉華%李永亮
손백성%정뢰%기병군%강휘%하위화%리영량
膝关节%韧带%创伤与损伤%磁共振成像
膝關節%韌帶%創傷與損傷%磁共振成像
슬관절%인대%창상여손상%자공진성상
Knee joint%Ligaments%Wounds and injury%Magnetic resonance imaging
目的：探讨膝关节单发韧带损伤、多发韧带损伤及二者伴发半月板损伤的特点，比较分析MRI诊断单发韧带损伤、多发韧带损伤及伴发半月板损伤的准确性。方法对187例经临床手术证实为膝关节韧带损伤的MRI病例资料进行回顾性分析。结果187例病例中，单发韧带损伤103例，多发韧带损伤84例；单发韧带损伤组中，前交叉韧带（ACL）损伤38例，内侧副韧带（MCL）损伤36例，后交叉韧带（PCL）损伤14例，内侧髌股韧带（MPFL）损伤10例，髌韧带（PT）损伤3例，外侧副韧带（LCL）损伤2例，伴发内侧半月板（MM）损伤35例，伴发外侧半月板（LM）损伤23例；多发韧带损伤组中， ACL、MCL联合损伤37例，ACL、PCL联合损伤21例，ACL、PCL、MCL联合损伤10例，MPFL、MCL联合损伤8例，MPFL、MCL、ACL联合损伤4例，ACL、PT联合损伤2例，ACL、PCL、LCL联合损伤2例，伴发MM损伤43例，伴发LM损伤35例；单发韧带组与多发韧带组中，MRI诊断韧带损伤的敏感性、特异性、准确性分别为90.3%、97.7%、96.4%和81.5%、88.4%、85.9%，二者比较差异均有统计学意义（P＜0.05）；二者伴发MM、LM损伤的发生率分别为34%、22.3%和51.2%、41.7%，二者比较差异有统计学意义（P＜0.05），MRI诊断二者间伴发MM损伤的敏感性、特异性、准确性分别为88.6%、89.7%、89.3%和76.7%、65.9%、71.4%，二者比较特异性、准确性差异有显著统计学意义（P＜0.01），而敏感性差异无统计学意义（P＞0.05），MRI诊断二者间伴发LM损伤的敏感性、特异性、准确性分别为87%、93.8%、92.2%和85.7%、77.6%、77.4%，二者比较特异性、准确性差异有统计学意义（P＜0.05），而敏感性差异无统计学意义（P＞0.05）。结论单发韧带损伤以ACL损伤最为多见，其次为MCL；多发韧带损伤以ACL、MCL联合损伤最为常见，其次为ACL、PCL联合损伤，再次为ACL、PCL、MCL联合损伤；MRI诊断多发韧带损伤的敏感性、特异性、准确性均较单发韧带损伤下降；多发韧带损伤较单发韧带损伤更易伴发 MM、LM损伤；多发韧带组与单发韧带组比较，虽然MRI诊断伴发MM、LM损伤敏感性无明显差异，但特异性、准确性均较单发韧带组明显降低。
目的：探討膝關節單髮韌帶損傷、多髮韌帶損傷及二者伴髮半月闆損傷的特點，比較分析MRI診斷單髮韌帶損傷、多髮韌帶損傷及伴髮半月闆損傷的準確性。方法對187例經臨床手術證實為膝關節韌帶損傷的MRI病例資料進行迴顧性分析。結果187例病例中，單髮韌帶損傷103例，多髮韌帶損傷84例；單髮韌帶損傷組中，前交扠韌帶（ACL）損傷38例，內側副韌帶（MCL）損傷36例，後交扠韌帶（PCL）損傷14例，內側髕股韌帶（MPFL）損傷10例，髕韌帶（PT）損傷3例，外側副韌帶（LCL）損傷2例，伴髮內側半月闆（MM）損傷35例，伴髮外側半月闆（LM）損傷23例；多髮韌帶損傷組中， ACL、MCL聯閤損傷37例，ACL、PCL聯閤損傷21例，ACL、PCL、MCL聯閤損傷10例，MPFL、MCL聯閤損傷8例，MPFL、MCL、ACL聯閤損傷4例，ACL、PT聯閤損傷2例，ACL、PCL、LCL聯閤損傷2例，伴髮MM損傷43例，伴髮LM損傷35例；單髮韌帶組與多髮韌帶組中，MRI診斷韌帶損傷的敏感性、特異性、準確性分彆為90.3%、97.7%、96.4%和81.5%、88.4%、85.9%，二者比較差異均有統計學意義（P＜0.05）；二者伴髮MM、LM損傷的髮生率分彆為34%、22.3%和51.2%、41.7%，二者比較差異有統計學意義（P＜0.05），MRI診斷二者間伴髮MM損傷的敏感性、特異性、準確性分彆為88.6%、89.7%、89.3%和76.7%、65.9%、71.4%，二者比較特異性、準確性差異有顯著統計學意義（P＜0.01），而敏感性差異無統計學意義（P＞0.05），MRI診斷二者間伴髮LM損傷的敏感性、特異性、準確性分彆為87%、93.8%、92.2%和85.7%、77.6%、77.4%，二者比較特異性、準確性差異有統計學意義（P＜0.05），而敏感性差異無統計學意義（P＞0.05）。結論單髮韌帶損傷以ACL損傷最為多見，其次為MCL；多髮韌帶損傷以ACL、MCL聯閤損傷最為常見，其次為ACL、PCL聯閤損傷，再次為ACL、PCL、MCL聯閤損傷；MRI診斷多髮韌帶損傷的敏感性、特異性、準確性均較單髮韌帶損傷下降；多髮韌帶損傷較單髮韌帶損傷更易伴髮 MM、LM損傷；多髮韌帶組與單髮韌帶組比較，雖然MRI診斷伴髮MM、LM損傷敏感性無明顯差異，但特異性、準確性均較單髮韌帶組明顯降低。
목적：탐토슬관절단발인대손상、다발인대손상급이자반발반월판손상적특점，비교분석MRI진단단발인대손상、다발인대손상급반발반월판손상적준학성。방법대187례경림상수술증실위슬관절인대손상적MRI병례자료진행회고성분석。결과187례병례중，단발인대손상103례，다발인대손상84례；단발인대손상조중，전교차인대（ACL）손상38례，내측부인대（MCL）손상36례，후교차인대（PCL）손상14례，내측빈고인대（MPFL）손상10례，빈인대（PT）손상3례，외측부인대（LCL）손상2례，반발내측반월판（MM）손상35례，반발외측반월판（LM）손상23례；다발인대손상조중， ACL、MCL연합손상37례，ACL、PCL연합손상21례，ACL、PCL、MCL연합손상10례，MPFL、MCL연합손상8례，MPFL、MCL、ACL연합손상4례，ACL、PT연합손상2례，ACL、PCL、LCL연합손상2례，반발MM손상43례，반발LM손상35례；단발인대조여다발인대조중，MRI진단인대손상적민감성、특이성、준학성분별위90.3%、97.7%、96.4%화81.5%、88.4%、85.9%，이자비교차이균유통계학의의（P＜0.05）；이자반발MM、LM손상적발생솔분별위34%、22.3%화51.2%、41.7%，이자비교차이유통계학의의（P＜0.05），MRI진단이자간반발MM손상적민감성、특이성、준학성분별위88.6%、89.7%、89.3%화76.7%、65.9%、71.4%，이자비교특이성、준학성차이유현저통계학의의（P＜0.01），이민감성차이무통계학의의（P＞0.05），MRI진단이자간반발LM손상적민감성、특이성、준학성분별위87%、93.8%、92.2%화85.7%、77.6%、77.4%，이자비교특이성、준학성차이유통계학의의（P＜0.05），이민감성차이무통계학의의（P＞0.05）。결론단발인대손상이ACL손상최위다견，기차위MCL；다발인대손상이ACL、MCL연합손상최위상견，기차위ACL、PCL연합손상，재차위ACL、PCL、MCL연합손상；MRI진단다발인대손상적민감성、특이성、준학성균교단발인대손상하강；다발인대손상교단발인대손상경역반발 MM、LM손상；다발인대조여단발인대조비교，수연MRI진단반발MM、LM손상민감성무명현차이，단특이성、준학성균교단발인대조명현강저。
Objective To evaluate the characteristics of isolated and combined ligament injuries of knee joint, and compare the accuracy of MR imaging between above two type ligament injuries, incidence rate and diagnostic accuracy of concomitant meniscal tear. Methods MR images of 187 patients with ligament injuries proved clinically were reviewed. Results Among 187 patients, isolated ligament injury was seen in 103 cases and combined ligament injury in 84 cases. In isolated ligament injury group, there were 38 cases of anterior cruciate ligament (ACL) tear, 36 cases of medial collateral ligament (MCL) tear, 14 cases of posterior cruciate ligament (PCL) tear, 10 cases of medial patellofemoral ligament (MPFL) tear, 3 cases of patellar tendon (PT) tear, 2 cases of lateral collateral ligament (LCL) tear, which concomitant with 35 cases of medial meniscal (MM) tear and 23 cases of lateral meniscal (LM) tear. In combined ligaments injury group, there were 37 combined ACL and MCL injuries, 21 combined ACL and PCL injuries, 10 combined ACL, PCL, and MCL injuries, 8 combined MPFL and MCL injuries, 4 combined ACL, MCL, and MPFL injuries, 2 combined ACL and PT injuries, 2 combined ACL, PCL, and LCL injuries, which concomitant with 43 cases of MM tear and 35 cases of LM tear. The sensitivity, specificity and accuracy for diagnosing ligament tears to be 90.3%, 97.7%and 96.4%respectively in isolated ligament injury group, and 81.5%, 88.4% and 85.9% respectively significant(P<0.05). The concomitant incidence rate of MM tear and LM tear were 34% vs. 51.2% and 22.3% vs. 41.7% respectively, and the sensitivity, specificity and accuracy for diagnosing MM tear and LM tear were 88.6%vs. 76.7%, 89.7%vs. 65.9%, 89.3%vs. 71.4%and 87%vs. 85.7%, 93.8%vs. 77.6%, 92.2%vs. 77.4%respectively between isolated and combined ligaments injury group, which was statistically significant in incidence rate, diagnostic specificity and accuracy of concomitant meniscal tear(P<0.05), while no statistical difference in diagnosing sensitivity for meniscal tear(P>0.05). Conclusions ACL injury is the most common injury in isolated ligament injury group, followed by MCL injury. Combined ACL and MCL injuries are the most common injuries in combined ligaments injuries group, secondly followed by combined ACL and PCL injuries, and third followed by combined ACL, PCL, and MCL injuries. In knees with multiple ligament injuries, the diagnostic sensitivity, specificity and accuracy of MR imaging for ligament tears decrease significantly compared with isolated ligament injury, while the concomitant incidence rate of meniscal tear increases significantly compared with isolated ligament injury. Although there is no significant difference in diagnostic sensitivity, the diagnostic specificity, accuracy of MR imaging for ligament tears decreases significantly compared with isolated ligament injury in combined ligaments injuries group.
