中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2014年
8期
659-663
,共5页
吴俊峰%刘丽思%郑卓肇%付乃奇
吳俊峰%劉麗思%鄭卓肇%付迺奇
오준봉%류려사%정탁조%부내기
关节不稳定性%髌骨%膝关节%磁共振成像
關節不穩定性%髕骨%膝關節%磁共振成像
관절불은정성%빈골%슬관절%자공진성상
Joint instability%Patella%Knee joint%Magnetic resonance imaging
目的 探讨MR横断面定量测量指标对髌股关节不稳患者的诊断价值.方法 回顾性分析术前行膝关节MR检查,并经关节镜手术证实为髌股关节不稳的患者32例共34个患膝关节资料,作为髌股关节不稳组.为与髌股关节不稳组患者进行对照,收集无不适症状、无膝关节外伤或手术病史的23名志愿者作为对照组.对髌股关节不稳组患者患膝关节及志愿者双膝关节行伸膝位MR扫描,在横断面抑脂质子密度加权图像上测量股骨滑车面对称性、股骨外侧滑车倾斜度、股骨滑车深度、髌骨倾斜角、髌骨外移度和股骨滑车与胫骨结节水平距离(TTTG)6个指标,并采用独立样本t检验或Mann-Whitney U检验进行比较.采用ROC曲线观察各测量指标的曲线下面积,并以约登指数最大点作为诊断界值,计算各指标诊断髌股关节不稳的敏感度和特异度.结果 髌股关节不稳组患者的滑车面对称性、股骨外侧滑车倾斜度、股骨滑车深度分别为45.0％±9.2％、10.9°±5.0°和(3.7±1.3) mm,对照组上述指标分别为68.0％±10.5％、21.1°±3.4°和(6.3±1.0) mm,髌股关节不稳组患者低于对照组,差异有统计学意义(t值分别为10.123、10.862和9.835,P均＜0.01).髌股关节不稳组患者的髌骨倾斜角和髌骨外移度分别为24.8°±9.0°和7.36 mm,对照组分别为12.3°±5.2°和-3.93 mm,患者组较对照组增大,差异均有统计学意义(t值和Z值分别为-7.657和-6.953,P均＜0.01).2组间TTTG差异无统计学意义(P=0.798).股骨滑车面对称性、股骨外侧滑车倾斜度、股骨滑车深度、髌骨倾斜角和髌骨外移度诊断髌股关节不稳的曲线下面积分别为0.957、0.957、0.947、0.921和0.961,其诊断界值分别为＜55％、＜15°、＜5 mm、＞17°和＜3 mm,诊断的敏感度分别为91.2％(31/34)、85.3％(29/34)、91.2％ (31/34)、82.4％(28/34)和79.4％(27/34),特异度分别为91.3％(42/46)、97.8％(45/46)、89.1％(41/46)、89.1％(41/46)和100.0％(46/46).TTTG的曲线下面积为0.520.结论 伸膝状态下,股骨滑车面对称性、股骨外侧滑车倾斜度、股骨滑车深度、髌骨倾斜角及髌骨外移度对髌股关节不稳具有较好的诊断价值,而TTTG的诊断价值较低.
目的 探討MR橫斷麵定量測量指標對髕股關節不穩患者的診斷價值.方法 迴顧性分析術前行膝關節MR檢查,併經關節鏡手術證實為髕股關節不穩的患者32例共34箇患膝關節資料,作為髕股關節不穩組.為與髕股關節不穩組患者進行對照,收集無不適癥狀、無膝關節外傷或手術病史的23名誌願者作為對照組.對髕股關節不穩組患者患膝關節及誌願者雙膝關節行伸膝位MR掃描,在橫斷麵抑脂質子密度加權圖像上測量股骨滑車麵對稱性、股骨外側滑車傾斜度、股骨滑車深度、髕骨傾斜角、髕骨外移度和股骨滑車與脛骨結節水平距離(TTTG)6箇指標,併採用獨立樣本t檢驗或Mann-Whitney U檢驗進行比較.採用ROC麯線觀察各測量指標的麯線下麵積,併以約登指數最大點作為診斷界值,計算各指標診斷髕股關節不穩的敏感度和特異度.結果 髕股關節不穩組患者的滑車麵對稱性、股骨外側滑車傾斜度、股骨滑車深度分彆為45.0％±9.2％、10.9°±5.0°和(3.7±1.3) mm,對照組上述指標分彆為68.0％±10.5％、21.1°±3.4°和(6.3±1.0) mm,髕股關節不穩組患者低于對照組,差異有統計學意義(t值分彆為10.123、10.862和9.835,P均＜0.01).髕股關節不穩組患者的髕骨傾斜角和髕骨外移度分彆為24.8°±9.0°和7.36 mm,對照組分彆為12.3°±5.2°和-3.93 mm,患者組較對照組增大,差異均有統計學意義(t值和Z值分彆為-7.657和-6.953,P均＜0.01).2組間TTTG差異無統計學意義(P=0.798).股骨滑車麵對稱性、股骨外側滑車傾斜度、股骨滑車深度、髕骨傾斜角和髕骨外移度診斷髕股關節不穩的麯線下麵積分彆為0.957、0.957、0.947、0.921和0.961,其診斷界值分彆為＜55％、＜15°、＜5 mm、＞17°和＜3 mm,診斷的敏感度分彆為91.2％(31/34)、85.3％(29/34)、91.2％ (31/34)、82.4％(28/34)和79.4％(27/34),特異度分彆為91.3％(42/46)、97.8％(45/46)、89.1％(41/46)、89.1％(41/46)和100.0％(46/46).TTTG的麯線下麵積為0.520.結論 伸膝狀態下,股骨滑車麵對稱性、股骨外側滑車傾斜度、股骨滑車深度、髕骨傾斜角及髕骨外移度對髕股關節不穩具有較好的診斷價值,而TTTG的診斷價值較低.
목적 탐토MR횡단면정량측량지표대빈고관절불은환자적진단개치.방법 회고성분석술전행슬관절MR검사,병경관절경수술증실위빈고관절불은적환자32례공34개환슬관절자료,작위빈고관절불은조.위여빈고관절불은조환자진행대조,수집무불괄증상、무슬관절외상혹수술병사적23명지원자작위대조조.대빈고관절불은조환자환슬관절급지원자쌍슬관절행신슬위MR소묘,재횡단면억지질자밀도가권도상상측량고골활차면대칭성、고골외측활차경사도、고골활차심도、빈골경사각、빈골외이도화고골활차여경골결절수평거리(TTTG)6개지표,병채용독립양본t검험혹Mann-Whitney U검험진행비교.채용ROC곡선관찰각측량지표적곡선하면적,병이약등지수최대점작위진단계치,계산각지표진단빈고관절불은적민감도화특이도.결과 빈고관절불은조환자적활차면대칭성、고골외측활차경사도、고골활차심도분별위45.0％±9.2％、10.9°±5.0°화(3.7±1.3) mm,대조조상술지표분별위68.0％±10.5％、21.1°±3.4°화(6.3±1.0) mm,빈고관절불은조환자저우대조조,차이유통계학의의(t치분별위10.123、10.862화9.835,P균＜0.01).빈고관절불은조환자적빈골경사각화빈골외이도분별위24.8°±9.0°화7.36 mm,대조조분별위12.3°±5.2°화-3.93 mm,환자조교대조조증대,차이균유통계학의의(t치화Z치분별위-7.657화-6.953,P균＜0.01).2조간TTTG차이무통계학의의(P=0.798).고골활차면대칭성、고골외측활차경사도、고골활차심도、빈골경사각화빈골외이도진단빈고관절불은적곡선하면적분별위0.957、0.957、0.947、0.921화0.961,기진단계치분별위＜55％、＜15°、＜5 mm、＞17°화＜3 mm,진단적민감도분별위91.2％(31/34)、85.3％(29/34)、91.2％ (31/34)、82.4％(28/34)화79.4％(27/34),특이도분별위91.3％(42/46)、97.8％(45/46)、89.1％(41/46)、89.1％(41/46)화100.0％(46/46).TTTG적곡선하면적위0.520.결론 신슬상태하,고골활차면대칭성、고골외측활차경사도、고골활차심도、빈골경사각급빈골외이도대빈고관절불은구유교호적진단개치,이TTTG적진단개치교저.
Objective To explore the value of 6 commonly-used quantitative measures on crosssectional MR images to diagnose the patellofemoral instability.Methods Clinical data of 32 patients with patellofemoral instability(34 knees) confirmed by arthroscopy surgery were retrospective analyzed.Knee MR imaging at full extension of the knee was performed in them.Their MR images were compared with those of 23 asymptomatic volunteers.Trochlear facet asymmetry,lateral trochlear inclination,trochlear depth,patellar tilt angle,lateral patellar displacement,and tibial tuberosity-trochlear groove distance(TTTG) were measured in transverse fat-suppressed turbo spin-echo proton density-weighted MR images.Independent sample t test or Mann-Whitney U test were used to compare the differences of these measurements.ROC was used to calculate the area under curve(AUC) and to define the diagnostic threshold value of each measure.Results Trochlear facet asymmetry,lateral trochlear inclination,and trochlear depth in patients were 45.0％±9.2％,10.9°±5.0° and(3.7±1.3) mm,while these measurements were 68.0％±10.5％,21.1°±3.4° and (6.3 ± 1.0) mm in volunteers.These measures were significantly lower in patients than those in volunteers (t values were 10.123,10.862 and 9.835,P＜0.01).Patellar tilt angle and lateral patellar displacement were significantly higher in patients than those in volunteers(24.8°±9.0° vs.12.3°±5.2°,7.36 mm vs.-3.93 mm,t value and Z value were-7.657 and-6.953,P＜0.01).TTTG showed no significant difference between the 2 groups(P=0.798).AUC of trochlear facet asymmetry,lateral trochlear inclination,trochlear depth,patellar tilt angle,and lateral patellar displacement were 0.957,0.957,0.947,0.921 and 0.961,respectively.The recommended diagnostic threshold values for these 5 measures were＜55％,＜15°,＜5 mm,＞17° and＜3 mm,respectively.The sensitivity for these five measurements were 91.2％ (31/34),85.3％ (29/34),91.2％ (31/34),82.4％ (28/34) and 79.4％ (27/34),respectively.The specificity for these five measures were 91.3％ (42/46),97.8％ (45/46),89.1％ (41/46),89.1％ (41/46) and 100.0％ (46/46),respectively.AUC of TTTG was 0.520.Conclusions At full extension of the knee,trochlear facet asymmetry,lateral trochlear inclination,trochlear depth,patellar tilt angle and lateral patellar displacement are all effective in evaluating patellofemoral instability.The diagnostic value of TTTG is relatively poor.
