CAJ | 학술논문

目的探讨MRI诊断前交叉韧带(ACL)重建患者前内侧束(AMB)和后外侧束(PLB)损伤的价值.方法回顾性分析行关节镜下ACL重建术且术前行患侧膝关节MRI检查的141例患者资料.MRI检查与关节镜下ACL重建术时间间隔为4～29d,中位时间11d.在MRI上观察AMB和PLB的损伤情况,并行正常、部分撕裂、完全撕裂分级.以关节镜结果为金标准,应用x2检验比较MRI诊断AMB、PLB损伤诊断符合率的差异.结果关节镜下,单束损伤13例(9.2％,13/141),其中AMB损伤11例,PLB损伤2例;AMB和PLB均损伤128例(90.8％,128/141).单束损伤和双束损伤发生率的差异有统计学意义(x2=6.532,P=0.011).MRI上,正常纤维束表现为韧带纤维束形态、走行、信号正常;部分撕裂表现为纤维束局限性撕裂,连续性中断,并可见残存的纤细呈正常信号的纤维束;完全撕裂表现为韧带纤维束连续性中断.MRI诊断AMB损伤的正确率为85.8％(121/141),诊断PLB损伤的正确率为72.3％(102/141),二者差异有统计学意义(x2=7.737,P=0.005).MRI诊断AMB、PLB部分撕裂的符合率分别为77.8％(14/18)、50.0％(15/30),二者差异无统计学意义(x2=3.630,P=0.057);MRI诊断AMB、PLB完全撕裂的符合率分别为87.6％(106/121)、84.0％(84/100),二者差异无统计学意义(x2=0.589,P=0.443);MRI诊断AMB部分撕裂与完全撕裂符合率的差异无统计学意义(x2=1.282,P=0.258);MRI诊断PLB部分撕裂与完全撕裂符合率的差异有统计学意义(x2=14.690,P=0.001).结论在ACL重建患者中,AMB、PLB完全撕裂常见,AMB、PLB单束损伤少见.MRI诊断ACL损伤具有价值,能较准确显示AMB、PLB完全撕裂及AMB部分撕裂,但对于PLB部分撕裂的诊断符合率仍需要进一步提高.
목적 탐토MRI진단전교차인대(ACL)중건환자전내측속(AMB)화후외측속(PLB)손상적개치.방법 회고성분석행관절경하ACL중건술차술전행환측슬관절MRI검사적141례환자자료.MRI검사여관절경하ACL중건술시간간격위4～29d,중위시간11d.재MRI상관찰AMB화PLB적손상정황,병행정상、부분시렬、완전시렬분급.이관절경결과위금표준,응용x2검험비교MRI진단AMB、PLB손상진단부합솔적차이.결과 관절경하,단속손상13례(9.2％,13/141),기중AMB손상11례,PLB손상2례;AMB화PLB균손상128례(90.8％,128/141).단속손상화쌍속손상발생솔적차이유통계학의의(x2=6.532,P=0.011).MRI상,정상섬유속표현위인대섬유속형태、주행、신호정상;부분시렬표현위섬유속국한성시렬,련속성중단,병가견잔존적섬세정정상신호적섬유속;완전시렬표현위인대섬유속련속성중단.MRI진단AMB손상적정학솔위85.8％(121/141),진단PLB손상적정학솔위72.3％(102/141),이자차이유통계학의의(x2=7.737,P=0.005).MRI진단AMB、PLB부분시렬적부합솔분별위77.8％(14/18)、50.0％(15/30),이자차이무통계학의의(x2=3.630,P=0.057);MRI진단AMB、PLB완전시렬적부합솔분별위87.6％(106/121)、84.0％(84/100),이자차이무통계학의의(x2=0.589,P=0.443);MRI진단AMB부분시렬여완전시렬부합솔적차이무통계학의의(x2=1.282,P=0.258);MRI진단PLB부분시렬여완전시렬부합솔적차이유통계학의의(x2=14.690,P=0.001).결론 재ACL중건환자중,AMB、PLB완전시렬상견,AMB、PLB단속손상소견.MRI진단ACL손상구유개치,능교준학현시AMB、PLB완전시렬급AMB부분시렬,단대우PLB부분시렬적진단부합솔잉수요진일보제고.
Objective To analyze the value of MRI in the diagnosis of anteromedial bundle(AMB) and posterolateral bundle (PLB) tears in patients undergoing anterior cruciate ligament (ACL) reconstruction.Methods MRI of 141 knees undergoing ACL reconstruction were retrospectively reviewed with using arthroscopy as golden standard to evaluate diagnostic accuracy of MRI to predict AMB and PLB injury conditions.The interval time between MRI and arthroscopic ACL reconstruction was 4 days to 29 days.The median time was 11 days.The injury patterns of AMB and PLB was observed on MRI and classified into normal type,partial tear and complete tear.Using the arthroscopic findings as the golden standard,MRI diagnostic accuracy of AMB and PLB tears was compared with Chi-square test.Results Thirteen cases (9.2％,13/141) with isolated bundle injury were identified in the arthroscopic assessments among 141 patients,including 11 cases with isolated AMB injury and 2 cases with isolated PLB injury.Combined AMB and PLB injury were all identified in the remaining 128 knees (90.8％,128/141).There was statistical difference between the incidence rate of isolated bundle injury and double-bundles injury (x2=6.532,P=0.011).Partial tear was defined as partially torn or interrupted fiber bundles with remaining normal fiber bundles.Complete tear was defined as the fiber bundles in the expected region of the ligament were completely discontinuous.The diagnostic accuracy of MRI in prediction of AMB injury was better than PLB [85.8％ (121/141) versus 72.3％ (102/141);x2=7.737,P=0.005].There was no statistical difference between the accuracy rate of MRI in diagnosis of partial AMB and PLB tear [77.8％ (14/18) versus 50.0％ (15/30);x2=3.630,P=0.057].There was no statistical difference between the accuracy rate of MRI in diagnosis of complete AMB and PLB tear [87.6％ (106/121) versus 84.0％ (84/100);x2=0.589,P=0.443].There was no statistical difference between the accuracy rate of MRI in diagnosis of partial and complete AMB tear (x2=1.282,P=0.258).There was statistical difference between the accuracy rate of MRI in diagnosis of partial and complete PLB tear (x2=14.690,P=0.001).Conclusions Complete AMB and PLB tear are the common injury patterns among patients undergoing ACL reconstruction,while an isolated AMB or PLB tear is uncommon.MRI is of value in the diagnosis of ACL injury.MRI can accurately diagnose complete AMB tear,complete PLB tear and partial AMB tear,but the diagnostic accuracy of MRI in assessing partial PLB tear needs to be improved.