CAJ | 학술논문

目的探讨磁共振成像(MRI)技术在膝关节软骨损伤术前风险评判和手术方案制定中的临床应用价值. 方法 2013年1月至2014年6月共收集经手术证实的69例膝关节软骨损伤患者,男29例,女40例;年龄为15～76岁,平均46.9岁.69例患者术前均行1.5T磁共振四肢关节专用诊断仪常规检查,检查后依据Outerbridge分级标准进行分型,评估手术风险并制定相应手术方式(如钻孔术、微骨折术及自体软骨移植术).对比术中实际观察所见结果与术前MRI检查的符合情况.结果本组69例患者术前MRI检查发现345个软骨面,其中208个软骨面MRI表现异常:Ⅰ级75个(21.7％),表现为轮廓完整或略微隆起,软骨内有点片状低或高信号;Ⅱ级39个(11.3％),表现为关节软骨变薄、缺损,但未超过全层的50％,或(和)软骨表面不光整、呈锯齿状或波浪状,软骨内有点片状高低信号混杂影,关节腔内可见积液信号;Ⅲ级43个(12.5％),表现为软骨明显变薄,软骨局部缺损超过全层50％,多有关节腔内积液;Ⅳ级51个(14.8％),可见局部软骨全层缺损,缺损部位软骨下骨质暴露且伴有相邻组织结构异常.MRI检查结果(膝关节软骨损伤数量和程度)与术中所见基本一致. 结论 MRI能够准确显示膝关节软骨损伤的位置、大小、范围,可为临床制定手术方案提供可靠依据.
목적 탐토자공진성상(MRI)기술재슬관절연골손상술전풍험평판화수술방안제정중적림상응용개치. 방법 2013년1월지2014년6월공수집경수술증실적69례슬관절연골손상환자,남29례,녀40례;년령위15～76세,평균46.9세.69례환자술전균행1.5T자공진사지관절전용진단의상규검사,검사후의거Outerbridge분급표준진행분형,평고수술풍험병제정상응수술방식(여찬공술、미골절술급자체연골이식술).대비술중실제관찰소견결과여술전MRI검사적부합정황.결과 본조69례환자술전MRI검사발현345개연골면,기중208개연골면MRI표현이상:Ⅰ급75개(21.7％),표현위륜곽완정혹략미륭기,연골내유점편상저혹고신호;Ⅱ급39개(11.3％),표현위관절연골변박、결손,단미초과전층적50％,혹(화)연골표면불광정、정거치상혹파랑상,연골내유점편상고저신호혼잡영,관절강내가견적액신호;Ⅲ급43개(12.5％),표현위연골명현변박,연골국부결손초과전층50％,다유관절강내적액;Ⅳ급51개(14.8％),가견국부연골전층결손,결손부위연골하골질폭로차반유상린조직결구이상.MRI검사결과(슬관절연골손상수량화정도)여술중소견기본일치. 결론 MRI능구준학현시슬관절연골손상적위치、대소、범위,가위림상제정수술방안제공가고의거.
Objective To explore clinical value of magnetic resonance imaging (MRI) in preoperative risk assessment and choice of operation scheme for knee cartilage injury.Methods A retrospective study was conducted of the 69 cases of knee cartilage injury which had been confirmed by surgery between January 2013 and June 2014.They were 29 males and 40 females,aged from 15 to 76 years (average,46.9 years).All cases underwent preoperative 1.5 T MRI by a special diagnostic instrument for limbs.The injury was assessed after MRI according to the Outerbridge criteria to evaluate surgical risks and choose an appropriate operation scheme (drilling,micro-fracture or autoallergic cartilage grafting).The intraoperative observations were compared with the preoperative images.Results MRI found in the 69 patients 345 cartilage surfaces,of which 208 were abnormal.Of the abnormal ones,75 (21.7％) were grade Ⅰ which presented with intact or slightly eminent contour and dots or patches of low or high signals in the cartilage;39 (11.3％) were grade Ⅱ which presented with thinned cartilage,defects ＜ 50％ of the full thickness,or (and) indented or wavy cartilage surface,dots or patches of low or high signals in the cartilage,and dropsy signals in cavity;43 (12.5％) were grade Ⅲ which obviously thinned cartilage,defects ＞ 50％ of the full thickness,and massive dropsy signals in cavity;51 (14.8％) were grade Ⅳ which presented with full thickness defects of cartilage,subchondral bone exposure beneath the defcts,and abnormal adjacent tissues.The preoperative findings were in agreement with what were observed during surgery in terms of number and extent of cartilage injury.Conclusion Because MRI can exactly display knee cartilage injury in terms of location,degree,and size,it provides solid evidence for preoperative risk assessment and choice of operation scheme for knee cartilage injury.