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MRI在前交叉韧带损 伤辅助诊断中的应用

作者:陈 勇

所属单位:沈阳医学院奉天医院骨外科(辽宁 沈阳 110075)

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摘要

目的 研究磁共振成像(MRI)在 前交叉韧带损伤辅助诊断中的应用。方 法 选取我院2011年9月至2013年9月前交 叉韧带损伤患者78例,对患者先进行临床 检查和MRI检查,然后进行关节镜手术检 查。以关节镜检查的结果为金标准,比较 临床检查和MRI检查两种方式对前交叉韧 带损伤的诊断情况、准确度、敏感度和特 异度。结果 临床检查前交叉韧带的真阳 性率为38.46%较MRI检查66.67%显著较低 (P<0.05);临床检查前交叉韧带的假阴 性率为21.79%较MRI检查2.56%显著较高(P <0.05);MRI检查的准确度为94.87%、敏 感度为66.67%较临床检查70.51%、38.46% 显著较高(P<0.05)。结论 MRI检查是一 种无创、无放射性、准确性较高的诊断方 法,其检查结果能为关节镜检查和前交叉 韧带重建提供重要依据,在交叉韧带损伤 的诊断方面有一定的临床价值,应予以应 用推广。

Objective To study application of magnetic resonance imaging (MRI) in auxiliary diagnosis of anterior cruciate ligament injury. Methods 78 cases of anterior cruciate ligament injury treated in our hospital from September 2011 to September 2013 were selected, all patients underwent clinical examination and MRI examination, then underwent arthroscope operations research examination. Arthroscope operations research examination results were served as the gold standard, diagnosis of anterior cruciate ligament injury, accuracy, sensitivity and specificity by clinical examination and MRI examination were compared. Results True positive rate of clinical examination anterior cruciate ligament was 38.46%, which was significantly lower than MRI examination (66.67%) (P<0.05); false negative rate of clinical examination anterior cruciate ligament was 21.79%, which was significantly higher than MRI examination (2.56%) (P<0.05); accuracy of MRI examination was 94.87%, sensitivity was 66.67%, which were significantly higher than clinical examination (70.51%, 38.46%) (P<0.05). Conclusion MRI examination is a noninvasive, non radioactive diagnostic method with a higher accuracy, its inspection result can provide an important basis for arthroscopic examination and anterior cruciate ligament reconstruction, it has some clinical value in the diagnosis of cruciate ligament injury, should be applied and popularized.

【关键词】MRI;前交叉韧带损伤;诊断

【中图分类号】R445.2;R686

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.10.040

前言

前交叉韧带损伤是一种常见的膝关节损伤,前交叉韧带是膝关节 重要的前向稳定结构,损伤后会造成膝关节不稳定,膝关节功能受 损、疼痛,影响正常行走,若不能得到及时的诊断治疗,可继发膝关 节不稳定、创伤性关节炎、月半板损伤、软骨退变等损伤,严重影 响患者的生活质量[1-2]。临床上治疗前交叉韧带损伤的主要方法是手 术重建治疗,早期的诊断对重建方案的选择与对预后的判断有重要意 义[3]。临床诊断中,肢体血肿、肌肉痉挛等现象会影响最终的判断, 往往会出现许多假阳性的检查结果,误诊率较高[4]。关节镜检查被视 为前交叉韧带损伤检查的金标准,属于一种微创手术,是将关节镜插 入关节内部直接观察关节内部的结构,而MRI检查因其具有无创性, 且对肌肉、肌腱的软组织具有较高的分辨率在临床诊断中逐渐得到重 视[5-6]。为提高对前交叉韧带损伤患者的诊断水平,本次研究特选取我 院前交叉韧带损伤患者78例,先进行临床检查和MRI检查,再进行关节 镜检查,现将结果报告如下。