膝关节内外侧半月板后根部撕裂的MRI诊断价值
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摘要
目的:探讨MRI对膝关节内外侧半月板后根部撕裂的诊断价值。方法:回顾性分析2012年1月至2016年1月,关节镜下证实为半月板后根部撕裂的患者43例。其中男25例,女18例;年龄27~69(42.5±8.3)岁;右侧27例,左侧16例。由2名医师采用双盲法独立回顾性分析经关节镜证实的43例半月板后根部撕裂患者的MRI表现,计算MRI对半月板后根部撕裂的诊断敏感性、特异性和准确性,并计算膝关节韧带损伤及半月板脱位等伴随情况。结果:143例中,关节镜手术证实43例半月板后根部撕裂,包括内侧撕裂24例,外侧撕裂19例。医师A诊断内侧半月板后根部撕裂的敏感性、特异性、准确性分别为91.67%、86.6%、83.9%,伴内侧半月板突出19例,伴前交叉韧带撕裂2例;外侧半月板后跟部撕裂的敏感性、特异性、准确性分别为73.7%、79.9%、79%,伴外侧半月板突出4例,伴前交叉韧带撕裂16例。医师B诊断内侧半月板后根部撕裂的敏感性、特异性、准确性分别为87.5%、87.4%、87.4%,伴内侧半月板突出19例,伴前交叉韧带撕裂2例;外侧半月板后跟部撕裂的敏感性、特异性、准确性分别为78.9%、82.3%、82.5%,伴外侧半月板突出4例,伴前交叉韧带撕裂16例。2名医师采用MRI诊断内、外侧半月板后根部撕裂的一致性均好,Kappa值分别为0.81和0.67。结论 :膝关节MRI诊断内外侧半月板后跟部撕裂及其伴随征象具有较大价值,为临床医生术前诊断提供依据,值得临床推广应用。
Objective:To explore diagnostic value of MRI on posterior root tear of medial and lateral meniscus. Methods:From January 2012 to January 2016,clinical data of 43 patients with meniscal posterior root tear confirmed by arthroscopy were retrospective analyzed,including 25 males and 18 females,aged from 27 to 69 years old with an average age of(42.5±8.3)years old;27 cases on the right side and 16 cases on the left side. MRI examinations of 43 patients with tear of posterior meniscus root confirmed by knee arthroscopies were retrospectively reviewed. MRI images were double blinded,independently,retrospectively scored by two imaging physicians. Sensitivity,specificity and accuracy of MRI diagnosis of lateral and medial meniscus posterior root tear were calculated,and knee ligament injury and meniscal dislocation were calculated. Results:Forty three of 143 patients were diagnosed with meniscus posterior root tears by arthroscopy,including 19 patients with lateral tears and 24 patients with medial tears. The sensitivity,specificity and accuracy in diagnosis of posterior medial meniscus root tears for doctor A were 91.67%,86.6% and 83.9% respectively,and for doctor B were 87.5%,87.4% and 87.4%,19 patients with medial meniscal protrusion and 2 patients with anterior cruciate ligament tear. The sensitivity,specificity and accuracy in diagnosis of posterior lateral meniscus root tears for doctor A were 73.7%,79.9% and 79% respectively,and for doctor B were 78.9%,82.3% and 82.5%,4 patients with lateral meniscus herniation and 16 patients with cruciate ligament tear. Kappa statistics for posterior medial meniscus root tears and posterior lateral meniscus root tears were 0.84 and 0.72. Conclusion:MRI could effectively demonstrate imaging features of medial and lateral meniscal root tear and its accompanying signs. It could provide the basis for preoperative diagnosis of clinicians,and be worthy to be popularized.
Objective:To explore diagnostic value of MRI on posterior root tear of medial and lateral meniscus. Methods:From January 2012 to January 2016,clinical data of 43 patients with meniscal posterior root tear confirmed by arthroscopy were retrospective analyzed,including 25 males and 18 females,aged from 27 to 69 years old with an average age of(42.5±8.3)years old;27 cases on the right side and 16 cases on the left side. MRI examinations of 43 patients with tear of posterior meniscus root confirmed by knee arthroscopies were retrospectively reviewed. MRI images were double blinded,independently,retrospectively scored by two imaging physicians. Sensitivity,specificity and accuracy of MRI diagnosis of lateral and medial meniscus posterior root tear were calculated,and knee ligament injury and meniscal dislocation were calculated. Results:Forty three of 143 patients were diagnosed with meniscus posterior root tears by arthroscopy,including 19 patients with lateral tears and 24 patients with medial tears. The sensitivity,specificity and accuracy in diagnosis of posterior medial meniscus root tears for doctor A were 91.67%,86.6% and 83.9% respectively,and for doctor B were 87.5%,87.4% and 87.4%,19 patients with medial meniscal protrusion and 2 patients with anterior cruciate ligament tear. The sensitivity,specificity and accuracy in diagnosis of posterior lateral meniscus root tears for doctor A were 73.7%,79.9% and 79% respectively,and for doctor B were 78.9%,82.3% and 82.5%,4 patients with lateral meniscus herniation and 16 patients with cruciate ligament tear. Kappa statistics for posterior medial meniscus root tears and posterior lateral meniscus root tears were 0.84 and 0.72. Conclusion:MRI could effectively demonstrate imaging features of medial and lateral meniscal root tear and its accompanying signs. It could provide the basis for preoperative diagnosis of clinicians,and be worthy to be popularized.
引文
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[3]De Smet AA,Blankenbaker DG,Kijowski R,et al.MR diagnosis of posterior root tears of the lateral meniscus using arthroscopy as the reference standard[J].AJR Am J Roentgenol,2009,192(2):480-486.
[4]Koenig JH,Ranawat AS,Umans HR,et al.Meniscal root tears:di鄄agnosis and treatment[J].Arthroscopy,2009,25(9):1025-1032.
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[6]Costa CR,Morrison WB,Carrino JA.Medial meniscus extrusion on knee MRI:is extent associated with severity of degenerationor type of tear[J].AJR Am J Roentgenol,2004,183(1):17-23.
[7]Brody JM,Lin HM,Hulstyn MJ,et al.Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear[J].Radiol鄄ogy,2006,239(3):805-810.
[8]Papalia R,Vasta S,Franceschi F,et al.Meniscal root tears:from basic science to ultimate surgery[J].Br Med Bull,2013,106:91-115.
[9]Johannsen AM,Civitarese DM,Padalecki JR,et al.Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci[J].Am J Sports Med,2012,40(10):2342-2347.
[10]刘秀香,郑卓肇,程钢,等.MR诊断膝关节内、外侧半月板后根部撕裂的价值[J].中华放射学杂志,2014,48(11):919-922.LIU XX,ZHENG ZZ,CHENG G,et al.The value of MR in diag鄄nosis of posterior root tear of the medial and lateral meniscus[J].Zhonghua Fang She Xue Za Zhi,2014,48(11):919-922.Chi鄄nese.
[11]Brody JM,Hulstyn MJ,Fleming BC,et al.The meniscal roots:gross anatomic correlation with 3-T MRI findings[J].AJR J Roentgenol,2007,188(5):446-450.
[12]张建军,郑卓肇,李选,等.膝关节半月板后根部撕裂的MRI评价[J].中华放射学杂志,2010,44(12):1300-1303.ZHANG JJ,ZHENG ZZ,LI X,et al.MRI evaluation of the posterior meniscus root tear[J].Zhonghua Fang She Xue Za Zhi,2010,44(12):1300-1303.Chinese.
[13]Marzo JM,Gurske DePerio J.Effects of medial meniscus posterior horn avulsion and Repair on tibiofemoral contact area and peak contact pressure with clinical implications[J].Am J Sports Med,2009,37(1):124-129.
[14]Lerer DB,Umaus HR,Hu MX,et al.The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion[J].Skeletal Radiol,2004,33(11):569-574.
[15]Brody JM,Lin HM,Hulstyn MJ,et al.Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament teal[J].Radiology,2006,239(9):805-810.
[16]Park LS,Jacobson JA,Jamadar DA,et at.Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear:Mm findings[J].Skelet Radiol,2007,36(9):399-403.
[2]Allaire R,Muriuki M,Gilberston L,et al.Biomechanical conse鄄quences of a tear of the posterior root of the medial meniscus[J].J Bone Joint Surg Am,2008,90(10):1922-1931.
[3]De Smet AA,Blankenbaker DG,Kijowski R,et al.MR diagnosis of posterior root tears of the lateral meniscus using arthroscopy as the reference standard[J].AJR Am J Roentgenol,2009,192(2):480-486.
[4]Koenig JH,Ranawat AS,Umans HR,et al.Meniscal root tears:di鄄agnosis and treatment[J].Arthroscopy,2009,25(9):1025-1032.
[5]Jones C,Reddy S,Ma CB.Repair of the posterior root of the medial meniscus[J].Knee,2009,17(8):77-80.
[6]Costa CR,Morrison WB,Carrino JA.Medial meniscus extrusion on knee MRI:is extent associated with severity of degenerationor type of tear[J].AJR Am J Roentgenol,2004,183(1):17-23.
[7]Brody JM,Lin HM,Hulstyn MJ,et al.Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear[J].Radiol鄄ogy,2006,239(3):805-810.
[8]Papalia R,Vasta S,Franceschi F,et al.Meniscal root tears:from basic science to ultimate surgery[J].Br Med Bull,2013,106:91-115.
[9]Johannsen AM,Civitarese DM,Padalecki JR,et al.Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci[J].Am J Sports Med,2012,40(10):2342-2347.
[10]刘秀香,郑卓肇,程钢,等.MR诊断膝关节内、外侧半月板后根部撕裂的价值[J].中华放射学杂志,2014,48(11):919-922.LIU XX,ZHENG ZZ,CHENG G,et al.The value of MR in diag鄄nosis of posterior root tear of the medial and lateral meniscus[J].Zhonghua Fang She Xue Za Zhi,2014,48(11):919-922.Chi鄄nese.
[11]Brody JM,Hulstyn MJ,Fleming BC,et al.The meniscal roots:gross anatomic correlation with 3-T MRI findings[J].AJR J Roentgenol,2007,188(5):446-450.
[12]张建军,郑卓肇,李选,等.膝关节半月板后根部撕裂的MRI评价[J].中华放射学杂志,2010,44(12):1300-1303.ZHANG JJ,ZHENG ZZ,LI X,et al.MRI evaluation of the posterior meniscus root tear[J].Zhonghua Fang She Xue Za Zhi,2010,44(12):1300-1303.Chinese.
[13]Marzo JM,Gurske DePerio J.Effects of medial meniscus posterior horn avulsion and Repair on tibiofemoral contact area and peak contact pressure with clinical implications[J].Am J Sports Med,2009,37(1):124-129.
[14]Lerer DB,Umaus HR,Hu MX,et al.The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion[J].Skeletal Radiol,2004,33(11):569-574.
[15]Brody JM,Lin HM,Hulstyn MJ,et al.Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament teal[J].Radiology,2006,239(9):805-810.
[16]Park LS,Jacobson JA,Jamadar DA,et at.Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear:Mm findings[J].Skelet Radiol,2007,36(9):399-403.