膝半月板MRI影像测量与分析及数据库建立
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摘要
背景
随着现代医学的发展,半月板对于膝关节乃至下肢活动的重要功能已经得到越来越明确的认识。半月板具有传导负荷、吸收震荡、加强膝关节活动的协调性和稳定性以及润滑关节、防治膝关节软骨过早磨损等功能,故准确诊断半月板疾病显得尤为重要。而目前临床的研究多停留在损伤及病变的半月板,对正常半月板的形态及其与关节软骨的关系均无明确阐述,且广东省内尚未建立正常膝关节半月板各项解剖学数据库,而目前已有文献中的测量方法有待完善。
目的
主要通过精确测量膝关节半月板在MRI扫描的大小,初步建立广东省正常膝关节半月板的大体解剖学测量数据库,为半月板的临床研究及疾病诊断提供依据。
方法
对男女共690名广东籍人士行膝MRI扫描,测量MRI图像中上内外侧半月板的长度、宽度、厚度,胫骨平台的最大矢状径、最大横径,股骨内外髁的横纵径,并通过计算得出各项数据间比例关系,建立数据库。
结果
建立了广东地区半月板相关数值的数据库,并按年龄分组对其进行分析；对半月板周缘性移位发生的机理和相关因素进行深入的探讨；分析内外侧半月板损伤的发生率；探讨了半月板退变、股骨髁变形及关节软骨三者退变的关系；
结论
一定程度上揭示了半月板退变与年龄、软骨退变的关系；通过线性回归性分析证明了半月板周缘性脱位与半月板宽度及厚度的系数关系；揭示股骨髁曲度随年龄增长可能变平,并用曲度将其量化；证实了半月板退变与膝骨关节炎的相关性,为诊断和治疗半月板退变及膝关节退行性变提供有价值的理论依据。
Objectives
Set up the anatomic database of meniscus in nomal knee joint in Guangdong Province by the accurate measurement of knee in MRI imaging and provide evidence to improve the clinical research and diagnosis of meniscus.
Methods
We select normal knee MRI scan of about690people in Guangdong Province, measure the width and the thickness of medial meniscus and lateral meniscus, and measure the maximum transverse diameter and longitudina diameter of the tibial plateau, and measure the transverse diameter and longitudina diameter of the lateral femoral condyle. Then we get the ratio of the data above by calculate and set up the anatomic database of meniscus.
Result
To establish the anatomic database of meniscus in Guangdong Province and set up the analysis according to the age group; to make a deep analysis of the incidence of radial displacement of meniscus and find out the reason; then we set up an analysis about the incidence of injury in medial and lateral meniscus; then we explore the relationship between meniscal degeneration and change of the femoral condyle and the degeneration of cartilage, and quantify the change of the femoral condyle with curvature.
Conelusion
We reveal the relationship of cartilage degeneration, meniscal degeneration and age to a certain extent, and prove that the incidence of radial displacement of meniscus have coefficient relationship with the width and thickness of meniscus by linear regression analysis. Then we reveal the flatting of femoral condyle with age and quantify it with curvature, and confirmed the relationship between degeneration of meniscus and osteoarthritis of knee, and provide some valuable theoretical basis to prevent the degeneration of meniscus and knee at last.
随着现代医学的发展,半月板对于膝关节乃至下肢活动的重要功能已经得到越来越明确的认识。半月板具有传导负荷、吸收震荡、加强膝关节活动的协调性和稳定性以及润滑关节、防治膝关节软骨过早磨损等功能,故准确诊断半月板疾病显得尤为重要。而目前临床的研究多停留在损伤及病变的半月板,对正常半月板的形态及其与关节软骨的关系均无明确阐述,且广东省内尚未建立正常膝关节半月板各项解剖学数据库,而目前已有文献中的测量方法有待完善。
目的
主要通过精确测量膝关节半月板在MRI扫描的大小,初步建立广东省正常膝关节半月板的大体解剖学测量数据库,为半月板的临床研究及疾病诊断提供依据。
方法
对男女共690名广东籍人士行膝MRI扫描,测量MRI图像中上内外侧半月板的长度、宽度、厚度,胫骨平台的最大矢状径、最大横径,股骨内外髁的横纵径,并通过计算得出各项数据间比例关系,建立数据库。
结果
建立了广东地区半月板相关数值的数据库,并按年龄分组对其进行分析；对半月板周缘性移位发生的机理和相关因素进行深入的探讨；分析内外侧半月板损伤的发生率；探讨了半月板退变、股骨髁变形及关节软骨三者退变的关系；
结论
一定程度上揭示了半月板退变与年龄、软骨退变的关系；通过线性回归性分析证明了半月板周缘性脱位与半月板宽度及厚度的系数关系；揭示股骨髁曲度随年龄增长可能变平,并用曲度将其量化；证实了半月板退变与膝骨关节炎的相关性,为诊断和治疗半月板退变及膝关节退行性变提供有价值的理论依据。
Objectives
Set up the anatomic database of meniscus in nomal knee joint in Guangdong Province by the accurate measurement of knee in MRI imaging and provide evidence to improve the clinical research and diagnosis of meniscus.
Methods
We select normal knee MRI scan of about690people in Guangdong Province, measure the width and the thickness of medial meniscus and lateral meniscus, and measure the maximum transverse diameter and longitudina diameter of the tibial plateau, and measure the transverse diameter and longitudina diameter of the lateral femoral condyle. Then we get the ratio of the data above by calculate and set up the anatomic database of meniscus.
Result
To establish the anatomic database of meniscus in Guangdong Province and set up the analysis according to the age group; to make a deep analysis of the incidence of radial displacement of meniscus and find out the reason; then we set up an analysis about the incidence of injury in medial and lateral meniscus; then we explore the relationship between meniscal degeneration and change of the femoral condyle and the degeneration of cartilage, and quantify the change of the femoral condyle with curvature.
Conelusion
We reveal the relationship of cartilage degeneration, meniscal degeneration and age to a certain extent, and prove that the incidence of radial displacement of meniscus have coefficient relationship with the width and thickness of meniscus by linear regression analysis. Then we reveal the flatting of femoral condyle with age and quantify it with curvature, and confirmed the relationship between degeneration of meniscus and osteoarthritis of knee, and provide some valuable theoretical basis to prevent the degeneration of meniscus and knee at last.
引文
[1]王亦璁.骨与关节损伤[M].人民卫生出版社,2009,p1306-1310.
[2]Baracz ME, Mengator R. Menlscaltears:The effect of meniscectomy and repair on intra-articular contact areas and stress in the human Knee[J]Am J Sports Med,1986,14,270-275.
[3]金鸿宾.筋骨并重的微创理念[J].中国骨伤,2003,16(7)：385-386.
[4]丁仁奎,孙材江,王万春,等.膝关节退行性骨关节病与骨质疏松的相关研究[J].湖南医学,1997,16(6)：323-324.
[5]韩清民,王跃辉等.膝骨关节炎从筋论治思路探讨[J].新中医,2009,1(41)：5-6.
[6]李广德.膝关节骨性关节炎中医治疗述评[J].中医杂志,2000,42(2)：116-117.
[7]陈兴灿,潘永青,等.正常和损伤膝关节半月板低场MRI研究[M].中国临床医学影像杂志2005,16(12)：710—715.
[8]Stoller DW, MartincC, CruesJV. Menical tear pathological correlation with MR imaging [J]. Radiology,1987,163(3):731-735.
[9]雷益,李顶夫,丘德政,等.膝关节损伤的MRI诊断[J].放射学实践,2001,13(3)：190-192.
[10]李静,张建新.正常半月板MRI测量及临床意义[J].医学影像学杂志,2008,18(6)：652-655.
[11]王国珍,纪斌平.正常半月板形态的磁共振研究[J].基层医学论坛,2008,12(3)：246-247.
[12]黄加张,顾小华,王旭.人体正常半月板MRI三维定量测量及临床意义[J].中国医学计算机成像杂志,2005,11(1)：51-53.
[13]Erbagci H, Gumns burun E, Bayrain M, et al. The normal menici:in VIVO MRI meas urements. Surg Radiol Anat,2004,26:28-32.
[14]马立恒,刘斯润,陈汉芳.正常成年人膝关节的MR测量及其成像[J].中国医学影像技术,2005，21(11)：1729-1731.
[15]Samoto N, Kozuma M, Tokuhisa T, et al. Diagnosis of discoid lateral meniscus of the knee on MR imaging. Magn Reson Imaging.2002,20:59-64
[16]陈兴灿,潘永青等.正常和损伤膝关节半月板低场MRI研究.中国临床医学影像杂志,2005,16(12),710—715.
[17]Breitenseher MJ, Trattnig S, Dobreky I, et al. MR ima sins of meniscal subluxation in the Knee. Acta Radiol,1997,38:876-879.
[18]黄加张,顾湘杰,潘哲尔,王旭,华英汇,陈飞雁.半月板突出在膝关节骨关节炎中地位的初步研究[J].中国临床医学,2004,12,11(6)：1102-1104.
[19]黄加张,顾湘杰,王旭,陈飞雁.膝关节半月板半脱位的相关因素分析[J].复旦学报,2005Jul,32(4)：433-435.
[20]陈坚,吕厚山,劳山,等.膝关节半月板周缘性移位现象的初步MRI研究[J].中华放射学杂志,2006,6,40[6]：612-615.
[21]Vedi V, Williams A, Tennant SJ, et al. Meniscalmovement:anin—vivo study using dynamic MRL[J]Bone Joint Surg Br,1999,81:37-41.
[22]李金松,金合,等.半月板径向移位的MRI研究及临床意义[J].中国中西医结合影像学杂志,2005,6,3[2],97100.
[23]周自明,丁永生等.膝关节半月板周缘性脱位征象的MRI研究及其临床意义初探[J].医学影像学杂志,2008,18(9)：1055-1058.
[24]劳山,陈坚,吕厚山.骨关节炎患者关节间隙狭窄半月板周缘性滑脱的临床研究[M].中华关节外科杂志,2009,3(6)：681-685.
[25]陈家祥,宋桂芳,马岩.退行性膝关节炎关节软骨损伤的MRI表现[J].中国CT和MRI杂志,2008，4(6)：55-57.
[26]楼海燕等.关节软骨的MRI成像.临床放射学杂志,2001,20(12)：952-954.
[27]王亦璁.骨与关节损伤[M].人民卫生出版社,2009,p1320-1321.
[28]尚平,许永涛,卓奎明,等.85例半月板损伤与关节软骨损伤相关性研究.生物骨科材料与临床研究.
[29]王达文,蔡谮,刘玉杰.关节镜下膝关节骨性关节炎伴半月板损伤分析[J].中华医学杂志,2005,9,7,85(34),2425-2427.
[30]陈兴灿,潘永青等.正常和损伤膝关节半月板低场MRI研究.中国临床医学影像杂志,2005,16(12)：710—715.
[31]马聪.3.0T MRI上膝关节软骨体积的定量测量研究[D].江苏大学,2010.
[32]孙英彩,崔建岭,李石玲.MRI测量正常人膝关节软骨厚度[J].实用放射学杂志,2004,2011：1007-1010.
[33]Kenny C. Radial displacement of the medial meniscus and Fairbanks signs[J]. Chin orthop.1997,339:163-173.
[34]Miller Tr, Staron RB, Feldman F, et al. Meniscal position on routine MR imaging of the knee. Skeletal Badiol,1997,26:424-427.
[35]Costa RC, Morrison WB, et al. Medial meniscus extrusion on knee MRI:is extent associatedwith severity of degeneration or type of tear?[J]. AJR,2004,183:7-23.
[36]王亦璁.骨与关节损伤[M].人民卫生出版社,2009,p1330-1331.
[2]Baracz ME, Mengator R. Menlscaltears:The effect of meniscectomy and repair on intra-articular contact areas and stress in the human Knee[J]Am J Sports Med,1986,14,270-275.
[3]金鸿宾.筋骨并重的微创理念[J].中国骨伤,2003,16(7)：385-386.
[4]丁仁奎,孙材江,王万春,等.膝关节退行性骨关节病与骨质疏松的相关研究[J].湖南医学,1997,16(6)：323-324.
[5]韩清民,王跃辉等.膝骨关节炎从筋论治思路探讨[J].新中医,2009,1(41)：5-6.
[6]李广德.膝关节骨性关节炎中医治疗述评[J].中医杂志,2000,42(2)：116-117.
[7]陈兴灿,潘永青,等.正常和损伤膝关节半月板低场MRI研究[M].中国临床医学影像杂志2005,16(12)：710—715.
[8]Stoller DW, MartincC, CruesJV. Menical tear pathological correlation with MR imaging [J]. Radiology,1987,163(3):731-735.
[9]雷益,李顶夫,丘德政,等.膝关节损伤的MRI诊断[J].放射学实践,2001,13(3)：190-192.
[10]李静,张建新.正常半月板MRI测量及临床意义[J].医学影像学杂志,2008,18(6)：652-655.
[11]王国珍,纪斌平.正常半月板形态的磁共振研究[J].基层医学论坛,2008,12(3)：246-247.
[12]黄加张,顾小华,王旭.人体正常半月板MRI三维定量测量及临床意义[J].中国医学计算机成像杂志,2005,11(1)：51-53.
[13]Erbagci H, Gumns burun E, Bayrain M, et al. The normal menici:in VIVO MRI meas urements. Surg Radiol Anat,2004,26:28-32.
[14]马立恒,刘斯润,陈汉芳.正常成年人膝关节的MR测量及其成像[J].中国医学影像技术,2005，21(11)：1729-1731.
[15]Samoto N, Kozuma M, Tokuhisa T, et al. Diagnosis of discoid lateral meniscus of the knee on MR imaging. Magn Reson Imaging.2002,20:59-64
[16]陈兴灿,潘永青等.正常和损伤膝关节半月板低场MRI研究.中国临床医学影像杂志,2005,16(12),710—715.
[17]Breitenseher MJ, Trattnig S, Dobreky I, et al. MR ima sins of meniscal subluxation in the Knee. Acta Radiol,1997,38:876-879.
[18]黄加张,顾湘杰,潘哲尔,王旭,华英汇,陈飞雁.半月板突出在膝关节骨关节炎中地位的初步研究[J].中国临床医学,2004,12,11(6)：1102-1104.
[19]黄加张,顾湘杰,王旭,陈飞雁.膝关节半月板半脱位的相关因素分析[J].复旦学报,2005Jul,32(4)：433-435.
[20]陈坚,吕厚山,劳山,等.膝关节半月板周缘性移位现象的初步MRI研究[J].中华放射学杂志,2006,6,40[6]：612-615.
[21]Vedi V, Williams A, Tennant SJ, et al. Meniscalmovement:anin—vivo study using dynamic MRL[J]Bone Joint Surg Br,1999,81:37-41.
[22]李金松,金合,等.半月板径向移位的MRI研究及临床意义[J].中国中西医结合影像学杂志,2005,6,3[2],97100.
[23]周自明,丁永生等.膝关节半月板周缘性脱位征象的MRI研究及其临床意义初探[J].医学影像学杂志,2008,18(9)：1055-1058.
[24]劳山,陈坚,吕厚山.骨关节炎患者关节间隙狭窄半月板周缘性滑脱的临床研究[M].中华关节外科杂志,2009,3(6)：681-685.
[25]陈家祥,宋桂芳,马岩.退行性膝关节炎关节软骨损伤的MRI表现[J].中国CT和MRI杂志,2008，4(6)：55-57.
[26]楼海燕等.关节软骨的MRI成像.临床放射学杂志,2001,20(12)：952-954.
[27]王亦璁.骨与关节损伤[M].人民卫生出版社,2009,p1320-1321.
[28]尚平,许永涛,卓奎明,等.85例半月板损伤与关节软骨损伤相关性研究.生物骨科材料与临床研究.
[29]王达文,蔡谮,刘玉杰.关节镜下膝关节骨性关节炎伴半月板损伤分析[J].中华医学杂志,2005,9,7,85(34),2425-2427.
[30]陈兴灿,潘永青等.正常和损伤膝关节半月板低场MRI研究.中国临床医学影像杂志,2005,16(12)：710—715.
[31]马聪.3.0T MRI上膝关节软骨体积的定量测量研究[D].江苏大学,2010.
[32]孙英彩,崔建岭,李石玲.MRI测量正常人膝关节软骨厚度[J].实用放射学杂志,2004,2011：1007-1010.
[33]Kenny C. Radial displacement of the medial meniscus and Fairbanks signs[J]. Chin orthop.1997,339:163-173.
[34]Miller Tr, Staron RB, Feldman F, et al. Meniscal position on routine MR imaging of the knee. Skeletal Badiol,1997,26:424-427.
[35]Costa RC, Morrison WB, et al. Medial meniscus extrusion on knee MRI:is extent associatedwith severity of degeneration or type of tear?[J]. AJR,2004,183:7-23.
[36]王亦璁.骨与关节损伤[M].人民卫生出版社,2009,p1330-1331.