高频超声波对膝骨关节炎诊断价值的探讨
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摘要
目的:
探讨超声波在膝骨关节炎(osteoarthritis,OA)的诊断中价值和意义,用超声波检测膝骨关节炎患者软骨的厚度,并评价用高频超声波(high-frequencyultrasound,HF US)判断软骨退行性变的分期结果与手术中对软骨分期结果的相关性。
对象和方法:
采用高频超声波对35例膝骨关节炎患者共70个膝关节进行超声波检查,分析结果并与膝关节X线及磁共振作对比。
对70个患骨关节炎的膝关节不同部位软骨厚度,包括滑车中央沟,股骨髁前方、负重区、后方7个部位进行超声波测量。并取10例20个正常膝关节软骨厚度作对照。
选择35例患者36个拟行关节镜或关节置换手术的膝关节,术前行超声波检查。观察股骨滑车中央沟、滑车内侧斜面、滑车外侧斜面、股骨外髁及股骨内髁软骨关节面,共计180处关节面。分析超声波检查结果,并与关节镜或手术结果作比较。
结果:
对于髌上囊积液、滑膜增厚、软骨退行性变、软骨下骨质破坏、半月板退行性变、胭窝囊肿等方面,超声波检查具有良好的分辨率,检出率分别为88.6%、85.7%、92.9%、58.6%、41.4%、44.3%,与X线摄片检出率比较,两者差异有统计学意义(P值均＜0.05);与MRI检出率比较,两者差异并无统计学差异(P值均＞0.05)。但在骨质增生、关节间隙狭窄及骨质疏松等反映骨性结构改变方面,超声波检查不如X线及MRI检查敏感。
正常膝关节各部位软骨的厚度是不一致的。正常组膝关节股骨滑车软骨厚度为2.41±0.37mm,股骨内髁、外髁前方软骨厚度分别为1.22±0.11mm、1.31±0.14mm,股骨内、外髁负重区软骨厚度分别为1.31±0.16mm、1.42±0.16mm,股骨内髁、外髁后方软骨厚度分别为1.34±0.17mm、1.45±0.13mm。股骨内、外髁相对应部位的软骨厚度之间的差异有统计学意义(P值均＜0.05)。
膝骨关节炎患者组的膝关节股骨滑车软骨厚度为1.94±0.28mm,股骨外髁前方、负重区、后方的软骨厚度分别为1.02±0.20mm、0.88±0.27mm、0.99±0.20mm,股骨内髁前方、负重区、后方的软骨厚度分别为0.98±0.18mm、0.81±0.27mm、0.95±0.21mm。与正常组各个部位的软骨厚度之间的差异有统计学意义(P值均＜0.05)。
本组180处关节面中手术结果显示:27处关节面的软骨正常;153处关节面软骨有不同程度退行性变(其中Ⅰ期23处、Ⅱ期43处、Ⅲ期40处、Ⅳ期47处)。
用超声波检查评价膝关节软骨退行性变分期结果与手术中肉眼观察结果比较,显示超声波所见分期与手术中肉眼观察分期有相关性,相关系数r=0.806(P值＜0.05)。
结论:
1.高频超声波对于膝骨关节炎的诊断具有独特价值和意义。
2.高频超声波能够较准确地评价膝骨关节炎软骨厚度的变化。
3.超声波评判膝关节软骨退行性变的分期与手术中肉眼观察分期有一定的相关性,能反映出病变的严重程度,有助于估计病情,指导治疗。
Objective:
To evaluate the value and clinical significance of high-frequency ultrasound examination in the diagnosis of knee osteoarthritis. Also, to assess the correlation of grading cartilage degeneration of the knee between the high-frequency ultrasound examination and the observation by eye during the operation.
Methods:
Both High-frequency ultrasound examination and knee roentgenography were used for detecting grading cartilage degeneration of the knee in 35 cases with osteoarthritis and the detected results of both methods were compared.
The thickness of articular cartilage of the knees were measured by ultrasound both in 35 patients and 10 normal people. The measure spot of the cartilage was 7 parts of the joint surface, they were intercondylar groove, the front、the weight-bearing and the posterior of femoral condyle. The results were compared.
Thirty-five patients with osteoarthritis of the knee (36 knees) who underwent arthroscopic surgery or total knee arthroplasty were included in the study. The articular cartilages of all knees covering the center of the intercondylar groove (CIG), medial trochlearportion (MTP), lateral trochlearportion (LTP), the weight-bearing aspect of medial femoral condyle (MFC) and lateral femoral condyle (LFC) were examined by High-frequency ultrasound. The ultrasound examination results were compared with the arthroscopic or surgery findings.
Results:
In detecting the changes of effusion, synovial hypertrophy, knee cartilage affection, destruction of bone under cartilage, popliteal cyst and meniscus apomorphosis, the ultrasonography had higher resolution power than X-ray film. The detection rate of above changes by ultrasonography was 88.6%, 85.7%, 92.9%, 58.6%, 41.4% and 44.3% respectively. The difference between the detection rates of ultrasonography and X-ray was significant (P<0.05). Both ultrasonography and MRI could discover changes of cartilage, synovial membrane, meniscus of knee joint well. The difference between the two methods was not significant (P>0.05).
The thickness of articular cartilage of the knees was difference in the difference location. In normal group, the outcome of ultrasound measurement for the center of the intercondylar groove cartilage was 2.41±0.37mm, the thickness of cartilage in the front of medial and lateral femoral condylar was 1.22±0.11mm、1.31±0.14mm respectively, that in the weight-bearing of MFC and LFC was 1.31±0.16mm、1.42±0.16mm, that in the posterior of MFC and LFC was 1.34±0.17mm、1.45±0.13mm. The difference between the thickness of articular cartilage of MFC and LFC was significant (P>0.05).
The outcome of ultrasound measurement the center of the intercondylar groove cartilage was 1.94±0.28mm. The thickness of cartilage in the front、the weight-bearing and the posterior of LFC was 1.02±0.20mm、0.88±0.27mm、0.99±0.20mm respectively, that in the front、the weight-bearing and the posterior of MFC was 0.98±0.18mm、0.81±0.27mm、0.95±0.21mm. The difference of the thickness of articular cartilage of the knees between the osteoarthritis patients and normal people was significant (P>0.05).
Operation grading of knee cartilage degenerative lesion was grade 0 in 27 articular surfaces, gradeⅠin 23, gradeⅡin 43, gradeⅢin 40 and grade in 47.
Cartilage degeneration grades determined with Ultrasound were correlated with these determined during the operation. The correlation coefficients were 0.806 (P<0.05).
Conclusions:
1. High-frequency ultrasound is useful in the diagnosis of knee osteoarthritis.
2. The articular cartilage thickness of the knee can be accurately measured by ultrasound.
3. High-frequency ultrasound is reliable for grading articular cartilage degeneration of knee.
探讨超声波在膝骨关节炎(osteoarthritis,OA)的诊断中价值和意义,用超声波检测膝骨关节炎患者软骨的厚度,并评价用高频超声波(high-frequencyultrasound,HF US)判断软骨退行性变的分期结果与手术中对软骨分期结果的相关性。
对象和方法:
采用高频超声波对35例膝骨关节炎患者共70个膝关节进行超声波检查,分析结果并与膝关节X线及磁共振作对比。
对70个患骨关节炎的膝关节不同部位软骨厚度,包括滑车中央沟,股骨髁前方、负重区、后方7个部位进行超声波测量。并取10例20个正常膝关节软骨厚度作对照。
选择35例患者36个拟行关节镜或关节置换手术的膝关节,术前行超声波检查。观察股骨滑车中央沟、滑车内侧斜面、滑车外侧斜面、股骨外髁及股骨内髁软骨关节面,共计180处关节面。分析超声波检查结果,并与关节镜或手术结果作比较。
结果:
对于髌上囊积液、滑膜增厚、软骨退行性变、软骨下骨质破坏、半月板退行性变、胭窝囊肿等方面,超声波检查具有良好的分辨率,检出率分别为88.6%、85.7%、92.9%、58.6%、41.4%、44.3%,与X线摄片检出率比较,两者差异有统计学意义(P值均＜0.05);与MRI检出率比较,两者差异并无统计学差异(P值均＞0.05)。但在骨质增生、关节间隙狭窄及骨质疏松等反映骨性结构改变方面,超声波检查不如X线及MRI检查敏感。
正常膝关节各部位软骨的厚度是不一致的。正常组膝关节股骨滑车软骨厚度为2.41±0.37mm,股骨内髁、外髁前方软骨厚度分别为1.22±0.11mm、1.31±0.14mm,股骨内、外髁负重区软骨厚度分别为1.31±0.16mm、1.42±0.16mm,股骨内髁、外髁后方软骨厚度分别为1.34±0.17mm、1.45±0.13mm。股骨内、外髁相对应部位的软骨厚度之间的差异有统计学意义(P值均＜0.05)。
膝骨关节炎患者组的膝关节股骨滑车软骨厚度为1.94±0.28mm,股骨外髁前方、负重区、后方的软骨厚度分别为1.02±0.20mm、0.88±0.27mm、0.99±0.20mm,股骨内髁前方、负重区、后方的软骨厚度分别为0.98±0.18mm、0.81±0.27mm、0.95±0.21mm。与正常组各个部位的软骨厚度之间的差异有统计学意义(P值均＜0.05)。
本组180处关节面中手术结果显示:27处关节面的软骨正常;153处关节面软骨有不同程度退行性变(其中Ⅰ期23处、Ⅱ期43处、Ⅲ期40处、Ⅳ期47处)。
用超声波检查评价膝关节软骨退行性变分期结果与手术中肉眼观察结果比较,显示超声波所见分期与手术中肉眼观察分期有相关性,相关系数r=0.806(P值＜0.05)。
结论:
1.高频超声波对于膝骨关节炎的诊断具有独特价值和意义。
2.高频超声波能够较准确地评价膝骨关节炎软骨厚度的变化。
3.超声波评判膝关节软骨退行性变的分期与手术中肉眼观察分期有一定的相关性,能反映出病变的严重程度,有助于估计病情,指导治疗。
Objective:
To evaluate the value and clinical significance of high-frequency ultrasound examination in the diagnosis of knee osteoarthritis. Also, to assess the correlation of grading cartilage degeneration of the knee between the high-frequency ultrasound examination and the observation by eye during the operation.
Methods:
Both High-frequency ultrasound examination and knee roentgenography were used for detecting grading cartilage degeneration of the knee in 35 cases with osteoarthritis and the detected results of both methods were compared.
The thickness of articular cartilage of the knees were measured by ultrasound both in 35 patients and 10 normal people. The measure spot of the cartilage was 7 parts of the joint surface, they were intercondylar groove, the front、the weight-bearing and the posterior of femoral condyle. The results were compared.
Thirty-five patients with osteoarthritis of the knee (36 knees) who underwent arthroscopic surgery or total knee arthroplasty were included in the study. The articular cartilages of all knees covering the center of the intercondylar groove (CIG), medial trochlearportion (MTP), lateral trochlearportion (LTP), the weight-bearing aspect of medial femoral condyle (MFC) and lateral femoral condyle (LFC) were examined by High-frequency ultrasound. The ultrasound examination results were compared with the arthroscopic or surgery findings.
Results:
In detecting the changes of effusion, synovial hypertrophy, knee cartilage affection, destruction of bone under cartilage, popliteal cyst and meniscus apomorphosis, the ultrasonography had higher resolution power than X-ray film. The detection rate of above changes by ultrasonography was 88.6%, 85.7%, 92.9%, 58.6%, 41.4% and 44.3% respectively. The difference between the detection rates of ultrasonography and X-ray was significant (P<0.05). Both ultrasonography and MRI could discover changes of cartilage, synovial membrane, meniscus of knee joint well. The difference between the two methods was not significant (P>0.05).
The thickness of articular cartilage of the knees was difference in the difference location. In normal group, the outcome of ultrasound measurement for the center of the intercondylar groove cartilage was 2.41±0.37mm, the thickness of cartilage in the front of medial and lateral femoral condylar was 1.22±0.11mm、1.31±0.14mm respectively, that in the weight-bearing of MFC and LFC was 1.31±0.16mm、1.42±0.16mm, that in the posterior of MFC and LFC was 1.34±0.17mm、1.45±0.13mm. The difference between the thickness of articular cartilage of MFC and LFC was significant (P>0.05).
The outcome of ultrasound measurement the center of the intercondylar groove cartilage was 1.94±0.28mm. The thickness of cartilage in the front、the weight-bearing and the posterior of LFC was 1.02±0.20mm、0.88±0.27mm、0.99±0.20mm respectively, that in the front、the weight-bearing and the posterior of MFC was 0.98±0.18mm、0.81±0.27mm、0.95±0.21mm. The difference of the thickness of articular cartilage of the knees between the osteoarthritis patients and normal people was significant (P>0.05).
Operation grading of knee cartilage degenerative lesion was grade 0 in 27 articular surfaces, gradeⅠin 23, gradeⅡin 43, gradeⅢin 40 and grade in 47.
Cartilage degeneration grades determined with Ultrasound were correlated with these determined during the operation. The correlation coefficients were 0.806 (P<0.05).
Conclusions:
1. High-frequency ultrasound is useful in the diagnosis of knee osteoarthritis.
2. The articular cartilage thickness of the knee can be accurately measured by ultrasound.
3. High-frequency ultrasound is reliable for grading articular cartilage degeneration of knee.
引文
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