外伤性膝关节隐性骨折的核磁共振成像表现及其诊断价值分析

doi:10.7517/issn.1674-0475.190816

摘要/Abstract

摘要： 为分析外伤性膝关节隐性骨折的核磁共振成像表现及其诊断价值，本次研究回顾性分析我院2017年1月~2018年12月收治的55例外伤性膝关节隐性骨折患者临床资料，分别实施核磁共振成像检查以及多层螺旋CT检查，然后以手术结果为参照，分析核磁共振成像对外伤性膝关节隐性骨折的诊断价值及具体的影像表现。经手术证实，55例外伤性膝关节隐性骨折患者中隐性骨皮质下骨折34例、骨皮质骨折14例、骨软骨骨折7例，核磁共振成像符合率高于多层螺旋CT，差异有统计学意义（P<0.05）；两种影像学检查手段敏感度、特异度、准确度相比较，核磁共振成像高于多层螺旋CT，差异有统计学意义（P<0.05）；外伤性膝关节隐性骨折核磁共振成像表现如下：隐性骨皮质下骨折存在大范围的地图样、网格状或线状信号区，边界模糊但骨关节面完整；骨皮质骨折呈低信号带中断，与骨髓高信号存在强烈对比；骨软骨骨折呈多层次或者是连续性中断。说明外伤性膝关节隐性骨折核磁共振成像表现具有多样性特点，仔细分析不难鉴别，可作为优选诊断手段推广使用。

关键词: 外伤性膝关节隐性骨折, 核磁共振成像, 多层螺旋CT, 诊断价值

Abstract: To analyze the MRI findings and diagnostic value of traumatic knee joint recessive fractures, this study retrospectively analyzed 55 patients with traumatic knee joint recessive fractures from 138 January 2017 to December 2018 in our hospital. The clinical data were analyzed by MRI and multi-slice spiral CT. The surgical results were used as reference. The diagnostic value and specific imaging findings of MRI in traumatic knee joint fractures were analyzed. According to the operation, there were 34 cases of occult subcortical fractures, 14 cases of cortical fractures and 7 cases of osteochondral fractures in 55 patients with traumatic knee joint fracture. The coincidence rate of MRI was higher than that of multi-slice spiral CT (P<0.05). The sensitivity, specificity, and accuracy of the two imaging methods were compared, and the MRI was higher than the multi-slice spiral CT, the difference was statistically significant (P<0.05).The magnetic resonance imaging of the traumatic knee joint recessive fractures is as follows:there are a large number of map-like, grid-like or linear signal areas in the recessive subcortical fractures, the boundary is blurred but the osteoarticular surface is intact; the cortical fracture is interrupted by a low signal band, and there is a strong contrast in bone marrow high signal; osteochondral fractures are multi-level or continuous disruption. According to this, the magnetic resonance imaging findings of traumatic knee joint recessive fractures are characterized by diversity. It is not difficult to identify them carefully and can be used as a preferred diagnostic tool.

Key words: traumatic knee joint recessive fracture, magnetic resonance imaging, multi-slice spiral CT, diagnostic value

孙秋原, 李骥, 牛亚峰. 外伤性膝关节隐性骨折的核磁共振成像表现及其诊断价值分析[J]. 影像科学与光化学, 2020, 38(1): 138-143.

SUN Qiuyuan, LI Ji, NIU Yafeng. MRI Findings and Diagnostic Value of Traumatic Knee Joint Recessive Fracture[J]. Imaging Science and Photochemistry, 2020, 38(1): 138-143.

参考文献

[1] 丁亮,张敏,龙飞翔,等.1.5T磁共振成像在诊断膝关节隐匿性骨折中的应用价值[J].安徽卫生职业技术学院学报,2019,18(1):32-33,35. Ding L, Zhang M, Long F X, et al. The Application value of 1.5T nuclear magnetic resonance imaging in diagnosing occult fracture of knee-joint[J]. Journal of Anhui Health Vocational & Technical College, 2019, 18(1):32-33,35.
[2] 揭双民.磁共振成像对膝关节隐性骨折的诊断价值研究[J].影像研究与医学应用,2019,3(4):42-43. Jie S M.Research on the diagnostic value of magnetic resonance imaging for recessive knee joint fracture[J]. Journal of Imaging Research and Medical Applications, 2019, 3(4):42-43.
[3] 廉养杰.三维CT重建及MRI检查在胫骨平台隐性骨折诊疗中的应用[J].中国CT和MRI杂志,2018,16(11):134-136. Lian Y J. Application of three-dimensional CT reconstruction and MRI in diagnosis and treatment of tibial plateau occult fracture[J]. Chinese Journal of CT and MRI, 2018, 16(11):134-136.
[4] 张军胜,赵波.多层螺旋CT对膝关节损伤后胫骨平台隐匿性骨折早期诊断的效果及价值[J].解放军医药杂志,2018,30(8):96-99. Zhang J S, Zhao B. Effect and value of multislice CT in early diagnosis of patients with tibial plateau occult fracture after injury of knee joint[J]. Medical & Pharmaceutical Journal of Chinese People's Liberation Arm, 2018, 30(8):96-99.
[5] 程少斐.MSCT联合MRI对不同类型隐匿性骨折患者诊断效能的影响[J].现代医用影像学,2018,27(3):829-830. Cheng S F. Effect of MSCT combined with MRI on the diagnostic efficacy of patients with different types of occult fractures[J].Modern Medical Imaging,2018,27(3):829-830.
[6] 吴礼胜,林尤军,易晓玲,等.X线数字断层融合技术在膝关节外伤检查中的应用[J].海南医学院学报,2018,24(7):815-816. Wu L S, Lin Y J, Yi X L, et al. Application of X ray digital tomosynthesis in the examination of knee joint injury[J]. Journal of Hainan Medical University, 2018, 24(7):815-816.
[7] 汪丽娜.磁共振在膝关节隐匿性骨折患者中的应用及诊断效果评价[J].影像研究与医学应用,2018,2(7):159-160. Wang L N. Application of magnetic resonance imaging in patients with occult fracture of knee joint and evaluation of its diagnostic effect[J]. Journal of Imaging Research and Medical Applications, 2018, 2(7):159-160.
[8] 姚君华,杨斌,叶承锋,等.膝关节隐匿性骨折患者MRI及CT诊断的临床分析[J].浙江创伤外科,2018,23(1):189-191. Yao J H, Yang B, Ye C F, et al. Clinical analysis of MRI and CT diagnosis of patients with occult fracture of knee joint[J]. Zhejiang Journal of Traumatic Surgery, 2018, 23(1):189-191.
[9] 姜国印,叶如意.多层螺旋CT图像后处理技术对67例膝关节创伤患者的临床诊断价值研究[J].浙江创伤外科,2018,23(1):195-197. Jiang G Y, Ye R Y. The clinical diagnostic value of multi-slice spiral CT image post-processing technique in 67 patients with knee joint trauma[J]. Zhejiang Journal of Traumatic Surgery, 2018, 23(1):195-197.
[10] 宋晓飞,张长成,李振武,等.64层螺旋CT诊断膝关节创伤后隐匿病变及软组织损伤价值探究[J].中国CT和MRI杂志,2017,15(12):140-143. Song X F, Zhang C C, Li Z W, et al. Value of 64 slice spiral CT in the diagnosis of occult lesions and soft tissue injury after knee trauma[J]. Chinese Journal of CT and MRI, 2017, 15(12):140-143.
[11] 陈玉权,吴勇江.多层螺旋CT与MRI对膝关节隐匿性骨折的诊断价值比较[J].实用医院临床杂志,2017,14(6):252-254. Chen Y Q, Wu Y J. Comparison of multi-slice spiral CT and MRI in the diagnosis of occult fractures of the knee[J]. Practical Journal of Clinical Medicine, 2017, 14(6):252-254.
[12] 刘国彬,张国平,任庆云,等.磁共振成像在隐性骨折临床早期诊断中的应用价值分析[J]. 河北医科大学学报,2017,38(4):412-414,432. Liu G B, Zhang G P, Ren Q Y, et al. Analysis of application value of magnetic resonance imaging in the early diagnosis of occult fracture[J].Journal of Hebei Medical University, 2017, 38(4):412-414,432.
[13] 陶文生,时志刚.核磁共振成像与多层螺旋CT对膝关节隐匿性骨折的诊断效果对比[J].现代医用影像学,2018,27(8):2794-2795. Tao W S, Shi Z G. Comparative effect of magnetic resonance imaging and multi-slice spiral CT on the diagnosis of occult fracture of knee joint[J]. Journal of Imaging Research and Medical Applications, 2018, 27(8):2794-2795.
[14] 刘婕,肖锡昌,刘成磊.膝关节隐匿性骨折的影像诊断分析[J].实用医学影像杂志,2016,17(6):484-487. Liu J, Xiao X C, Liu C L. Image diagnosis of occult fracture of knee joint[J]. Journal of Practical Medical Imaging, 2016, 17(6):484-487.