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急性滑脱性髌股关节撞击症的认识与MRI诊断 被引量:27

The magnetic resonance imaging diagnosis of acute patellofemoral joint impingent
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摘要 目的认识并定义急性滑脱性髌股关节撞击症,探讨其发病机制及MRI诊断.方法回顾性分析自2001年5月~2002年7月,34例经MRI诊断的急性滑脱性髌股关节撞击症的MRI表现,并结合临床资料、X线片、CT及关节镜所见进行分析.从矢状、冠状及横断三个平面行MR扫描.扫描方法采用:(1)三维快速梯度回波序列(FE3D)T1及T2*加权像,该序列可较好地显示关节软骨及软骨下骨的损伤程度;(2)脂肪抑制梯度回波反转恢复序列(STIR)PD加权像,该序列对骨及软骨损伤有非常高的敏感性;(3)脂肪抑制快速自旋回波反转恢复序列(TSHIRT)T2加权像,该序列可显示韧带损伤情况.结果34例外伤后膝关节MRI均显示髌骨内下部及股骨外髁前外侧部对应的软骨下骨质异常信号改变,表明为骨损伤.与关节镜相比,34例中MRI可见20例髌骨内下部软骨骨折,其中15例为骨软骨骨折;8例股骨外髁前外侧部软骨骨折,其中6例为骨软骨骨折;11例于关节囊内可见游离软骨或骨软骨碎片影.27例MRI显示不同程度髌内侧支持带损伤,其中Ⅰ度8例,Ⅱ度12例,Ⅲ度7例.所有患者均可见关节积液,其中单纯积液6例,血性积液18例,脂肪血性积液10例.23例可见髌骨外侧半脱位.结论急性滑脱性髌股关节撞击症拟定义为当膝关节急性屈曲外翻时,髌骨在向外侧滑脱或脱位后再自行复位的过程中,髌骨内侧面与股骨外髁相互撞击或挤压,并随之产生的一系列膝关节各解剖结构的损伤,主要包括髌骨内侧面骨软骨损伤、股骨外髁前外侧部骨软骨损伤、髌骨脱位或半脱位、髌内侧支持带损伤、关节囊积液.MRI提高对该症的检出率,并可全面而准确地表现各解剖结构的损伤程度. Objective Lateral dislocation of the patella pulled laterally from the trochlea and across the lateral femoral condyle,was often a transient phenomenon with spontaneous reduction,diagnosis based on the results of physical examination and clinical history was difficult.The present was in an effort to explore the mechanism and definition of acute patellofemoral dislocation as well as assessment with MRI of the injury.Methods From May2001to July2002,34patients aging from11to25years with18males and16females,had a history of knee joint,28of which were experienced a twisting injury with the knee in flexion and internal rotation of femur on a fixed foot.Sagital,coronal and transverse MRI were performed with T 1 WI,T 2 WI,STIR and TSHIRT sequences.The manifestations of MRI were analyzed retrospectively,and clinical data,X-ray films,CT scan and the findings of arthroscopy were studied as well.Results All of34cases injured were found the signal intensity abnormalities of subchondral bone in the inferior medial part of patella and the anteri-or lateral part of lateral femoral condyle,which suggested that bone was injured.MRI findings of cartilage fis-sure at medial patella were found in20cases and injury of the patella retinaculum was seen at MRI in27cas-es.MRI findings revealed joint effusion in all patients,and lateral subluxation of the patella was seen at MRI in23cases.Conclusion The resultant jury on MRI findings of acute patellofemoral joint dislocation caused by a-cute impingent of patellar medial facet to lateral femoral chondyle at the various degree of flexion and rotation of the knee include the osteochondral fracture in the inferior medial part of patella,the anterior lateral part of lateral femoral condyle,the subluxation or dislocation of patella,the injury of medial patella retinaculum and the joint effusion.MRI could be helpful for the diagnosis of the disease,and demonstrate the location and ex-tent of injury on the different compartments of the involved knee.
作者 王植 王林森 胡永成 张铁良 赵力 黄竟敏 WANG Zhi  ,WANG Lin-sen,HU Yong-cheng,et al.  Department of Radiology,Tianjin Hospital,Tianjin300211,China
出处 《中华骨科杂志》 CAS CSCD 北大核心 2003年第7期 408-413,共6页 Chinese Journal of Orthopaedics
关键词 急性滑脱性髌股关节撞击症 发病机制 MRI诊断 软骨损伤 X线片 髌骨脱位 Knee joint Patella Wounds and injuries Magnetic resonance imaging
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