膝关节滑膜皱襞综合征的MRI诊断价值

发布时间：2019-01-05 11:00

【摘要】：目的: 探讨膝关节髌内侧滑膜皱襞的解剖及滑膜皱襞综合征的MRI表现，并与关节镜进行对照，为临床提供形态及诊断依据。研究分析髌内侧滑膜皱襞的宽度值与滑膜皱襞综合征的相关性及滑膜皱襞综合征患者与正常对照组的髌内侧滑膜皱襞宽度有无差异性。通过探讨膝关节髌内侧滑膜皱襞的存在与否、形态改变及发生率来评估膝关节MRI对髌内侧滑膜皱襞及其综合征的诊断价值，从而为临床诊断因膝关节髌内侧滑膜皱襞异常引起的疾病提供影像方面支持。材料与方法: 收集2012年7月至2013年11月在泰山医学院附属医院做膝关节MRI检查794例794膝，其中169侧膝同时行膝关节镜手术。统计794侧膝关节髌内侧滑膜皱襞的发生率，分析髌内侧滑膜皱襞的发生与性别、膝侧的相关性；以关节镜为标准，分析169侧膝的髌内侧滑膜皱襞MRI检查的敏感性、特异性、阳性预测值、阴性预测值；同期收集20例40侧膝健康志愿者的MRI检查作为正常对照组(40膝中20膝存在髌内侧滑膜皱襞，其中将存在髌内侧滑膜皱襞但无任何临床征状的情况视为正常)分析滑膜皱襞综合征患者的皱襞宽度与健康志愿者皱襞宽度是否存在差异性。结果: 1、膝关节髌内侧滑膜皱襞的MRI诊断的灵敏性为92.6%，，特异性94.6%，阳性预测值为95.7%，阴性预测值为90.9%。 2、MRI检查的794膝中髌内侧滑膜皱襞的发生率为59.9%，且其发生与性别、左右膝侧无关，关节镜检查的169膝中髌内侧滑膜皱襞综合征的发生率为21.9%。 3、经卡方检验，得P0.05，髌内侧滑膜皱襞的皱襞宽度与髌内侧滑膜皱襞综合征的发生相关，皱襞的宽度越大，发病的可能性就越大，经独立样本t检验，P0.05，髌内侧滑膜皱襞综合征患者的皱襞宽度与健康志愿者的皱襞宽度存在差异性。结论: 1、膝关节髌内侧滑膜皱襞的MRI诊断的准确性很高，可以很好的为临床提供有价值的形态学的信息。 2、本组实验中髌内侧滑膜皱襞的发生率为59.9%，髌内侧滑膜皱襞综合征的发生率为21.9%，与国内外文献报道的基本一致。 3、髌内侧滑膜皱襞的皱襞宽度值大小与髌内侧滑膜皱襞综合征的发生是相关的，髌内侧滑膜皱襞综合征患者与正常对照组的皱襞宽度之间存在差异性。MRI对髌内侧滑膜皱襞综合征的诊断是有一定价值的，MRI上髌内侧滑膜皱襞宽度可作为诊断滑膜皱襞综合征的一项参考指标。
[Abstract]:Objective: to study the anatomy of medial patellar plica of knee joint and the MRI manifestations of synovial plica syndrome, and to provide the clinical appearance and diagnostic basis for arthroscopy. To study the correlation between the width of medial patellar plica and synovial plica syndrome and whether there is any difference in the width of medial patellar plica between the patients with synovial plica syndrome and the normal control group. To evaluate the diagnostic value of MRI in the diagnosis of medial patellar synovial fold and its syndrome by discussing the existence, morphological change and incidence of medial patellar synovial fold of knee joint. It provides imaging support for clinical diagnosis of diseases caused by abnormal medial synovial plica of knee joint. Materials and methods: from July 2012 to November 2013, 794 patients (794 knees) were examined by MRI in affiliated Hospital of Taishan Medical College. The incidence of medial synovial fold in 794 sides of knee joint was counted and the correlation between the occurrence of medial patellar synovial fold and sex and knee side was analyzed. The sensitivity, specificity, positive predictive value and negative predictive value of medial patellar plica MRI in 169 knees were analyzed by arthroscopy. During the same period, 20 healthy volunteers with 40 knees were examined by MRI as the normal control group (20 of 40 knees had medial patellar synovial folds. The medial patellar plica but no clinical symptoms were regarded as normal. The difference between the plica width of the patients with synovial plica syndrome and that of the healthy volunteers was analyzed. Results: 1. The sensitivity and specificity of MRI in the diagnosis of medial patellar plica of knee joint was 92.62.The positive predictive value was 95.7 and the negative predictive value was 90.9. 2The incidence of medial patellar synovial fold in 794 knees examined by MRI was 59.9, and its occurrence was not related to sex. The incidence of medial patellar plica syndrome in 169 knees examined by arthroscopy was 21.9. The width of the plica of medial patellar synovial fold was related to the occurrence of medial patellar synovial fold syndrome. The larger the width of plica, the more likely the disease was. The width of plica in patients with medial patellar plica syndrome was different from that in healthy volunteers. Conclusion: 1. The MRI diagnostic accuracy of medial patellar plica of knee joint is very high, which can provide valuable morphological information for clinic. 2. The incidence of medial patellar synovial fold and medial patellar plica syndrome was 59.9 and 21.9respectively, which was consistent with the literature reported at home and abroad. 3. The width of the plica of the medial patellar synovial fold is related to the occurrence of the medial patellar plica syndrome. The width of plica in patients with medial patellar plica syndrome is different from that in normal control group. MRI is valuable in the diagnosis of medial patellar synovial fold syndrome. The width of medial synovial plica on MRI can be used as a reference index for diagnosis of synovial plica syndrome.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R686;R445.2

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