年轻军人膝关节前交叉韧带损伤的MRI CT影像学表现及影像学相关影响因素研究

doi:10.3969/j.issn.1006-6233.2025.03.028

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (2608 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要 目的: 观察年轻军人膝关节前交叉韧带(ACL)损伤的MRI、CT影像学表现,并分析影像学相关影响因素。方法: 回顾性分析2021年5月至2023年4月在我院就诊的101例由于非接触机制而出现单侧膝关节不适的年轻军人临床资料,其均予以MRI、CT检查和关节镜检查,根据关节镜检查结果将患者分为ACL断裂组与ACL正常组,评估MRI、CT对ACL损伤的诊断效能,并观察MRI、CT影像学表现,采用单因素和多因素Logistic分析年轻军人膝关节前交叉韧带断裂影像学相关影响因素。结果: 关节镜检查结果显示,本次101例患者中ACL正常者33例,ACL断裂者68例,其中完全断裂30例,部分断裂38例;即ACL断裂组68例,ACL正常组33例。在ACL损伤的影像学表现中,CT扫描显示部分断裂为韧带增粗与边界不清,而完全断裂则表现为韧带扭曲和增粗。MRI扫描冠状位显示,部分断裂的ACL呈局部信号增强,而完全断裂的ACL出现不连续和团块状影,信号呈弥漫性增强;在矢状位中,部分断裂的ACL整体变细、局部变粗但仍保持连续性,走形区信号增强,而完全断裂的ACL呈现波浪状、断端痉挛,信号增强。以关节镜检结果为金标准,MRI、CT对年轻军人ACL损伤诊断的灵敏度分别为94.12%、85.29%,特异度分别为78.79%、75.76%,准确度分别为89.11%、82.18%。ACL断裂组髁间窝形态、髁间窝宽度、胫骨髁间隆突宽度、胫骨髁间隆突宽度/髁间窝宽度与ACL正常组比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,髁间窝形态为A型、胫骨髁间隆突宽度/髁间窝宽度比值低是年轻军人膝关节ACL断裂的影像学的影响因素(P<0.05)。结论: 年轻军人膝关节ACL损伤的MRI、CT影像学表现各有不同,MRI诊断效能稍高于CT;髁间窝形态为A型、胫骨髁间隆突宽度/髁间窝宽度比值低是年轻军人膝关节ACL断裂的影像学影响因素。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：膝关节, 前交叉韧带断裂, 军人, 影像学, 影响因素

Abstract：Objective: To investigate the MRI and CT imaging findings of anterior cruciate ligament (ACL) injury in young soldiers and to analyze imaging-related influencing factors. Methods: A retrospective analysis was conducted on 101 young soldiers with unilateral knee discomfort due to non-contact mechanisms treated at our hospital from May 2021 to April 2023. All patients underwent MRI, CT, and arthroscopy. Based on arthroscopy results, patients were divided into an ACL rupture group (n=68) and a normal ACL group (n=33). The diagnostic efficacy of MRI and CT for ACL injury was evaluated, and imaging findings were analyzed. Univariate and multivariate logistic regression analyses were performed to identify imaging-related influencing factors for ACL rupture. Results: Arthroscopy revealed 33 cases with normal ACL and 68 cases with ACL rupture (30 complete ruptures and 38 partial ruptures). CT imaging showed that partial ACL ruptures exhibited ligament thickening and blurred boundaries, while complete ruptures displayed ligament distortion and thickening. On MRI, partial ruptures showed localized signal enhancement in the coronal plane, while complete ruptures exhibited discontinuous and lumpy shadows with diffuse signal enhancement. In the sagittal plane, partial ruptures demonstrated overall thinning with localized thickening and maintained continuity, whereas complete ruptures appeared wavy with stump spasm and signal enhancement. Using arthroscopy as the gold standard, MRI and CT had sensitivities of 94.12% and 85.29%, specificities of 78.79% and 75.76%, and accuracies of 89.11% and 82.18%, respectively. Significant differences were observed in intercondylar fossa morphology, intercondylar fossa width, tibial intercondylar eminence width, and the ratio of tibial intercondylar eminence width to intercondylar fossa width between the ACL rupture and normal groups (P<0.05). Multivariate logistic regression identified type A intercondylar fossa morphology and a low ratio of tibial intercondylar eminence width to intercondylar fossa width as significant imaging-related influencing factors for ACL rupture (P<0.05). Conclusion: MRI and CT imaging findings for ACL injury in young soldiers differ, with MRI demonstrating slightly higher diagnostic efficacy. Type A intercondylar fossa morphology and a low ratio of tibial intercondylar eminence width to intercondylar fossa width are significant imaging-related influencing factors for ACL rupture in this population.

Key words： Knee joint Anterior cruciate ligament rupture Soldiers Imaging Influencing factors

基金资助:2020年度江苏省中医药科技发展计划项目,(编号:YB2020038)

通讯作者: 郭莉莉

引用本文:

张影, 赵汉青, 陈凯, 张秋怡, 刘增辉, 朱洁, 石静, 李婷, 郭莉莉. 年轻军人膝关节前交叉韧带损伤的MRI CT影像学表现及影像学相关影响因素研究[J]. 河北医学, 2025, 31(3): 504-508.
ZHANG Ying, ZHAO Hanqing, CHEN Kai, et al. MRI and CT Imaging Findings and Imaging-Related Influencing Factors of Anterior Cruciate Ligament Injury in Young Soldiers. HeBei Med, 2025, 31(3): 504-508.

链接本文:

http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.03.028 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I3/504

[1] 徐丹,黎华茂,杨慧,等.悬吊运动疗法在青年军人膝关节前交叉韧带重建同期半月板缝合术后康复中的作用[J].创伤外科杂志,2023,25(8):579-585.
[2] 张宇,胡军,宋李军,等.Schatzker Ⅳ型胫骨平台骨折韧带损伤的MRI观察及对膝关节稳定性的影响[J].中华创伤骨科杂志,2020,22(11):927-932.
[3] Simonsson R,Magnusson C,et al.To achieve the unachievable-patients' experiences of opting for delayed anterior cruciate ligament reconstruction after trying rehabilitation alone as primary treatment:a qualitative study[J].Scandinavian journal of medicine & science in sports,2024,34(2):14569.
[4] Flannery S W,Barnes D A,Costa M Q,et al.Automated segmentation of the healed anterior cruciate ligament from T2* relaxometry MRI scans[J].Journal of orthopaedic research,2023,41(3):649-656.
[5] Milandri G,Sivarasu S.A randomized controlled trial of eccentric versus concentric cycling for anterior cruciate ligament reconstruction rehabilitation[J].The American Journal of Sports Medicine,2021,49(1):626-636.
[6] Zeyu L,Bo H,Hui Y,et al.High-resolution contrast-enhanced MRI with three-dimensional fast spin echo improved the diagnostic performance for identifying pituitary microadenomas in Cushing's syndrome[J].European radiology,2023,33(9):5984-5992.
[7] Giesler P,Baumann F A,Weidlich D,et al.Patellar instability MRI measurements are associated with knee joint degeneration after reconstruction of the medial patellofemoral ligament[J].Skeletal radiology,2022,51(3):535-547.
[8] 郭美苑,李茂英.原发性胃癌病灶诊断中MRI的应用及对病灶检出率的影响[J].重庆医学,2021,50(S01):193-195.
[9] Grmeli C A,Grmeli G,Burak Yamur zturk,et al.The effect of the intercondylar notch width index on anterior cruciate ligament injuries:a study on groups with unilateral and bilateral ACL injury[J].Acta orthopaedica Belgica,2015,81(2):240-244.
[10] Huang M,Li Y,Li H,et al.Predictive effects of the intercondylar notch morphology on anterior cruciate ligament injury in males:a magnetic resonance imaging analysis[J].Medicine,2020,99(10):19411.
[11] Iriuchishima T,Goto B,Fu F H.The occurrence of ACL injury influenced by the variance in width between the tibial spine and the femoral intercondylar notch[J].Knee Surgery Sports Traumatology Arthroscopy,2020,28(11):3625-3630.
[12] 王星亮,彭超,华国军.膝关节前交叉韧带损伤危险因素的影像学分析[J].中国组织工程研究,2022,26(15):2361-2366.