摘要
目的:通过对膝骨性关节炎(OA)关节软骨病损MRI成像和关节镜检查结果的对照比较,研究两者对反映膝关节软骨病损的严重程度是否具有相关性,以指导临床医师如何对膝OA关节软骨病损进行科学有效的评估及制定相应的治疗方案。方法:将每个膝关节的软骨面分成6个部分:股骨内髁面、股骨外髁面、髌骨内侧面、髌骨外侧面、胫骨平台内侧面和胫骨平台外侧面。术前由磁共振医师按Recht分级标准对各序列图像中关节软骨情况作出诊断和病变分级,写出报告。关节镜检查术前参考常规序列的MRI片,术中采集关节镜检图片,以术中关节镜下所见和采集的图片对病变进行评价并写出报告。结果:40例膝关节共240个关节面,MRI和(或)关节镜发现有软骨病变的关节面共101处,以关节镜的诊断为标准,评价各级MRI诊断的准确性,灵敏性,特异性,一致性。其中1级诊断分析:灵敏度=58.62%,特异度=86.11%,ROC曲线下面积为0.852,与机会线0.5相比,差异有统计学意义(P<0.000 1);2级诊断分析:灵敏度=86.96%,特异度=85.90%,ROC曲线下面积为0.870,与机会线0.5相比,差异有统计学意义(P<0.000 1);3级诊断分析:灵敏度=86.36%,特异度=96.20%,ROC曲线下面积为0.875,与机会线0.5相比,差异有统计学意义(P<0.000 1);4级的诊断分析:灵敏度=94.44%,特异度=97.59%,ROC曲线下面积为0.940,与机会线0.5相比,差异有统计学意义(P<0.000 1)。结论:软骨病损的程度越严重,MRI可以比关节镜更早一步发现软骨早期病变。
Objective： To compare the difference between MRI image and arthroscopy,and research the relationship of two methods to the serious degree of knee joint cartilage disease.Methods： Each surface of knee cartilage was divided into 6 parts： Surface of epicondylus medialis femoris,surface of epicondylus lateralis femoris,facies medialis of patella,facies lateralis of patella,facies medialis of tibial plateau,facies lateralis of tibial plateau.The doctor of performing the MRI made the diagnosis and the pathologic classification on the basis of Recht＇s grading standard by MRI image before operation.The doctor of performing arthroscopy made the classification by both the finding of arthroscopy and the image which were collected by arthroscopy.Results： Total 240 joint surfaces of 40 knee joints.The arthroscopy and（or） MRI discovered 101 cartilage pathological changes of different degree.Taking the diagnosis of the arthroscopy as standard,all the levels of MRI diagnosis of accuracy,sensibility,specificity and consistency were evaluated.The class 1： sensibility=58.62%,specificity=86.11%,the acreage below ROC curves was 0.852.Comparing to the opportunity line 0.5,the difference was statistical significance（P0.000 1）.The class 2： sensibility=86.96%,specificity=85.90%,the acreage below ROC curves was 0.870.Comparing to the opportunity line 0.5,the difference was a statistical significance（P0.000 1）.The class 3： sensibility=86.36%,specificity=96.20%,the acreage below ROC curves was 0.875.Comparing to the opportunity line 0.5,the difference was a statistical significance（P0.000 1）.The class 4： sensibility=94.44%,specificity=97.59%,the acreage below ROC curves was 0.940.Comparing to the opportunity line 0.5,the difference was a statistical significance（P0.000 1）.Conclusion： The cartilage disease more serious,the MRI diagnosis is more valuable.Moreover,before appearance of the joint cartilage injury,MRI can discover cartilage earlier period pathological changes,earlier than using arthroscopy.
出处
《海南医学院学报》
CAS
2010年第10期1356-1359,共4页
Journal of Hainan Medical University
基金
海南医学院科研基金资助学报项目(0020100377)~~
