摘要
目的通过对膝关节骨性关节炎(KOA)患者起病时和起病2年内的临床资料进行分析,旨在发现KOA早期诊断的方法及提高诊断正确率。方法对300例KOA患者的临床资料进行回顾性分析,观察患者起病时及起病2年内的主要临床症状及体征,并分析其中37例行膝关节镜手术的资料。术前均行膝关节1.5 T MRI常规扫描及3.0 T MRI UTE成像检查,按分级标准分别对KOA进行分级,以关节镜下诊断为标准,对比分析2种MRI检查的诊断符合率。结果 300例KOA中,245例首发症状为膝关节冷痛,阳性率81.7%;231例关节弹响,阳性率77.0%;82例晨僵,阳性率27.3%。在膝关节体格检查中,挺髌试验阳性者143例,阳性率47.7%;髌股研磨试验阳性者125例,阳性率41.7%;膝内翻者74例,阳性率24.7%。行膝关节手术的37例关节镜分级:0级5例,Ⅰ级20例,Ⅱ级12例。以关节镜下诊断为标准,3.0 T MRI UTE成像检查与关节镜的Ⅰ级(χ2=4.497,P=0.034)、Ⅱ级(χ2=5.196,P=0.014)诊断符合率均高于1.5 T MRI常规扫描,差异有统计学意义(P<0.05)。结论早期KOA多数以膝关节冷痛为首发症状,关节弹响及晨僵也是确诊KOA的重要线索;体格检查中主要以挺髌试验及髌股研磨试验为主,同时应检查膝内翻情况;辅助检查主要依靠膝关节MRI,且运用3.0 T MRI UTE序列关节软骨成像可提高对KOA的早期确诊率。
Objective To discover KOA method of early diagnosis and improve diagnostic accuracy by analyzing clinical data of knee osteoarthritis（KOA） patients during two years. Methods The clinical data of 300 KOA patients were retrospectively analyzed, patients＇ clinical symptoms and signs were observed during two years and analyzed for the data of 37 patients who underwent knee arthroscopic surgery. Preoperative scans included knee 1.5 T MRI and 3.0 T MRI UTE imaging. According to the classification criteria for grading each KOA to arthroscopic diagnosis as the standard, the compliance rate of two kinds MRI examination was compared and analyzed. Results There were 245 cases whose first symptom was cold sore and the positive rate was 81.7%, 231 cases＇ first symptom was snapping joint and the positive rate was 77.0%, 82 cases＇ first symptom was cold sore and the positive rate was 27.3%. Physical examination of the knee： test of traction of patella（143 cases, 47.7%）, patella grind test（125 cases, 41.7%）, genu varum（74 cases, 24.7%）. Thirty seven cases of knee arthroscopy surgery rating： 0 grade in 5cases,Ⅰgrade 20 cases, Ⅱ grade 12 cases. In arthroscopic diagnosis criteria, 3.0 T MRI UTE imaging in gradeⅠ（χ2 =4.497, P =0.034）, gradeⅡ（χ2 =5.196, P =0.014） diagnosis was higher than 1.5 T MRI scan, there was statistically significant difference（P 0.05）. Conclusion The most important symptoms of early KOA is cold sore, snapping joint and morning stiffing also are important. The physical examination of the knee is test of traction of patella, Patella grind test, and Genu varum. The auxiliary examination mainly rely on knee MRI, and the use of 3.0T MRI UTE imaging could improve the early diagnosis rate of KOA.
出处
《中国骨与关节损伤杂志》
2015年第2期161-163,共3页
Chinese Journal of Bone and Joint Injury
基金
浙江省科技计划项目(2012C13017-2)
