| 距骨骨软骨损伤的MRI诊断及骨软骨移植术后的动态随访分析 |
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投稿时间：2016-03-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 方军杰 |
FANG Jun-jie |
宁波市第二医院放射科, 浙江 宁波 315016 |
Department of Orthopaedics, Ningbo No.2 Hospital, Ningbo 315016, Zhejiang, China |
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| 陈良 |
CHEN Liang |
宁波市第二医院骨科, 浙江 宁波 315016 |
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alanchenl@aliyun.com |
| 胡碧波 |
HU Bi-bo |
宁波市第二医院放射科, 浙江 宁波 315016 |
Department of Orthopaedics, Ningbo No.2 Hospital, Ningbo 315016, Zhejiang, China |
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| 夏建笔 |
XIA Jian-bi |
宁波市第二医院放射科, 浙江 宁波 315016 |
Department of Orthopaedics, Ningbo No.2 Hospital, Ningbo 315016, Zhejiang, China |
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| 孙微 |
SUN Wei |
宁波市第二医院放射科, 浙江 宁波 315016 |
Department of Orthopaedics, Ningbo No.2 Hospital, Ningbo 315016, Zhejiang, China |
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| 期刊信息：《中国骨伤》2016年，第29卷，第9期，第814-819页 |
| DOI：10.3969/j.issn.1003-0034.2016.09.009 |
| 基金项目:浙江省医药卫生科技计划项目（编号：2015KYB342） |
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中文摘要:
目的：研究踝关节距骨骨软骨损伤的MRI表现，评价MRI对距骨骨软骨损伤的诊断及分期的价值，探讨MRI对自体骨软骨移植术后的临床随访价值。
方法：收集2013年2月至2015年3月治疗的距骨骨软骨损伤患者79例，以踝关节镜检查结果为参考标准，研究MRI诊断的准确性，并进行Hepple分期。其中15例行自体骨软骨移植手术，1年后行踝关节MRI随访，进行软骨修复评分（MOCART），分析术后MRI随访的价值。
结果：79例Hepple分期诊断：Ⅰ期7例，Ⅱ期12例，Ⅲ期24例，Ⅳ期16例，Ⅴ期20例。踝关节镜分级（剔除Ⅴ期20例，共59例）:A级2例，B级2例，C级4例，D级14例，E级22例，F级15例。将MRI对Hepple Ⅴ期的准确率定为100%，HeppleⅠ期对应于关节镜A、B、C期，Ⅱ-Ⅳ期分别对应D-F级。MRI对HeppleⅠ、Ⅱ、Ⅲ、Ⅳ期软骨损伤的准确率分别为87.5%、85.7%、95.4%、93.3%.15例术后MRI检查显示移植区域的软骨面较平滑，骨质愈合良好，周围水肿消失。MOCART评分30～80分，平均（59.0±15.6）分，其中9例得分高于60分。
结论：MRI对踝关节距骨软骨损伤具有明显的临床诊断及分期价值，MRI作为术后远期随访手段，可较好地评估术后骨软骨修复情况。 |
| 【关键词】软骨,关节 距骨 踝关节 创伤和损伤 磁共振成像 |
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| MRI diagnosis of osteochondral lesions in the talus and the dynamic follow-up analysis after osteochondral transplantation |
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ABSTRACT
Objective: To investigate MRI findings of osteochondral lesions in the talus;to evaluate the value of MRI in diagnosing and determining the stage of osteochondral lesions;to analyze the follow-up clinical value of MRI in osteochondral transplantation of autologous bone.
Methods: A total of 79 patients from February 2013 to March 2015 had been retrospectively analyzed. All the patients were treated in our hospital. The ankle arthroscopy results were used as the reference standard,and the accuracy of MRI in diagnosis and Hepple staging had been investigated. Fifteen patients with cartilage transplantation of autologous bone were followed up with MRI examination and evaluation of cartilage repair score(MOCART) after one year. The values of MRI in the postoperative follow-up were analyzed.
Results: Hepple staging of 79 patients was shown as follows:7 cases of stageⅠ,12 cases of stage Ⅱ,24 cases of stage Ⅲ,16 cases of stage Ⅳ,and 20 cases of stage Ⅴ. Ankle arthroscopy grading of 59 patients in this group(in addition of 20 cases of stage Ⅴ):2 cases of grade A,2 cases of grade B,4 cases of grade C,14 cases of grade D,22 cases of grade E,and 15 cases of grade F. The accuracy rate of MRI in determining Hepple Ⅴ was set at 100%,and Hepple stageⅠcorresponds to the arthroscopic A,B,C stage,stageⅡcorresponds to D stage,stage Ⅲ corresponds to E stage,stage Ⅳ corresponds to F stage. The accuracy rate of MRI in determining Hepple stageⅠto Ⅳ was 87.5%,85.7%,95.4% and 93.3% respectively. After cartilage transplantation of autologous bone,MRI of 15 patients showed cartilage surface in transplanted area was smooth,bone healed well,and the surrounding edema disappeared. The MOCART was 30 to 80 scores with an average score 59.0±15.6;9 cases of these 15 patients were(9/15,60%) higher than 60 score.
Conclusion: MRI plays a significant role in clinical diagnosis and staging of the talus osteochondral injury. As a method of long-term follow-up after cartilage transplantation,MRI can well evaluate the rapair of the postoperative osteochondral injury. |
| KEY WORDS Cartilage,articular Talus Ankle joint Wounds and injuries Magnetic resonance imaging |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 方军杰,陈良,胡碧波,夏建笔,孙微.距骨骨软骨损伤的MRI诊断及骨软骨移植术后的动态随访分析[J].中国骨伤,2016,29(9):814~819 |
| 英文格式: | FANG Jun-jie,CHEN Liang,HU Bi-bo,XIA Jian-bi,SUN Wei.MRI diagnosis of osteochondral lesions in the talus and the dynamic follow-up analysis after osteochondral transplantation[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(9):814~819 |
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