Diagnostic and therapeutic value of ultrasound in knee joint meniscus injury and cysts
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摘要:
目的分析高频超声对膝关节半月板囊肿的显像特点及引导微创治疗,提供一种对该病的诊疗方法。 方法回顾性分析我院2017年1月~2019年6月86例超声诊断为膝关节半月板囊肿的病例,并与MRI、关节镜对照,并对8例采用超声引导下微创治疗,探讨高频超声对膝关节半月板囊肿及其撕裂情况的的诊疗价值。 结果高频超声诊断半月板囊肿的86例,与MRI、关节镜对照,超声对半月板囊肿的敏感性很高,但是误诊1例,特异性约98.83%;82例半月板囊肿合并撕裂病例中超声明确显示合并半月板撕裂78例,漏诊4例,敏感性约95.12%。行超声引导下微创治疗8例,术后效果均改善,1例复发,暂未见明显临床症状。 结论高频超声对膝关节半月板囊肿及其撕裂情况有较高的临床诊断价值,并可行超声引导微创治疗。 Abstract:ObjectiveTo explore the imaging characteristics of high frequency ultrasound in meniscus cyst of knee joint, guide minimally invasive treatment, and provide a method for diagnosis and treatment of this disease. MethodsThe ultrasonographic findings of 86 cases of meniscus cyst of knee joint from January 2017 to June 2019 were retrospectively analyzed. The ultrasonographic findings of meniscus cyst of knee joint were compared with those of MRI and arthroscopy. Eight cases were treated with ultrasound-guided minimally invasive therapy. ResultsAmong 86 cases of meniscus cysts diagnosed by high frequency ultrasound, compared with MRI and arthroscopy, ultrasound was highly sensitive to meniscal cysts. But 1 case was misdiagnosed, with a specificity of about 98.83%. In 82 cases of meniscal cysts, ultrasound showed 78 cases with meniscal tear, but 4 case was missed diagnossis, with a sensitivity of about 95.12%. The effect of ultrasound-guided minimally invasive treatment was improved in 8 cases. One case recurred, but no obvious clinical symptoms were found. ConclusionHigh-frequency ultrasound has a high clinical value in the diagnosis of meniscal cysts. It can be used for ultrasound-guided minimally invasive treatment. -
Key words:
- muscle-bone ultrasound /
- knee joint /
- meniscus cyst /
- minimally invasive treatment
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表 1 膝关节半月板囊肿一般资料(n=86)
项目 合并半月板撕裂 与半月板关系 半月板内 半月板旁 超声 78(8例未见明显撕裂) 7 79 MRI 82(4例未见明显撕裂) 7 78(1例为滑膜囊肿) -
[1] Stefano B, Carlo M. Ultrasound of the musculoskeletal system[M]. Springer: Verlag Berlin Heidelberg, 2007. [2] Azam M, Shenoy R. The role of arthroscopic partial meniscectomy in the management of degenerative meniscus tears: a review of the recent literature[J]. Open Orthop J, 2016, 10(6): 797-804. [3] 熊 奡, 康 斌, 马泽涛, 等. 膝关节周围囊肿的超声诊断[J]. 实用医学影像杂志, 2010, 11(2): 116-8. doi: 10.3969/j.issn.1009-6817.2010.02.018 [4] 韩长年, 屈 辉. 膝关节囊性病变的磁共振影像诊断探讨[J]. 中华临床医师杂志: 电子版, 2018, 12(10): 576-9. [5] 王 成, 胡跃林. 膝关节半月板囊肿104例临床特点分析[J]. 中国微创外科杂志, 2009, 9(11): 1032-4, 1041. doi: 10.3969/j.issn.1009-6604.2009.11.023 [6] 周 元, 战爱玲, 曾红春, 等. 超声评分法分级诊断膝骨性关节炎的初步研究[J]. 中国超声医学杂志, 2018, 4(6): 556-60. doi: 10.3969/j.issn.1002-0101.2018.06.025 [7] 张 波. 超声对类风湿关节炎髌上囊滑膜炎疗效评价及与风湿病活动期指标相关性分析[J]. 中国医师进修杂志, 2012, 35(17): 43-7. [8] 万 蓉, 钟 娜, 冯宁娜. 高频超声评价膝骨性关节炎软骨病变及膝周组织的价值[J]. 中国老年学杂志, 2016, 36(21): 5409-10. doi: 10.3969/j.issn.1005-9202.2016.21.090 [9] 张国荣, 张 雷, 刘长庆, 等. 彩色多普勒超声对膝关节骨性关节炎患者滑膜炎的诊断探讨[J]. 中国超声医学杂志, 2010, 26(3): 276-8. doi: 10.3969/j.issn.1002-0101.2010.03.025 [10] 任 杰, 郑荣琴, 黄冬梅, 等. 膝关节软骨退行性变的声像学表现[J]. 中国超声医学杂志, 2006, 22(2): 151-3. doi: 10.3969/j.issn.1002-0101.2006.02.025 [11] 李拾林, 吕国荣, 胡麦果, 等. 超声评分法评价类风湿关节炎的意义[J]. 中国超声医学杂志, 2014, 30(6): 266-9. [12] Ohishi T, Suzuki D, Matsuyama Y. Arthroscopic decompression for a giant meniscal cyst[J]. Orthopedics, 2016, 39(1): e166-8. doi: 10.3928/01477447-20151222-15 [13] 李东明, 蔡林君, 张 滔. 膝关节半月板囊肿的MRI特点[J]. 实用放射学杂志, 2016, 32(6): 911-4. doi: 10.3969/j.issn.1002-1671.2016.06.022 [14] 程智涛, 邹 季. 关节镜下手术治疗膝关节半月板囊肿17例体会[J]. 创伤外科杂志, 2014, 16(2): 165-184. [15] 蒋雪梅, 董 磊, 史 浩, 等. 半月板损伤的声像图分析[J]. 中国中西医结合影像学杂志, 2011, 9(4): 325-7. doi: 10.3969/j.issn.1672-0512.2011.04.012 [16] 孙永梅, 周保军, 张思筠. 半月板囊肿分型诊断的超声应用[J]. 中国临床医学影像杂志, 2013, 24(10): 750-1. doi: 10.3969/j.issn.1008-1062.2013.10.021 [17] 李镇超, 黄洁玲, 区耀庭, 等. 彩色多普勒超声诊断膝关节半月板囊肿的价值探讨[J]. 临床超声医学杂志, 2009, 11(6): 419-20. doi: 10.3969/j.issn.1008-6978.2009.06.022 [18] Wu CC, Hsu YC, Chiu YC, et al. Parameniscal cyst formation in the knee is associated with meniscal tear size: an MRI study[J]. Knee, 2013, 20(6): 556-61. doi: 10.1016/j.knee.2013.03.008 [19] 张传军, 贾堂宏, 奚修全, 等. 关节镜下半月板部分切除加内减压术治疗半月板囊肿[J]. 中国矫形外科杂志, 2007, 15(9): 669-71. doi: 10.3969/j.issn.1005-8478.2007.09.009 [20] 张春礼, 徐 虎, 范宏斌, 等. 半月板囊肿的关节镜下手术治疗[J]. 中国矫形外科杂志, 2006, 14(15): 1729-33. [21] 赵小二, 张 继, 钟 星, 等. MRI在膝关节非肿瘤性病变中的应用[J]. 医学影像学杂志, 2016, 26(7): 1292-5, 1303. [22] Hulet C, Souquet D, Alexandre P, et al. Arthroscopic treatment of 105 lateral meniscal cysts with 5-year average follow-up[J]. Arthroscopy, 2004, 20(8): 831-6. doi: 10.1016/S0749-8063(04)00599-7