CT与MRI在成年膝关节结核中的诊断价值

doi:10.3969/j.issn.1000-6621.2020.01.008

摘要/Abstract

摘要：

目的比较CT与MRI检查在成年膝关节结核诊断中的应用价值。方法选择2017年1月至2018年6月浙江中医药大学附属中西医结合医院经手术病理证实的36例单侧膝关节结核患者。36例患者年龄18~85岁,平均(52.3±18.9)岁;男26例,女10例。所有患者入院后均行CT与MRI检查,比较两种检查方式的诊断发现率。结果 CT检查和MRI检查对于膝关节结核骨质破坏、死骨、滑膜增厚、关节积液、钙化的诊断发现率分别为58.3%(21/36)、52.8%(19/36)、22.2%(8/36)、36.1%(13/36)、30.6%(11/36)和91.7%(33/36)、5.6%(2/36)、97.2%(35/36)、80.6%(29/36)、0.0%(0/36),其中CT检查对骨质破坏、滑膜增厚和关节积液的诊断发现率明显低于MRI检查,对死骨和钙化的诊断发现率明显高于MRI检查,差异均有统计学意义(χ ²值分别为8.96、17.21、39.03、14.63、17.24,P值分别为0.003、0.000、0.000、0.000、0.000);CT检查和MRI检查对于关节间隙异常、关节周围冷脓肿及并发窦道形成的诊断发现率分别为97.2%(35/36)、75.0%(27/36)、11.1%(4/36)和94.4%(34/36)、80.6%(29/36)、11.1%(4/36),差异均无统计学意义(χ ²值分别为0.00、0.32、0.00,P值分别为1.000、0.571、1.000)。结论 CT检查对于发现死骨、钙化占优势;MRI检查对于观察膝关节骨质破坏、滑膜增厚及评估整个关节破坏程度有明显优势。

关键词: 结核,骨关节, 膝关节, 体层摄影术,X线计算机, 磁共振成像, 诊断显像, 对比研究

Abstract:

Objective To compare the application value of CT and MRI in the diagnosis of adult knee joint tuberculosis. Methods Thirty-six patients with unilateral knee joint tuberculosis confirmed by surgical pathology from January 2017 to June 2018 in the Zhejiang Integrated Traditional and Western Medicine Hospital affiliated to Zhejiang Chinese Medical University were selected. The age of 36 patients (26 males and 10 females) ranged from 18 to 85 years, with an average of (52.3±18.9) years old. All patients underwent CT and MRI examinations after admission. The diagnostic discovery rates of the two methods was compared. Results The diagnostic discovery rates of bone destruction, bone death, synovium thickening, joint effusion and calcification were 58.3% (21/36), 52.8% (19/36), 22.2% (8/36), 36.1% (13/36), 30.6% (11/36) by CT, and 91.7% (33/36), 5.6% (2/36), 97.2% (35/36), 80.6% (29/36), 0.0% (0/36) by MRI. The diagnostic discovery rates of bone destruction, synovium thickening, and joint effusion by CT were significantly lower than those by MRI, while the diagnostic discovery rates of bone death, and calcification by CT were obviously higher than those by MRI, all with the statistically significant differences between groups (χ ² values were 8.96, 17.21, 39.03, 14.63, 17.24, P values were 0.003, 0.000, 0.000, 0.000 and 0.000, respectively). The diagnostic discovery rates of abnormal joint space, cold abscess around the joint, and concurrent sinus formation were 97.2% (35/36), 75.0% (27/36), 11.1% (4/36) by CT, and 94.4% (34/36), 80.6% (29/36), 11.1% (4/36) by MRI, without significant difference between the groups (χ ² values were 0.00, 0.32, 0.00, P values were 1.000, 0.571, and 1.000, respectively). Conclusion CT examination is dominant in finding dead bone and calcification predominate, while MRI examination has significant advantages in observing knee joint bone destruction, synovial thickening and assessing the degree of joint destruction.

Key words: Tuberculosis,osteoarticular, Knee joint, Tomography,X-ray computed, Magnetic resonance imaging, Diagnostic imaging, Comparative study

司马斌,邱小伟,王安龙. CT与MRI在成年膝关节结核中的诊断价值[J]. 中国防痨杂志, 2020, 42(1): 26-30. doi: 10.3969/j.issn.1000-6621.2020.01.008

SIMA Bin,QIU Xiao-wei,WANG An-long. Diagnostic value of CT and MRI in adult knee joint tuberculosis[J]. Chinese Journal of Antituberculosis, 2020, 42(1): 26-30. doi: 10.3969/j.issn.1000-6621.2020.01.008

图/表 8

图1

图2

图3

图4

图5

图6

图7

表1

参考文献 15

[1]	乔宁宁, 唐毓金, 陈文成 , 等. 红细胞补体受体1单核苷酸多态性与骨关节结核易感性的关联研究. 免疫学杂志, 2016,32(7):601-606.
[2]	蓝旭, 许建中, 罗飞 , 等. Ⅰ期手术经后路病灶清除内固定治疗儿童胸椎结核. 中国骨伤, 2013,26(4):320-323. doi: 10.3969/j.issn.1003-0034.2013.04.014 URL
[3]	程鸿鑫, 陈何 . 关节镜治疗早、中期膝关节结核与切开病灶清除术治疗的疗效对比. 中国伤残医学, 2017,25(18):34-35.
[4]	张宏其, 王龙杰, 唐明星 , 等. 脓肿清除术联合置管小剂量灌洗处理胸腰椎结核术后复发的临床疗效. 中国矫形外科杂志, 2016,24(5):401-405.
[5]	陈明旺, 徐向东 . 骨关节结核的影像诊断与误诊分析. 医学影像学杂志, 2013,13(13):55-56.
[6]	廖伟, 杨国强, 覃一珏 . 结核病灶清除术联合植骨融合外固定术治疗膝关节结核的疗效分析. 广西医学, 2017,39(3):302-304, 315.
[7]	孙江艳, 呼芳 . 舒适护理对膝关节置换术后下肢深静脉血栓形成的影响. 血栓与止血学, 2017,23(4):659-661.
[8]	高鹏, 李翰鹏, 姜磐 . 氨甲环酸在全膝关节置换术中不同时间应用的止血效果比较. 血栓与止血学, 2017,23(4):612-615.
[9]	周鹏飞 . 多层螺旋CT与数字摄影对骨关节结核的诊断价值. 中国地方病防治杂志, 2016,31(5):598.
[10]	王彩芬, 蒋天安 . 高频超声对膝关节结核的诊断价值. 中国超声医学杂志, 2015,31(4):363-365.
[11]	蒋国元, 周志琴, 邱毅 , 等. 乳腺中间性钙化的MRI研究. 实用医学杂志, 2016,32(2):248-251.
[12]	陆佳, 陶弘武 . 膝关节骨性关节炎的MRI特点与中医分型的关系. 中华中医药学刊, 2016, 34(8): 2038-2042, 后插14.
[13]	李元, 董伟杰, 兰汀隆 , 等. 膝关节结核病灶清除术及联合植骨融合外固定术的临床治疗效果观察. 中国防痨杂志, 2016,38(4):296-299.
[14]	庄志雄, 许新明, 曹欣荔 . 磁共振成像联合血清RANKL、OPG水平诊断早期类风湿关节炎及骨关节损伤的价值. 中国骨质疏松杂志, 2017,23(3):333-336, 401.
[15]	刘情, 王国峰 . 成人滑膜型膝关节结核的多螺旋CT诊断. 中国地方病防治杂志, 2014, 29(4): 308, 310.