膝关节及周围常见疾病的超声诊断研究
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| 时间：2009-02-01 20:34:28 来源： 作者： |
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Study on ultrasonic diagnosis of common diseases of knee joint or knee joint peripheral
GUO Zi-jun,YANG Xing-li.Department of Ultrasound,Renhe District Peoples Hospital,Panzhihua 617061,China
［Abstract］ Objective To investigate the value of ultrasonography in diagnosis of common diseases of the knee joint or knee joint peripheral.Methods According to the results of 20 cases of popliteal fossa cysts and 21 cases of popliteal fossa lipoma as well as 11 cases of articular effusion of knee joint ultrasonography proved by surgical pathology，the diagnostic accordance rate was 100%.The examination results by ultrasonography were compared with those of arthroscopic operation.Results Forty-six meniscal lesions were diagnosed by arthroscopic operation，and 38 of which were actually diagnosed by ultrasonography，and 8 meniscal lesions were mis-diagnosed.Actual-negative were found in 97 meniscus，falsepositive in 5 lesions.For all meniscal lesions，the accuracy of ultrasound was 91.2%，sensitivity 82.6%，specificity 95.1%，positive predictive value 88.4%，negative predictive value 92.4%.Conclusion Ultrasonography is the main method for diagnosis of meniscus lesions because it is noninvasive，convenient and may provide with prompt diagnosis.The CT examination and arthroscopy in big hospital are unnecesary，patients can avoid economic losses and delaying treatment time.
［Key words］ knee joints;ultrasonography diagnosis; diseases
以前超声界认为膝关节及周围疾病主要依靠CT和关节镜才能诊断，而超声检查是无能为力的。然而随着现代超声技术和超声工作者经验的不断提高，对膝关节及周围疾病，超声也能迅速地做出正确的诊断。我院2001年6月~2007年6月的6年运用超声诊断膝关节及周围疾病126例。采用手术后病理证实和关节镜进行确诊，发现超声诊断的符合率相当高，达到了96%。有利于在广大的基层医院推广运用。
1 资料与方法
1.1 一般资料 本组腘窝囊肿21例，男8例，女13例，年龄41~55岁；腘窝脂肪瘤20例，男11例，女9例，年龄37~50岁均为腘窝无痛性包块，膝关节活动障碍而就诊。膝关节腔积液11例，男3例，女8例，年龄35~56岁，以膝关节疼痛、关节肿大，功能障碍就诊。膝关节半月板损伤74例，男31例，女43例，年龄18~56岁，平均38.5岁。左膝28例，右膝46例，其中有外伤史者62例，无明确外伤史12例；有外伤史的62例伤后至手术时间5天~1年8个月，平均4~5个月。无外伤史患者从关节疼痛至手术时间4个月~6年3个月，平均2年7个月。
1.2 检查方法
1.2.1 超声检查方法 使用日本阿洛卡阿尔发5型彩超及日本岛津450黑白超声诊断仪。探头选择7.5~10.0 MHz线阵探头。检查腘窝包块和膝关节积液时，无需特殊准备，患者采用俯卧位；检查膝关节损伤时，超声检查时间应选在关节镜检查前1~2天进行。采用直接扫查，检查半月板前角和体部时，患者采用坐位或仰卧位，膝关节屈曲70°~90°，首先在膝眼稍偏后方找到半月板声像，再沿膝关节间隙向前后追踪扫查半月板的前角、体部及部分后角。检查后角时患者采用俯卧位，膝关节伸直或屈膝15°，于腘窝处扫查内、外侧半月板后角。检查过程中采用纵切与横切扫查相结合的方法进行，观察半月板回声情况，并记录异常回声的部位及形态。对临床检查的压痛点进行重点扫查，必要时行双膝相同部位对比扫描。
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