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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2020, Vol. 17 ›› Issue (05) : 473 -477. doi: 10.3877/cma.j.issn.1672-6448.2020.05.015

所属专题： 文献；

骨骼肌肉超声影像学

膝关节前外侧韧带的超声影像特征及损伤的诊断分析
余秋锦1, 冉海涛1,†(), 杨扬1, 聂茂2,†()   
  1. 1. 400010　重庆医科大学附属第二医院超声科　超声分子影像重庆市重点实验室
    2. 400010　重庆医科大学附属第二医院骨科
  • 收稿日期:2019-10-27 出版日期:2020-05-01
  • 通信作者: 冉海涛, 聂茂

Ultrasonographic features and injured diagnosis

Qiujin Yu1, Haitao Ran1,†(), Yang Yang1, Mao Nie2,†()   

  1. 1. Ultrasound Department of the Second Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ultrasound Molecular Imagine, Chongqing 400010, China
    2. Department of Orthopaedics, the Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
  • Received:2019-10-27 Published:2020-05-01
  • Corresponding author: Haitao Ran, Mao Nie
  • About author:
    Corresponding author: Nie Mao, Email: ;
    Ran Haitao, Email:
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余秋锦, 冉海涛, 杨扬, 聂茂. 膝关节前外侧韧带的超声影像特征及损伤的诊断分析[J]. 中华医学超声杂志（电子版）, 2020, 17(05): 473-477.

Qiujin Yu, Haitao Ran, Yang Yang, Mao Nie. Ultrasonographic features and injured diagnosis[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(05): 473-477.

目的

分析正常及损伤的膝关节前外侧韧带在超声中的影像学表现。

方法

选取2018年1月至2019年7月在重庆医科大学附属第三医院的20例磁共振成像确诊的单膝急性前交叉韧带（ACL）损伤患者的双膝关节前外侧韧带（ALL）进行超声检查，获得高分辨率超声图像后对图像进行评估。Cohen的Kappa系数用于评估观察者之间的一致性。通过受试者工作特性曲线（ROC）获得ALL损伤的厚度阈值。

结果

在正常膝关节的超声影像中，ALL近股骨外侧髁附着处90%（18/20，Kappa=0.85）可显示，ALL胫骨平台插入处100% （20/20，Kappa=1）可显示，ALL半月板插入处无法显示（0/20，Kappa=1）。在合并ACL损伤的膝关节中，ALL损伤的发生率为45%（9/20，Kappa=0.80），其中胫骨平台插入处损伤有9例（Kappa=1），近股骨外侧髁附着处损伤有2例（Kappa=0.79）。ROC曲线法分析结果表明，超声下ALL近股骨外侧髁附着处厚度大于0.65 mm考虑为韧带损伤（敏感度100%，特异度40%），ALL胫骨平台插入处厚度大于1.25 mm考虑为韧带损伤（敏感度88%，特异度93%）。

结论

ALL损伤常与ACL撕裂伴随发生，并且损伤多发生在胫骨平台插入处，超声是检查ALL简单、快速的方法。

关键词: 前外侧韧带, 前交叉韧带, 超声检查
Objective

To analyze the ultrasonographic findings of normal and injured anterolateral ligament (ALL).

Methods

The ALLs of 20 patients with acute unilateral anterior cruciate ligament (ACL) injuries, as diagnosed by MRI, were examined by ultrasonography and MRI. The injuries were evaluated after obtaining high-resolution images. The Cohen's Kappa coefficient was used to evaluate consistency between observers. The threshold of thickness for ALL injury was obtained by receiver operating characteristic (ROC) curve analysis.

Results

In the normal knee joints, the incidence of ALL in proximal femoral condyle attachment was 90% (18/20, Kappa=0.85) and the incidence of ALL in tibial plateau insertion was 100% (20/20, Kappa=1). The insertion of the meniscus of ALL cannot be displayed (0/20, Kappa=1). In knee joints with ACL injury, the incidence of ALL injury, as diagnosed by ultrasound, was 45% (9/20, Kappa=0.80), including nine cases with insertion tibial plateau injuries (Kappa=1) and two cases with lateral condyle of the femur attachment injuries (Kappa=0.79). The results of ROC curve analysis showed that a lateral femoral condyle attachment ALL thicker than 0.65 mm as measured by ultrasound was considered to be an injury (sensitivity: 100%; specificity: 40%), whereas an tibial plateau insertion ALL thicker than 1.25 mm was considered to be an injury (sensitivity: 88%; specificity: 93%).

Conclusion

ALL injury is often accompanied by ACL tear, and the injury usually occurs at the insertion of the tibial plateau. Ultrasound is a simple and rapid method for the examination of ALL.

Key words: Anterolateral ligament, Anterior cruciate ligament, Ultrasound
图1 超声下正常受检者的膝关节髂胫束图像
图2 超声下正常受检者的膝关节前外侧韧带图像。示正常ALL为一带状低回声结构，一端附着于腓骨头（箭头所示）加彩后位于ALL深面的LIGA
图3 超声下前交叉韧带损伤的受检者的膝关节前外侧韧带图像。示损伤的前外侧韧带，胫骨附着处回声减低，增厚伴周围软组织积液（白箭头）
图4 胫骨平台插入处前外侧韧带损伤的受试者工作特征曲线（曲线下面积0.849）
图5 近股骨外侧髁处前外侧韧带损伤阈值的受试者工作特征曲线（曲线下面积0.764）
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