【作者】 李德平；

【导师】 鹿均先；

【作者基本信息】 东南大学 ， 外科学， 2006， 硕士

【摘要】 目的评价螺旋CT扫描多平面重建及仿真内镜成像对髌骨关节软骨损害的诊断价值,为髌骨软骨损害的临床诊断和治疗提供影像学依据。方法采用牛膝关节17个,予以标记,将关节切开,向上翻转髌骨,参照Recht’s标准进行软骨损害模型制作:0级正常软骨;1级软骨表面缺损<软骨全层的50%;2级软骨表面缺损>软骨全层的50%,但软骨下骨未裸露;3级全层软骨缺损,软骨下骨裸露或缺损。其中6个髌骨软骨面不做软骨损害处理,作为0级。11个分别用直径3、4、5mm钻头在髌骨软骨面上、中、下三部位制作不同级别损害3-5个,予以记录并测量损害直径。然后将关节囊紧密缝合,防止漏气。以上步骤完成后,以7号针头经髌骨外上方向关节腔内注入150 ml空气,然后作CT扫描;将扫描所得数据输入工作站进行多平面重建图像及仿真内镜处理,观察髌骨软骨损害,将其诊断结果与模型标本结果比较。分别计算MPR和SCT-VA对软骨损害诊断的灵敏度、特异度;将CT测量损害直径与标本损害直径进行配对T检验。结果与大体标本对照,17例牛髌骨软骨损害的MPR和SCT-VA检查敏感度、特异度分别为93.1%、100%和97.7%、100%。MPR测量损害直径与大体标本经配对T检验无显著性差异P>0.05。结论多平面重建和仿真内镜相结合,能够对髌骨软骨缺损害的级别、部位作出较准确的诊断;MPR对软骨损害的直径可以测量,从而评价软骨损害的大小。更多还原

【Abstract】 Objective To evaluate the value of spiral CT multiplanar reconstruction technique (MPR)and spiral CT virtual endoscopy (SCT-VE)in the detection of articular cartilage damage of the patellar facets. Methods 17 bovine knees were used for the experiment. Eleven of the patellar cartilage facets were damaged artificially with the diameter 3 or 4 or 5mm of a drill after arthrotomy according to Reach’s criteria: grade 0,normal cartilage; grade 1, mildly or moderately irregular outline of cartilage surface, depth of local cartilage defects less than 50% of the cartilage thickness; grade 2, moderately or severely irregular outline of chondral surface ,depth of local cartilage defects less than 50% of the cartilage thickness more than 50% of the cartilage thickness But less than 100% of the cartilage thickness without shedding; grade 3,complete loss or denudation of articular cartilage with exposure of subchondral bone; Six of them were only incised but the patellar cartilage facets were not damaged. After the incision was carefully sutured, 150 ml of air was injected into the joint, which was then scanned with a PQ6000 spiral computed tomograjphy (SCT) scanner. The data obtained were transformed to the work station, MPR and SCT-VE were used to illustrate damages in patellar cartilage facets. The results of CT diagnosis were compared with what were inspected in the specimens. Results Compared with the specimens, the sensitivity, specificity were 93.1%、100% and 97.7%、100% respectively with multiplanar reconstruction and SCT-virtual endoscopy.T-test P>0.05.Conclosion Comparing with specimens, the diagnosis accuracy of spiral computed tomography multiplanar reconstruction and spiral computed tomography virtual endoscopy in detecting patellar cartilage damage is remarkeble.更多还原