【作者】 王莉；

【导师】 万业达；

【作者基本信息】 天津医科大学 ， 影像医学与核医学（专业学位）， 2018， 硕士

【摘要】 目的:采用MRI定量T2 mapping技术,探讨股四头肌腱和髌韧带在膝关节骨性关节病(KOA)时是否存在变化、股四头肌腱和髌韧带不同部位的生化结构是否存在差异,为评价股四头肌腱和髌韧带的变化与KOA的相关性提供影像依据。对象与方法:对膝关节正常的志愿者、于我院就诊的具有膝关节症状的患者及拟行全膝关节置换术的患者行MRI检查,对其行常规序列及定量T2 mapping序列扫描。将研究对象分为三组:A组,正常对照组;B组,具有膝关节症状组;C组,拟行全膝关节置换术组。使用ADW4.6工作站内的Functool软件对T2mapping原始图像进行伪彩色处理,选取矢状位图像上显示股四头肌腱面积最大层面,将扫描野中所显示的股四头肌腱腱性部分平均分为三个亚区(PQT、MQT、DQT)进行测量。在上述三个位置选取面积为50mm~2的圆,在圆心处选取三个连续的感兴趣区(ROI),设定ROI面积为1mm~2,测量其T2值。选取矢状位图像上显示髌韧带面积最大的层面,将髌韧带平均分为三个亚区(PPL、MPL、DPL)进行T2值测量,具体测量方法同股四头肌腱。应用SPSS 21.0软件,采用单因素方差分析(ANOVA)比较股四头肌腱和髌韧带的不同测量点在A、B、C三组之间T2值的差异,以及三组内股四头肌腱和髌韧带不同测量点之间的T2值的差异。显著性P<0.05有意义。结果:(1)股四头肌腱:(1)股四头肌腱不同测量点的T2值在A、B、C三组之间比较差异无统计学意义(P>0.05),且两两比较也均无显著性差异(P>0.05)。(2)A组内,PQT与DQT、MQT与DQT的T2值比较差异有统计学意义(P<0.05),PQT与MQT的T2值比较无显著性差异(P>0.05);B组内,PQT与DQT的T2值比较差异有统计学意义(P<0.05),PQT与MQT、MQT与DQT的T2值比较无显著性差异(P>0.05);C组内,PQT与DQT的T2值比较差异有统计学意义(P<0.05),PQT与MQT、MQT与DQT的T2值比较无显著性差异(P>0.05)。(2)髌韧带:(1)髌韧带不同测量点的T2值在A、B、C三组之间比较具有统计学差异(P<0.05),且两两比较均有显著性差异(P<0.05),A组>B组>C组。(2)A组内,PQT、MQT、DQT三个测量点的T2值两两比较差异均无统计学意义(P>0.05);B组内,PQT、MQT、DQT三个测量点的T2值两两比较差异均有统计学意义(P<0.05);C组内,PQT、MQT、DQT三个测量点的T2值两两比较差异均无统计学意义(P>0.05)。结论:股四头肌腱内部结构存在差异性,近端较远端含有更多的胶原蛋白和水。股四头肌腱在KOA时T2值不发生变化。KOA伴有髌韧带的改变。髌韧带在KOA时的损伤过程不具有一致性和同时性。更多还原

【Abstract】 Objective:To investigate any difference between the quadriceps tendon and patellar tendon of the knee osteoarthritis(KOA)by a quantitative MRI technique-T2mapping.Further understanding differences in the biochemical structure of the quadriceps tendon and patellar ligament of the knee,and to provide the image basis for the evaluation of the correlation between the degeneration of the quadriceps tendon and the patellar ligament.Subjects and Methods:MRI was used to perform scans of the knee joint in normal volunteers,in the participants with knee joint symptoms and in patients scheduled for total knee replacement surgery.Normal routine knee scans along with quantitative T2mapping sequences were scanned for all the subjects.The subjects were divided into three groups:Group A-Normal control group,Group B-Symptomatic knee group and Group C–patients scheduled for total knee replacement surgery.The Functool software in ADW4.6 workstation was used to perform pseudo color processing on the original T2 mapping image.Maximum area of the quadriceps tendon was displayed on the sagittal image,thus the latter was used for evaluation.The quadriceps tendon in the scanned field were divided into three subregions(PQT,MQT,DQT).In all three locations,an area of 50mm~2 was manually selected along with three continuous point each of 1mm~2 as region of interest(ROI),which were measured as T2 values.The maximum area of the patellar ligament was displayed on the sagittal image,and the patellar ligament in the scanned field were divided into three subregions(PPL,MPL,DPL).The specific measurement method was the same as the quadriceps tendon.SPSS 21.0 software was used to analyze the differences in the T2 values between all three groups by single factor variance analysis of the quadriceps tendon and patellar ligament,as well as the difference of the T2 values between the quadriceps tendon and the patellar ligament in the three groups.P<0.05 was considered statistically significant.Results:(1)Quadriceps tendon:(1)There was no significant difference in the T2value of quadriceps tendon in the Groups A,B and C(P>0.05),and there was no significant difference on pairwise comparison(P>0.05).(2)In group A,there was a significant difference in the T2 value between PQT and DQT,MQT and DQT(P<0.05),and there was no significant difference in PQT and MQT(P>0.05).In group B,there was a significant difference in the T2 value between PQT and DQT(P<0.05).There was no significant difference in T2 value between PQT and MQT,MQT and DQT(P>0.05).In group C,there was a significant difference in the T2value between PQT and DQT(P<0.05).There was no significant difference in T2value between PQT and MQT,MQT and DQT.(2)Patellar ligament:(1)There was a significant difference in the T2 value of patellar ligament in the Groups A,B and C(P<0.05),and there was a significant difference on pairwise comparison(P<0.05).(2)In group A,the T2 values of PQT,MQT and DQT were not statistically significant on pairwise comparison(P>0.05).In group B,the difference of T2 value of PQT,MQT and DQT was statistically significant on pairwise comparison(P<0.05).In group C,there was no significant difference in T2 value of PQT,MQT,DQT on pairwise comparison(P>0.05).Conclusions:There are differences in the internal structure of the quadriceps tendon.The proximal quadriceps tendon contains more collagen and water.The T2 values of the quadriceps tendon didn’t change at KOA.KOA occurred with degeneration of patellar ligament.The degenerative process of the patellar ligament at KOA is inconsistency and simultaneity.更多还原