膝關節攝影術對半月板病變之評估

Double Contrast Knee Arthrography Evaluating Meniscal Abnormalities

吳銘庭(Ming-Ting Wu) ； 陳坤煌(Kuen-Huang Chen) ； 徐少克(Shao-Keh Hsu) ； 賴炳宏(Ping-Hong Lai) ； 葉力仁(Lee-Ren Yeh) ； 張晉民(Jinn-Ming Chang) ； 楊建芳(Chien-Fang Yang) ； 黃志賢(Chi-Yin Wong) ； 張政彥(Jeng-Yann Chang) ； 張遵(Tsueu Chang)

《中華放射線醫學雜誌》 18卷1期 (1993/03) Pp. 33-41

摘要

半月板病變為膝關節疼痛之重要病因。國內以往習以關節鏡作為第一線檢查工具，自從磁振造影術問世，已成為膝關節病變的最佳診斷利器。但在國內尚未能普遍實施之際，我們運用傳統的膝關節攝影術來檢查半月板，研究其病變的類型及分佈位置，並與膝關節鏡所見比較，以探討兩者之相關性及優劣處。我們回溯性地分析一年來163個病人的半月板攝影像，選出十分明確的病變加以研究，發現裂傷在內側半月板有43處(78%)，在外側者有12處(22%)。整體而言則以內側後角之病灶最多(69%)。163個病人中有24人後來接受關節鏡檢查；兩者報告一致者16例；互異者8例，其中關節攝影偽陰性或不確定診斷者有2例，皆在外側半月板。關節鏡檢查偽陰性者有4例，皆在內側後角。另有2例兩者描述不合。關節攝影的長處在於對邊緣及後角（尤其是內側後角）之裂傷或剝離較易偵測。但對外側半月板之前後角較不敏感。關節鏡檢查擅於偵測前角、中緣的病灶及前十字韌帶等並可作適當的手術，但內側後角常是關節鏡檢查的死角。關節攝影的結果可提供關節鏡操作者參考，選擇更適當的切口以提高診斷率。對於膝關節半月板病變之診斷，兩者有互補其短、相輔相成的角色。

關鍵字

膝關節攝影術 ； 膝關節 ； 半月板

並列摘要

Meniscal abnormality is one of the major causes of knee pain. In our country, arthroscopy has been used for long as the first line procedure for both diagnosis and therapy of meniscal lesions. Magnetic resonance imaging, however, has been approved in recent years as the best noninvasive diagnostic tool for knee problems because of its high soft tissue contrast, anatomical precision and tissue characterization. Since MR examination is expensive and is not yet popular in Taiwan, we tried to use double contrast arthrography, an old but ignored procedure for internal derangements of knee joint, especially for patients who cannot afford the expensive MR examination.
From Oct. 1990 to Dec. 1991, 163 double contrast arthrograms were performed. We retrospectively reviewed the films for meniscal abnormalities. Twenty-four patients had also undergone arthroscopic examination. Fifty-five definite meniscal tears were selected for analysis; 43 (78%) were found on the medial meniscus and the other 12 lesions (22%) were on the lateral meniscus. That the majority (69%) of the lesions involved the posterior horn of medial meniscus. Arthrographic and arthroscopic findings weve well correlated in 16 out of 24 patitnts. In the other 8 cases, 2 false negative results were found in arthrography, both located on lateral meniscus, and 4 cases had false negative results by arthroscopy, all on the posterior horn of medial meniscus. Arthrography is especially to the advantage of the diagnosis of peripheral lesions, and also lesions on posterior horn of medial meniscus, a blind corner of arthroscopy. Arthroscopy, however, is better for detection of lesions over anterior horns, pical tears and also the cruciate ligaments.
In conclusion, arthrography is still a convenient and reliable screening procedure for meniscal abnormalities of the knee joint. The findings on the arthrogram can help the arthroscopist select an adequate or appropriate incision port for better result. Thus, in our opinion, these two procedures are complementary in the diagnosis and management of the meniscal abnormalities.

並列關鍵字

Joint, knee ； meniscus ； arthrography