膝关节痛风性关节炎前交叉韧带断裂的MRI诊断价值分析

作者	单位	邮编
杨大伟^*	中国中医科学院广安门医院南区骨伤科,北京,102618	102618
李辉	中国中医科学院广安门医院南区骨伤科,北京,102618	102618
王庆帅^*	吉林大学第二医院骨科中心运动医学与关节镜科,吉林长春,130041	130041
陈博	吉林大学第二医院骨科中心运动医学与关节镜科,吉林长春,130041	130041
张智乘	吉林大学第二医院骨科中心运动医学与关节镜科,吉林长春,130041	130041
唐雄风	吉林大学第二医院骨科中心运动医学与关节镜科,吉林长春,130041	130041
李智颖	吉林大学第二医院骨科中心运动医学与关节镜科,吉林长春,130041	130041

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中文摘要:

目的探讨磁共振成像（MRI）对膝关节痛风性关节炎（knee gouty arthritis, KGA）患者前交叉韧带（anterior cruciate ligament, ACL）断裂的诊断价值。方法回顾性分析吉林大学第二医院2018年12月至2023年6月行关节镜手术的55例患者（61个膝关节），包括14例KGA合并ACL断裂、19例单纯KGA（25个膝关节）和22例单纯ACL断裂，分为KGA+ACL组、KGA组和ACL组。由2名独立观察者分析上述患者MRI影像特征。通过组内相关系数检验观察者间一致性。采用单因素方差分析比较三组间的临床指标和MRI特征。结果本研究中各MRI特征的观察者间一致性良好。KGA组的ACL评分、PCL评分与KGA+ACL组、ACL组比较，差异具有统计学意义（P＜0.001），而KGA+ACL组与ACL组之间比较，差异无统计学意义（P＞0.05）。KGA组内侧副韧带（medial collateral ligament, MCL）评分较ACL组更低，差异存在统计学意义（P＜0.01）；KGA组的ACL角、PCL评分和PCL角更大，MRI表现包括Blumensaat角＞0°、胫骨前移位、对吻征水肿的发生率更低。KGA组和KGA+ACL组的痛风结节、骨侵蚀和软骨损伤的发生率明显高于ACL组（P＜0.05）。结论当KGA发生ACL断裂时，直接征象（如韧带连续性中断和纤维走行角度变小）以及间接征象（如内侧半月板撕裂、胫骨前移、PCL屈曲征和对吻征水肿）能够与单纯KGA患者进行鉴别。骨髓水肿结合好发部位、深度、边界等MRI特点在鉴别诊断方面存在一定价值。MSU晶体沉积可导致韧带变性以及强度下降，但对于韧带功能影响不大。当KGA患者难以判断是否存在ACL断裂，可结合病史及相关体格检查明确诊断。

英文摘要:

Objective To explore the diagnostic value of magnetic resonance imaging (MRI) for anterior cruciate ligament (ACL) rupture in patients with knee gouty arthritis (KGA).Methods A retrospective analysis was conducted on 55 patients (61 knee joints) who underwent arthroscopic surgery at the Second Hospital of Jilin University from December 2018 to June 2023. The study included 14 cases of KGA combined with ACL rupture, 19 cases of isolated KGA (25 knee joints), and 22 cases of isolated ACL rupture, and the patients were divided into three groups: the KGA+ACL group, the KGA group, and the ACL group. MRI characteristics of KGA patients with and without ACL rupture were analyzed by two independent observers. Interobserver reproducibility was analyzed by the intraclass correlation coefficient. One-way analysis of variance was used to compare clinical indicators and MRI features among the three groups.Results In this study, the inter-observer consistency of each MRI feature was good. The scores of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) in the KGA group showed statistically significant differences compared with the KGA+ACL group and the ACL group, while no significant difference was found between the KGA+ACL group and the ACL group (P>0.05). The medial collateral ligament (MCL) score in the KGA group was lower than that in the ACL group, with a statistically significant difference (P<0.01). The ACL angle, PCL score, and PCL angle in the KGA group were larger, and the incidence of MRI manifestations such as Blumensaat angle > 0°, tibial translation, and kissing sign edema was lower. Compared with the ACL group, the incidence of gouty nodules, bone erosion, and cartilage damage in the KGA group and the KGA+ACL group was significantly higher than that in the ACL group (P<0.05).Conclusion When KGA is combined with ACL rupture, direct signs, such as ligament discontinuity and abnormal direction, along with indirect signs, such as medial meniscal tears, anterior tibial translation, PCL buckling signs, and kissing contusions, aid in distinguishing KGA patients with and without ACL tears. In KGA combined with ACL rupture, MRI characteristics such as predilection site, depth, and border of bone marrow edema can distinguish it from KGA without ACL tear or ACL tear without KGA. MSU crystal deposition causes fibrinoid degeneration of the ligaments and decreases their strength, but it does not significantly impact ligament function. When determining whether an ACL rupture is present in KGA patients is challenging, considering the patient's medical history and relevant physical examinations clarifies the diagnosis.

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