中老年人群膝关节磁共振成像中半月板的偶然发现。
Incidental meniscal findings on knee MRI in middle-aged and elderly persons.
作者信息
Englund Martin, Guermazi Ali, Gale Daniel, Hunter David J, Aliabadi Piran, Clancy Margaret, Felson David T
机构信息
Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA 02118, USA.
出版信息
N Engl J Med. 2008 Sep 11;359(11):1108-15. doi: 10.1056/NEJMoa0800777.
BACKGROUND
Magnetic resonance imaging (MRI) of the knee is often performed in patients who have knee symptoms of unclear cause. When meniscal tears are found, it is commonly assumed that the symptoms are attributable to them. However, there is a paucity of data regarding the prevalence of meniscal damage in the general population and the association of meniscal tears with knee symptoms and with radiographic evidence of osteoarthritis.
METHODS
We studied persons from Framingham, Massachusetts, who were drawn from census-tract data and random-digit telephone dialing. Subjects were 50 to 90 years of age and ambulatory; selection was not made on the basis of knee or other joint problems. We assessed the integrity of the menisci in the right knee on 1.5-tesla MRI scans obtained from 991 subjects (57% of whom were women). Symptoms involving the right knee were evaluated by questionnaire.
RESULTS
The prevalence of a meniscal tear or of meniscal destruction in the right knee as detected on MRI ranged from 19% (95% confidence interval [CI], 15 to 24) among women 50 to 59 years of age to 56% (95% CI, 46 to 66) among men 70 to 90 years of age; prevalences were not materially lower when subjects who had had previous knee surgery were excluded. Among persons with radiographic evidence of osteoarthritis (Kellgren-Lawrence grade 2 or higher, on a scale of 0 to 4, with higher numbers indicating more definite signs of osteoarthritis), the prevalence of a meniscal tear was 63% among those with knee pain, aching, or stiffness on most days and 60% among those without these symptoms. The corresponding prevalences among persons without radiographic evidence of osteoarthritis were 32% and 23%. Sixty-one percent of the subjects who had meniscal tears in their knees had not had any pain, aching, or stiffness during the previous month.
CONCLUSIONS
Incidental meniscal findings on MRI of the knee are common in the general population and increase with increasing age.
背景
对于有不明原因膝关节症状的患者，常进行膝关节磁共振成像（MRI）检查。当发现半月板撕裂时，通常认为症状是由其引起的。然而，关于一般人群中半月板损伤的患病率以及半月板撕裂与膝关节症状和骨关节炎影像学证据之间的关联，数据较少。
方法
我们研究了来自马萨诸塞州弗雷明汉的人群，这些人群通过人口普查区数据和随机数字拨号电话抽取。受试者年龄在50至90岁之间且能行走；入选并非基于膝关节或其他关节问题。我们在从991名受试者（其中57%为女性）获得的1.5特斯拉MRI扫描中评估右膝半月板的完整性。通过问卷评估涉及右膝的症状。
结果
MRI检测到的右膝半月板撕裂或半月板破坏的患病率，在50至59岁女性中为19%（95%置信区间[CI]，15至24），在70至90岁男性中为56%（95%CI，46至66）；排除既往有膝关节手术史的受试者后，患病率并无实质性降低。在有骨关节炎影像学证据（Kellgren-Lawrence分级为2级或更高，范围为0至4级，数字越高表明骨关节炎体征越明确）的人群中，大多数日子有膝关节疼痛、酸痛或僵硬的患者中半月板撕裂的患病率为63%，无这些症状的患者中为60%。在无骨关节炎影像学证据的人群中，相应的患病率分别为32%和23%。膝关节有半月板撕裂的受试者中，61%在过去一个月内没有任何疼痛、酸痛或僵硬。
结论
膝关节MRI检查中偶然发现的半月板病变在一般人群中很常见，且随年龄增长而增加。
Zotero 插件