胫骨应力性损伤 MRI 分类系统的验证。
Validation of MRI classification system for tibial stress injuries.
机构信息
Department of Radiology, University of Wisconsin, Clinical Science Center, Madison, 53792-3252, USA.
出版信息
AJR Am J Roentgenol. 2012 Apr;198(4):878-84. doi: 10.2214/AJR.11.6826.
OBJECTIVE
The purpose of our study was to compare an MRI classification system for tibial stress injuries with semiquantitative MR features of injury severity and clinical outcome.
MATERIALS AND METHODS
Two musculoskeletal radiologists retrospectively reviewed in consensus the MR findings of 142 tibial stress injuries to quantify the degree of periosteal and bone marrow edema and grade the injuries using the Fredericson classification system (grade 1 = periosteal edema only, grade 2 = bone marrow edema visible on T2-weighted images, grade 3 = bone marrow edema visible on T1-weighted and T2-weighted images, grade 4a = multiple focal areas of intracortical signal abnormality, and grade 4b = linear areas of intracortical signal abnormality). Kruskal-Wallis tests were used to determine the relationship between the grade of stress injury and the degree of periosteal and bone marrow edema and the time to return to sports activity.
RESULTS
Grade 4b injuries had significantly (p < 0.002) more severe and grade 1 injuries less severe periosteal and bone marrow edema than grades 2, 3, and 4a injuries. Grade 4b injuries had significantly (p < 0.002) longer time and grade 1 injuries shorter time to return to sports activity than grades 2, 3, and 4a injuries. There was no significant difference (p = 0.06-0.79) among grades 2, 3, and 4a injuries in the degree of periosteal and bone marrow edema and the time to return to sports activity.
CONCLUSION
Grades 2, 3, and 4a stress injuries had similar degrees of periosteal and bone marrow edema and similar time to return to sports activity, which suggests that these three grades can be combined into a single category in an abbreviated Fredericson classification system.
目的
本研究旨在比较胫骨应激损伤的 MRI 分类系统与损伤严重程度和临床结果的半定量 MR 特征。
材料与方法
两名肌肉骨骼放射科医生回顾性地一致审查了 142 例胫骨应激损伤的 MR 发现，以量化骨膜和骨髓水肿的程度，并使用 Fredericson 分类系统（1 级=仅骨膜水肿，2 级= T2 加权图像可见骨髓水肿，3 级= T1 加权和 T2 加权图像可见骨髓水肿，4a 级=多个皮质内信号异常灶，4b 级=线性皮质内信号异常区）对损伤进行分级。使用 Kruskal-Wallis 检验确定应激损伤的严重程度与骨膜和骨髓水肿程度以及重返运动活动的时间之间的关系。
结果
4b 级损伤的骨膜和骨髓水肿程度明显（p<0.002）比 2、3 和 4a 级损伤更严重，而 1 级损伤则明显（p<0.002）比 2、3 和 4a 级损伤更轻。4b 级损伤重返运动活动的时间明显（p<0.002）比 2、3 和 4a 级损伤更长，而 1 级损伤重返运动活动的时间明显（p<0.002）比 2、3 和 4a 级损伤更短。2、3 和 4a 级损伤在骨膜和骨髓水肿程度以及重返运动活动的时间方面无显著差异（p=0.06-0.79）。
结论
2、3 和 4a 级应激损伤具有相似的骨膜和骨髓水肿程度以及相似的重返运动活动时间，这表明这三个等级可以在简化的 Fredericson 分类系统中合并为一个单一类别。
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