磁共振关节造影与髋关节镜翻修术的相关性。
Correlation of magnetic resonance arthrography with revision hip arthroscopy.
机构信息
Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, USA,
出版信息
Clin Orthop Relat Res. 2013 Dec;471(12):4006-11. doi: 10.1007/s11999-013-3202-5. Epub 2013 Aug 1.
BACKGROUND
Arthroscopic approaches for the diagnosis and treatment of hip disorders are well established; however, there are limited data regarding revision hip arthroscopy. There have been several studies evaluating the findings of MR arthrography with primary hip arthroscopy, but to our knowledge, no study has evaluated the diagnostic value of MR arthrography before revision hip arthroscopy.
QUESTIONS/PURPOSES: We obtained sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MR arthrography to detect labral lesions, chondral lesions and loose bodies before revision hip arthroscopy.
METHODS
We performed a single-surgeon, retrospective review of 70 revision hip arthroscopies (62 patients) and assessed the association between MR arthrography findings and intraoperative findings. There were 43 females and 19 males with a mean age of 36 years (range, 17-59 years). Radiographic interpretation was performed by one of four fellowship-trained musculoskeletal radiologists at three institutions, who had at least 5 years of experience. Radiographic findings were compared with surgical findings by one of the authors for calculation of sensitivity, specificity, PPV, and NPV.
RESULTS
The sensitivity, specificity, PPV, and NPV of MR arthrography for detecting labral tears were 82%, 70%, 94%, and 39%, respectively. The sensitivity, specificity, PPV, and NPV of MR arthrography for detecting chondral damage were 65%, 90%, 94%, and 50%, respectively. The sensitivity, specificity, PPV, and NPV of MR arthrography for detecting loose bodies were 33%, 100%, 100%, and 88%, respectively.
CONCLUSIONS
Our study showed the utility of MR arthrography to assist in the diagnosis and treatment of patients with ongoing or recurrent symptoms who have had prior hip arthroscopy. Our data show that MR arthrography is superior at ruling in, rather than ruling out, labral lesions, chondral lesions, and loose bodies, as there were studies interpreted as normal which in fact showed disorders.
背景
关节镜检查在髋关节疾病的诊断和治疗中已得到广泛应用；然而，关于髋关节镜翻修术的相关数据却很有限。已有多项研究评估了初次髋关节镜检查时磁共振关节造影术的检查结果，但据我们所知，尚无研究评估髋关节镜翻修术前磁共振关节造影术的诊断价值。
问题/目的：我们评估了髋关节镜翻修术前磁共振关节造影术诊断髋关节盂唇撕裂、软骨损伤和游离体的敏感度、特异度、阳性预测值（PPV）和阴性预测值（NPV）。
方法
我们对 70 例（62 例患者）由同一位外科医生实施的髋关节镜翻修术进行了回顾性单外科医生研究，并评估了磁共振关节造影术的检查结果与术中所见之间的相关性。患者中包括 43 名女性和 19 名男性，平均年龄为 36 岁（17-59 岁）。在三个机构由 4 位经过关节肌肉骨骼放射学专业培训的放射科医生中的一位进行影像学解释，每位医生都有至少 5 年的工作经验。作者之一将影像学发现与手术发现进行了比较，以计算敏感度、特异度、PPV 和 NPV。
结果
磁共振关节造影术诊断髋关节盂唇撕裂的敏感度、特异度、PPV 和 NPV 分别为 82%、70%、94%和 39%。磁共振关节造影术诊断软骨损伤的敏感度、特异度、PPV 和 NPV 分别为 65%、90%、94%和 50%。磁共振关节造影术诊断游离体的敏感度、特异度、PPV 和 NPV 分别为 33%、100%、100%和 88%。
结论
我们的研究表明，磁共振关节造影术有助于诊断和治疗曾接受过髋关节镜检查的患者，这些患者有持续性或复发性症状。我们的数据表明，磁共振关节造影术在诊断髋关节盂唇撕裂、软骨损伤和游离体方面的优势在于其能辅助确诊，而非排除这些病变，因为有一些影像学上看似正常的结果实际上存在病变。
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