Fang Jun-Jie, Chen Liang, Hu Bi-Bo, Xia Jian-Bi, Sun Wei
Department of Orthopaedics, Ningbo No.2 Hospital, Ningbo 315016, Zhejiang, China;
Zhongguo Gu Shang. 2016 Sep 25;29(9):814-819. doi: 10.3969/j.issn.1003-0034.2016.09.009.
To investigate MRI findings of osteochondral lesions in the talus;to evaluate the value of MRI in diagnosing and determining the stage of osteochondral lesions;to analyze the follow up clinical value of MRI in osteochondral transplantation of autologous bone.
A total of 79 patients from February 2013 to March 2015 had been retrospectively analyzed. All the patients were treated in our hospital. The ankle arthroscopy results were used as the reference standard, and the accuracy of MRI in diagnosis and Hepple staging had been investigated. Fifteen patients with cartilage transplantation of autologous bone were followed up with MRI examination and evaluation of cartilage repair score(MOCART) after one year. The values of MRI in the postoperative follow up were analyzed.
Hepple staging of 79 patients was shown as follows:7 cases of stage I, 12 cases of stage II, 24 cases of stage III, 16 cases of stage IV, and 20 cases of stage V. Ankle arthroscopy grading of 59 patients in this group(in addition of 20 cases of stage V):2 cases of grade A, 2 cases of grade B, 4 cases of grade C, 14 cases of grade D, 22 cases of grade E, and 15 cases of grade F. The accuracy rate of MRI in determining Hepple V was set at 100%, and Hepple stage I corresponds to the arthroscopic A, B, C stage, stage II corresponds to D stage, stage III corresponds to E stage, stage IV corresponds to F stage. The accuracy rate of MRI in determining Hepple stage I to IV was 87.5%, 85.7%, 95.4% and 93.3% respectively. After cartilage transplantation of autologous bone, MRI of 15 patients showed cartilage surface in transplanted area was smooth, bone healed well, and the surrounding edema disappeared. The MOCART was 30 to 80 scores with an average score 59.0±15.6;9 cases of these 15 patients were(9/15, 60%) higher than 60 score.
MRI plays a significant role in clinical diagnosis and staging of the talus osteochondral injury. As a method of long term follow up after cartilage transplantation, MRI can well evaluate the rapair of the postoperative osteochondral injury.
探讨距骨骨软骨损伤的MRI表现；评估MRI在距骨骨软骨损伤诊断及分期中的价值；分析MRI在自体骨软骨移植术后随访中的临床价值。
回顾性分析2013年2月至2015年3月期间我院收治的79例患者。以踝关节镜检查结果为参照标准，研究MRI在诊断及Hepple分期中的准确性。对15例行自体骨软骨移植的患者在术后1年进行MRI检查并评估软骨修复评分（MOCART），分析MRI在术后随访中的价值。
79例患者的Hepple分期结果如下：Ⅰ期7例，Ⅱ期12例，Ⅲ期24例，Ⅳ期16例，Ⅴ期20例。该组59例患者（除外20例Ⅴ期患者）的踝关节镜分级结果为：A级2例，B级2例，C级4例，D级14例，E级22例，F级15例。MRI诊断Hepple Ⅴ期的准确率为100%，Hepple Ⅰ期对应关节镜下A、B、C期，Ⅱ期对应D期，Ⅲ期对应E期，Ⅳ期对应F期。MRI诊断Hepple Ⅰ至Ⅳ期的准确率分别为87.5%、85.7%、95.4%和93.3%。自体骨软骨移植术后，15例患者的MRI显示移植区软骨表面光滑，骨愈合良好，周围水肿消失。MOCART评分为30至80分，平均（59.0±15.6）分；其中9例（9/15，60%）评分高于60分。
MRI在距骨骨软骨损伤的临床诊断及分期中具有重要作用。作为软骨移植术后长期随访的方法，MRI能够很好地评估术后骨软骨损伤的修复情况。
