Greenslopes Private Hospital, Newdegate Street, Greenslopes, Queensland, Australia.
Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, 259 Wickham Terrace, Spring Hill, Queensland, Australia.
Skeletal Radiol. 2021 Aug;50(8):1605-1616. doi: 10.1007/s00256-020-03701-8. Epub 2021 Jan 21.
To demonstrate the utility of MRI in separating clinically relevant from minor or incidental lesions of the triangular fibrocartilage complex and the major interosseous ligaments in the wrist.
In this retrospective study, we identified 89 patients and correlated MRI finding with subsequent arthroscopy. Triangular fibrocartilage complex abnormalities have been subdivided into disc lesions-central and radial-or ulnar-sided tears according to MRI appearances and surgical findings as the clinical and surgical approach is very different. Interosseous ligament tears were subdivided into partial or complete, highlighting the principle of recognising surgically relevant lesions.
For simple central to radial tears and perforations of the triangular fibrocartilage complex, MRI was 98.3% accurate. MRI identified all peripheral triangular fibrocartilage complex tears seen at arthroscopy; however, the specificity of 66.7% may reflect partly the use of arthroscopy limited to the radiocarpal joint. MRI proved 95.4% accurate for surgically relevant scapholunate interosseous ligament tears and was highly accurate at separating limited from complete lunotriquetral interosseous ligament tears showing 100% accuracy for complete tears.
The study shows excellent correlation between MRI and arthroscopic findings that determine surgical relevance with a very high sensitivity for triangular fibrocartilage complex lesions and accurate separation of minor versus surgically relevant ligamentous tears.
证明 MRI 在区分腕三角纤维软骨复合体和主要骨间韧带的临床相关与次要或偶发病变方面的效用。
在这项回顾性研究中，我们共纳入 89 名患者，将 MRI 结果与后续的关节镜检查结果相关联。根据 MRI 表现和手术发现，将三角纤维软骨复合体异常分为盘状病变（中央和桡侧或尺侧）撕裂，这与临床和手术方法非常不同。骨间韧带撕裂分为部分或完全撕裂，突出了识别手术相关病变的原则。
对于单纯的中央至桡侧撕裂和三角纤维软骨复合体穿孔，MRI 的准确率为 98.3%。MRI 识别了所有在关节镜下看到的外周三角纤维软骨复合体撕裂；然而，特异度为 66.7%可能部分反映了关节镜检查仅限于桡腕关节的使用。MRI 对手术相关的舟月骨间韧带撕裂的准确率为 95.4%，并能很好地区分有限性与完全性月三角骨间韧带撕裂，对完全性撕裂的准确率为 100%。
本研究显示 MRI 与关节镜检查结果具有极好的相关性，可确定手术相关性，对三角纤维软骨复合体病变具有很高的敏感性，并能准确区分较小的与手术相关的韧带撕裂。
