Đặc điểm hình ảnh cộng hưởng từ khớp gối trong tổn thương dây chằng chéo trước do chấn thương thể thao tại Bệnh viện Chấn thương Chỉnh hình

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Tác giả: Thị Hạnh Duyên Âu, Thị Phương Dung Hoàng, Chung Huỳnh, Ngọc Bảo Trân Lưu, Thị Tuyên Trân Nguyễn, Nguyên Vũ Phạm, Thy Thiên Phạm, Các Hùng Dũng Trần

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Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2024

Mô tả vật lý: tr.173

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Đặt vấn đề: Tổn thương dây chằng chéo trước là một chấn thương thường gặp do những đặc điểm về giải phẫu và chức năng đặc trưng của khớp gối, gây mất vững khớp gối và thường được điều trị bằng phẫu thuật. Chụp cộng hưởng từ là một phương pháp hiện đại không xâm lấn, giúp chẩn đoán nhanh các thương tổn của các dây chằng và mô mềm. Hiện nay, các máy chụp cộng hưởng mới từ giúp chẩn đoán chính xác tổn thương. Do vậy, chúng tôi thực hiện nghiên cứu đặc điểm hình ảnh cộng hưởng từ khớp gối trong tổn thương dây chằng chéo trước do chấn thương thể thao với mong muốn phân tích những dấu hiệu tổn thương trực tiếp, gián tiếp đặc trưng của dây chằng chéo trước trên cộng hưởng từ đối chiếu với nội soi khớp trong chấn thương do thể thao. Mục tiêu: Khảo sát đặc điểm hình ảnh cộng hưởng từ khớp gối trong tổn thương dây chằng chéo trước do chấn thương thể thao. Phương pháp nghiên cứu: Mô tả hàng loạt ca từ tháng 06/2019 đến tháng 06/2020 trên 40 bệnh nhân tại khoa Chẩn Đoán Hình Ảnh Bệnh viện Chấn Thương Chỉnh Hình. Kết quả: Nguyên nhân chủ yếu gây tổn thương dây chằng chéo trước trong chấn thương do thể thao là bóng đá (57,5%) và chạy bộ (20%). Với các dấu hiệu trực tiếp của tổn thương dây chằng chéo trước, dấu hiệu tăng tín hiệu trong dây chằng trên cộng hưởng từ gặp trong đa số các trường hợp (67,5%) và dấu hiệu dây chằng mất liên tục có 28 trường hợp, chiếm 70%. Trong khi các dấu hiệu trực tiếp khác ít gặp (như dấu hiệu không thấy dây chằng và dấu hiệu dây chằng nằm ngang, lần lượt chiếm tỷ lệ 15% và 20%). Một số các dấu hiệu gián tiếp trong tổn thương dây chằng chéo trước như có kèm tổn thương rách sụn chêm và tràn dịch khớp gối (chiếm 82,5%), trật xương chày ra trước hay thay đổi độ cong của dây chằng chéo sau chiếm khoảng 30% trường hợp. Đa số đánh giá trên hình ảnh cộng hưởng từ của dây chằng chéo trước trước khi phẫu thuật là đứt hoàn toàn và bán phần (hai nhóm này chiếm tỷ lệ 90%), khá tương ứng với kết quả sau phẫu thuật là 92,5%. Kết quả nghiên cứu cho thấy dấu hiệu mất liên tục dây chằng có độ nhạy cao nhất cho tình trạng đứt dây chằng chéo trước (73,0%), Dấu hiệu dây chằng nằm ngang và không thấy dây chằng là đặc hiệu nhất cho tình trạng đứt dây chằng chéo trước (100,0%). Tuy nhiên, hai dấu hiệu này có độ nhạy không cao (20,0% và 15,0%). Giá trị tiên đoán âm cho cả 4 dấu hiệu trực tiếp đều rất thấp (7,7 - 16,7%). Với các dấu hiệu gián tiếp, các dấu hiệu rách sụn chêm, tràn dịch khớp gối có độ nhạy khá cao trong việc chẩn đoán (67,6% và 81,1%) nhưng ngược lại độ đặc hiệu lại thấp (0%). Các dấu hiệu về độ cong của dây chằng chéo trước, trật mâm chày ra trước và đứt dây chằng khác kèm theo có độ đặc hiệu cao (100,0%) nhưng độ nhạy lại rất thấp (33,3%
32,4% và 13,5%). Cả năm dấu hiệu gián tiếp có giá trị tiên đoán dương cao (89,7 - 100,0%). Giá trị tiên đoán âm cho các dấu hiệu gián tiếp rất thấp (0,0 - 11,1%). Nghiên cứu cho thấy, độ nhạy của cộng hưởng từ đối với tình trạng đứt dây chằng chéo trước là 97,3%, độ đặc hiệu của MRI đối với tình trạng đứt DCCT là 100,0% và tỉ lệ âm tính giả là 2,7%. Mức độ tương hợp của cộng hưởng từ so với đánh giá qua mổ nội soi là cao với hệ số kappa là 0,844. Sự tương hợp này có ý nghĩa thống kê (p <
0,001). Kết luận: Cộng hưởng từ là phương pháp không xâm lấn độ nhạy và độ đặc hiệu cao trong chẩn đoán tổn thương dây chằng chéo trước và chỉ định chụp cộng hưởng từ là cần thiết trong trường hợp nghi ngờ trên lâm sàng và đặc biệt cần thiết trên những vận động viên thể thao có chấn thương.Abstract Background: Anterior cruciate ligament injury is a common injury due to the unique anatomical and functional characteristics of the knee joint, causing instability of the knee joint and is often treated with surgery. Magnetic resonance imaging is a modern, non - invasive method that helps quickly diagnose injuries to ligaments and soft tissues. Currently, magnetic resonance imaging machines help accurately diagnose lesions. Therefore, we conducted a study on the characteristics of magnetic resonance imaging of the knee joint in anterior cruciate ligament damage due to sports injuries with the desire to analyze the characteristic direct and indirect signs of damage to the ligament. Anterior cruciate MRI compared with arthroscopy in sports injuries. Objective: To investigate magnetic resonance imaging characteristics of the knee joint in anterior cruciate ligament damage due to sports injuries. Method: Cases series report from June 2019 to June 2020 on 40 patients at Diagnostic Imaging Department of Hospital for traumatology and orthopaedics. Results: The main causes of anterior cruciate ligament damage in sports injuries are football (57.5%) and jogging (20%). With direct signs of anterior cruciate ligament damage, signs of increased signal in the ligament on magnetic resonance were seen in the majority of cases (67.5%) and signs of continuous ligament loss were in 28 cases. combined, accounting for 70%. While other direct signs are less common (such as no visible ligament sign and horizontal ligament sign, accounting for 15% and 20% respectively). Some indirect signs of anterior cruciate ligament damage include meniscal tear and knee effusion (accounting for 82.5%), anterior tibial dislocation or change in curvature of the posterior cruciate ligament. accounts for about 30% of cases. The majority of assessments on magnetic resonance imaging of the anterior cruciate ligament before surgery were complete and partial ruptures (these two groups account for 90%), quite corresponding to the post - operative result of 92.5%. Research results show that the sign of continuous ligament loss has the highest sensitivity for anterior cruciate ligament rupture (73.0%), the horizontal ligament sign and no visible ligament are the most specific for the condition. anterior cruciate ligament rupture (100.0%). However, these two signs have not high sensitivity (20.0% and 15.0%). The negative predictive value for all four direct signs was very low (7.7 - 16.7%). With indirect signs, signs of meniscus tear and knee effusion have quite high sensitivity in diagnosis (67.6% and 81.1%) but conversely the specificity is low (0%). Signs of curvature of the anterior cruciate ligament, anterior tibial plateau dislocation and other associated ligament tears have high specificity (100.0%) but very low sensitivity (33.3%
32, 4% and 13.5%). All five indirect signs had high positive predictive value (89.7 - 100.0%). The negative predictive value for indirect signs was very low (0.0 - 11.1%). Research shows that the sensitivity of MRI for anterior cruciate ligament rupture is 97.3%, the specificity of MRI for ACL rupture is 100.0% and the false negative rate is 2. .7%. The agreement level of magnetic resonance compared with laparoscopic assessment is high with a kappa coefficient of 0.844. This correlation is statistically significant (p <
0.001). Conclusion: Magnetic resonance is a non - invasive method with high sensitivity and specificity in diagnosing anterior cruciate ligament damage and indication for magnetic resonance imaging is necessary in cases of clinical suspicion and is especially necessary for athlete’s injuries. DOI: 10.59715/pntjmp.3.1.20

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