【摘要】 目的 評價低場MRI對膝關節半月板撕裂的診斷準確性。 方法 2009年9月-2010年4月經關節鏡檢或手術確診的膝關節損傷患者69例，其中35例41個半月板撕裂，回顧性分析、整理其臨床、關節鏡及MRI表現，以傳統Reicher診斷的改良分級標準確定半月板撕裂的級別、形態并記錄，同時對關節內其它伴隨征象作統計。 結果 35例41個撕裂半月板中，17個為盤狀半月板，MRI顯示Ⅲa級撕裂信號24個，Ⅲb級撕裂信號5個，Ⅲc級撕裂信號4個，Ⅳ級撕裂信號1個，桶柄狀撕裂信號7個。本組低場MRI診斷半月板撕裂的敏感度、特異度、準確度分別為93.18%、92.11%、92.68%。 結論 低場MRI診斷膝關節半月板撕裂與關節鏡結果差異不大，是一種診斷半月板撕裂的可靠、無創性檢查方法。【Abstract】 Objective To evaluate the accuracy of low-field MRI in the diagnosis of meniscus tears. Methods We collected the clinical data of 69 patients with knee joint injuries confirmed by surgical operation or arthroscopy from Septembe 2009 to April 2010. Among them, 35 patients had 41 cases of meniscus tears. We retrospectively analyzed their clinical symptoms, and their manifestations on low-field MRI and arthroscopy. According to the modified diagnostic criteria based on Reicher’s diagnosis, the grade and the shape of meniscus tears were determined and recorded, and other accompanying signs inside the joint were also analyzed statistically. Results Among the 41 cases of meniscus tears of 35 patients, 17 were discoid meniscus. MRI showed that there were 24 signals of Ⅲa tears, 5 of Ⅲb tears, 4 of Ⅲc tears, 1 of Ⅳ tears and 7 of bucket-handle tears. The sensitivity, specificity and accuracy of low-field MRI in the diagnosis of meniscus tears were 93.18%, 92.11%, and 92.68%, respectively. Conclusions There is no significant difference between the results of arthroscopy and low-field MRI in diagnosing meniscus tears. Consequently, MRI is a reliable and non-invasive method in the diagnosis of meniscus tears.
目的研究半月板中軟骨退變相關基因的表達，探討半月板撕裂對軟骨退變的潛在影響，并分析miRNAs和軟骨退變的關系。
方法以2012年9月－2013年10月5例行關節鏡下撕裂半月板部分切除患者自愿捐贈的半月板組織作為實驗組，4例截肢患者自愿捐贈的正常半月板組織為對照組。取標本行HE染色，觀察組織學改變；行實時熒光定量PCR，檢測半月板中軟骨退變相關基因[蛋白多糖（Aggrecan，ACAN)、Ⅹ型膠原（type X collagen，COL10A1）、基質金屬蛋白酶13（matrix metalloproteinases 13，MMP-13）、CCAAT增強子結合蛋白β（CCAAT enhancer binding protein β，CEBP-β）、蛋白聚糖酶5（a disintegrin and metalloproteinase with thrombospondinmotif 5，ADAMTS-5）]以及miRNAs（miR-193b、miR-92a、miR-455-3p）表達水平。
結果組織學觀察示，實驗組撕裂半月板組織存在不同程度退行性改變。與對照組相比，實驗組ACAN表達水平下調，COL10A1、CEBP-β、ADAMTS-5、MMP-13表達水平均上調；除ACAN、MMP-13外，其余各退變相關基因組間差異均有統計學意義（P＜0.05）。實驗組miR-193b、miR-92a、miR-455-3p表達水平均較對照組顯著上調，比較差異亦有統計學意義（P＜0.05）。
結論撕裂半月板有退變趨勢，其促進軟骨退變作用較正常半月板顯著，miR-193b、miR-92a、miR-455-3p可能是促進軟骨退變的調控因子。
