使用磁共振成像评估儿童剥脱性骨软骨炎病变愈合的新技术的研究

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论证。为了评估剥脱性骨软骨炎病灶内骨组织的恢复情况，传统上采用X线评分法。虽然被广泛使用，但这个量表并没有考虑到关节软骨的再生。由于需要一种可靠和通用的工具来评估剥脱性骨软骨炎病灶的愈合，一种新的量表被开发出来。该新的量表是基于对膝关节磁共振成像的分析，反映了关节软骨和软骨下骨的状态，以及剥脱性骨软骨炎病灶的总体愈合情况。

本研究的目的是根据磁共振成像的结果，确定评估剥脱性骨软骨炎病理病灶愈合的方法的可靠性。

材料与方法。研究了 Children’s Municipal Clinical Hospital named after N.F. Filatov 对10名患有股骨髁剥脱性骨软骨炎的儿童在一年的随访期间通过磁共振成像进行的34项研究结果。除了一名儿童外，所有儿童都接受了关节内注射富含血小板血浆的经软骨骨手术。由6位不同专业水平的专家组成的小组对MRI结果进行了分析，涉及5个尺度参数。每位专家在4周内分析了两次。为了证实新技术的可靠性假设，使用了类内相关系数（ICC）。为了提高结果的可靠性，分别对早期（术后2–6个月）和晚期（术后9–12个月）行磁共振成像的亚组进行ICC计算。

结果。《骨物质水肿程度》指标的ICC值为0.972，《骨物质固结程度》为0.984，《骨物质结构》为0.977，《关节软骨结构》为0.977，《病灶总愈合程度》为0.993。对术后早期和晚期的磁共振成像亚组的分析证实了新技术的高度可靠性。在评估每位研究者间隔4周获得的数据的一致性时，整个样本的ICC值为0.86，术后早期的ICC值为0.81，术后晚期的ICC值为0.92（p<0.05）。

结论。所开发的磁共振成像剥脱性骨软骨炎病灶愈合评价量表具有较高的可重复性和可靠性，但要广泛应用于临床，还需要在大样本解剖性骨软骨炎患者中进行验证。

作者简介

Andrey V. Semenov

Pirogov Russian National Research Medical University

编辑信件的主要联系方式.
Email: dru4elos@gmail.com
ORCID iD: 0000-0001-6858-4127

MD, PhD student

俄罗斯联邦, Moscow

Mikhail S. Zubtsov

Pirogov Russian National Research Medical University

Email: zumi19979@yandex.ru
ORCID iD: 0000-0001-6845-5253

MD, resident

俄罗斯联邦, Moscow

Yuriy G. Lipkin

Pirogov Russian National Research Medical University

Email: lyg@mail.ru
ORCID iD: 0000-0002-3306-0523
SPIN 代码: 6396-4125

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Moscow

Grigoriy S. Dibrivnyy

Filatov Municipal Children Hospital

Email: dibrivniy11091976199@mail.ru
ORCID iD: 0000-0002-6263-5488

MD, Radiologist

俄罗斯联邦, Moscow

Ivan N. Isaev

Filatov Municipal Children Hospital

Email: i.n.isaev@gmail.com
ORCID iD: 0000-0001-7899-5800

MD, Orthopedic and trauma surgeon

俄罗斯联邦, Moscow

Vladimir V. Koroteev

Filatov Municipal Children Hospital

Email: 9263889457@mail.ru
ORCID iD: 0000-0003-4502-1465

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Moscow

Nikolay I. Tarasov

Filatov Municipal Children Hospital

Email: tarasov_doctor@mail.ru
ORCID iD: 0000-0002-9303-2372

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Moscow

Yulia I. Lozovaya

Pirogov Russian National Research Medical University; Filatov Municipal Children Hospital

Email: u.lozovaya@gmail.com
ORCID iD: 0000-0003-3899-1420

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Moscow; Moscow

Dmitriy Y. Vybornov

Pirogov Russian National Research Medical University; Filatov Municipal Children Hospital

Email: dgkb13@gmail.com
ORCID iD: 0000-0001-8785-7725

MD, PhD, Dr. Sci. (Med.)

俄罗斯联邦, Moscow; Moscow

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2. 图 1 一个患局灶性剥脱性骨软骨炎的儿童的膝关节的磁共振成像在PDFS的矢状视图中。一条连续的线标志着骨的母体部分强度增加的区域，对应于骨实质的水肿。它约占髁状突的25%。箭头表示骨软骨碎片和母体骨之间的低密度带。母体骨占据了整个前部至后部病灶长度的80%左右，镶嵌式排列的高浓区对应的是仍然部分连接碎片和母体骨的骨组织

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3. 图 3 国际软骨修复学会（ICRS）对关节软骨损伤的分类。该量表采用100分制，以方便使用。一级为85分。在软骨厚度不变的情况下出现单一的低整合区域。II级为60分。软骨边缘的厚度增加/不规则。III级为30分。软骨变薄和不规则。四级为0分。全厚度缺损是指该区域缺乏软骨

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4. Fig. 2. Magnetic resonance imaging of the knee joint (sagittal PD-FS image) of a child with an osteochondritis dissecans lesion. The arrowheads indicate the bone zone in the osteochondral fragment in the OD lesion. It has a hyperintense coloration and is closer to the articular cartilage on a gray-black color scale

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5. 图 4 一个患局灶性剥脱性骨软骨炎的儿童的膝关节的磁共振成像在PDFS的矢状视图中。剥脱性骨软骨炎病灶区关节软骨信号变薄、低强度。根据ICRS，MR图像对应的是III期软骨损伤

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6. 图 5 愈合评估的总体方案由四个主要参数来评估剥脱性骨软骨炎病灶的愈合情况：骨质肿胀（左图中用连续的线条圈出）；巩固程度（病灶的骨软骨碎片与母骨之间的线条，左图中的箭头表示）；骨结构（通过骨密度和结构评估）； 关节软骨结构（右图中用箭头表示）

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版权所有 © Semenov A., Zubtsov M., Lipkin Y., Dibrivnyy G., Isaev I., Koroteev V., Tarasov N., Lozovaya Y., Vybornov D., 2022

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