目的:拇指腕掌关节炎发病率高。然而,软骨损伤的程度尚未得到准确评估。本研究的目的是检查磁共振成像(MRI)期间拇指腕掌关节轴向牵引对拇指腕掌关节炎患者关节软骨可见性的影响,并使用MRI检查结果评估关节软骨缺损。
方法:44例拇指腕掌关节炎患者(14例男性,30名女性),平均年龄为67.3±8.6岁,根据伊顿第1、2、3和4阶段对2、14、24和4名患者进行了分类,分别。使用3-TeslaMRI(SiemensMagnetomSkyra)和3DT2*多回波数据成像组合,在有和没有牵引(3kg)的情况下进行轴向牵引MRI。在五个点(中央,volar,背侧,径向,和尺骨边缘)和原始关节软骨轮廓可见性分类(差,中间,complete).还评估了在每个关节表面上保留软骨的比率。在该研究中,统计学显著性设定为p<0.05。
结果:关节间隙宽度在牵引时均显着增加(P<0.01)。关节软骨轮廓可见度等级从7个中等和37个较差病例显著提高到15个完整病例,23个中间,不良病例6例(P<0.01)。与第3-4期关节炎相比,第1-2期关节软骨保留明显更多(第一掌骨P<0.01,梯形P=0.01)。
结论:拇指轴向牵引增加了拇指腕掌关节的关节间隙宽度并改善了关节软骨的能见度。我们的结果表明,轴向牵引MRI可用于拇指腕掌关节炎患者的关节软骨缺损的无创评估,并有助于选择最佳的手术方式。
OBJECTIVE: Thumb carpometacarpal arthritis has a high incidence. However, the degree of damage to the cartilage has not been accurately assessed. The purpose of this study was to examine the effects of axial traction of the thumb carpometacarpal joint during magnetic resonance imaging (MRI) on the visibility of articular cartilage in patients with thumb carpometacarpal arthritis and to evaluate the articular cartilage defect using MRI findings.
METHODS: Forty-four patients with thumb carpometacarpal arthritis (14 males, 30 females) and a mean age of 67.3±8.6 years were classified according to Eaton Stages 1, 2, 3, and 4 in 2, 14, 24, and 4 patients, respectively. Axial traction MRI was performed with and without traction (3 kg) using 3-Tesla MRI (Siemens Magnetom Skyra) with a 3D T2* multiecho data imaging combination. The effectiveness of traction was verified using the joint space width before and after traction at five points (central, volar, dorsal, radial, and ulnar margins) and the original articular cartilage outline visibility classification (poor, intermediate, complete). The rate of remaining cartilage on each joint surface was also evaluated. Statistical significance was set at p<0.05 in this study.
RESULTS: Joint space width increased significantly at all points with traction (P<0.01). The grade of articular cartilage outline visibility significantly improved from seven intermediate and 37 poor cases to 15 complete, 23 intermediate, and six poor cases (P<0.01). Significantly more articular cartilage remained in Stages 1-2 compared with Stages 3-4 arthritis of both articular surfaces (P<0.01 in first metacarpal, P=0.01 in trapezium).
CONCLUSIONS: Axial traction of the thumb increased the joint space width and improved articular cartilage visibility in the thumb carpometacarpal joint. Our results suggested that axial traction MRI can be used for noninvasive evaluation of articular cartilage defects in patients with thumb carpometacarpal arthritis and aid in selecting the optimal surgical procedure.