| 陈栗,汤晓牧,文华伟,等.“双疤征”对于急性后交叉韧带断裂的诊断效能及临床特征研究.骨科,2025,16(2): 97-103. |
| “双疤征”对于急性后交叉韧带断裂的诊断效能及临床特征研究 |
| Diagnostic efficacy and clinical characteristics of the double scar sign for acute posterior cruciate ligament rupture |
| 投稿时间：2025-02-08 |
| DOI：10.3969/j.issn.1674-8573.2025.02.001 |
| 中文关键词: 后交叉韧带 后交叉韧带断裂 双疤征 磁共振成像 |
| 英文关键词: Posterior cruciate ligament Posterior cruciate ligament rupture Double scar sign MRI |
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| 中文摘要: |
| 目的 探讨急性后交叉韧带（posterior cruciate ligament，PCL）断裂病人中“双疤征”（double scar sign，DSS）的发生率以及临床特征。方法 采用前瞻性研究设计，纳入2021年6月至2024年6月武汉市第四医院收治的86例急性PCL断裂病人，其中男52例，女34例，年龄（49.2±13.9）岁（24~69岁）。通过观察病人受伤膝关节外观照片，评估胫骨结节处和髌骨前软组织是否存在两处直径≥1 cm的外伤性类圆形瘢痕，以此判断是否存在DSS，并据此将病人分为DSS阳性组和DSS阴性组。收集病人膝关节外观照片、MRI图像、性别、年龄、病程以及受伤方式等临床信息，分析DSS与急性PCL断裂的相关性，并比较两组病人的临床特征差异。结果 86例病人中，DSS阳性组62例（72.1%），其中电动车事故损伤39例（62.9%），机动车事故损伤6例（9.7%），运动损伤17例（27.4%），膝关节MRI矢状位质子加权抑脂序列显示胫骨结节处和髌骨前软组织双高信号影（简称双高信号）占比100%；DSS阴性组24例（27.9%），其中电动车事故损伤4例（16.7%），机动车事故损伤5例（20.8%），运动损伤15例（62.5%），MRI双高信号占比25%。两组病人性别、年龄、病程、身体质量指数（BMI）等基础信息差异均无统计学意义（P＞0.05），DSS阳性组中MRI双高信号占比显著高于DSS阴性组（P＜0.001），且膝关节功能评分均低于DSS阴性组（P＜0.001），疼痛评分高于DSS阴性组（P＜0.001）。结论 DSS是一种与急性PCL断裂密切相关的重要临床警示征象，可作为早期诊断的重要体征，尤其对于电动车事故等屈膝位撞击损伤者，在基层医疗或影像检查受限时具有显著优势。MRI双高信号是PCL断裂的可靠间接征象，但需结合损伤机制及临床检查综合评估，避免与其他膝关节损伤混淆。 |
| 英文摘要: |
| Objective To investigate the incidence and clinical characteristics of the double scar sign (DSS) in patients with acute posterior cruciate ligament (PCL) rupture. Methods A prospective study was conducted on 86 patients diagnosed with acute PCL rupture at Wuhan Fourth Hospital between June 2021 and June 2024. The cohort included 52 males and 34 females, aged (49.2±13.9) years (24-69 years). The presence of DSS was assessed by examining external knee photographs for two trauma-induced, approximately circular scars (≥1 cm in diameter) located at the tibial tubercle and the prepatellar soft tissue. Patients were categorized into the DSS-positive and DSS-negative groups based on these findings. Collected data included external knee photographs, MRI images, and clinical parameters such as gender, age, duration of injury, and injury mechanism. The correlation between DSS and acute PCL rupture was analyzed, and clinical characteristics were compared between the two groups. Results Among the 86 patients, 62 cases (72.1%) were DSS-positive, with electric scooter accidents being the most common injury mechanism (39 cases, 62.9%), followed by motor vehicle accidents (6 cases, 9.7%) and sports injuries (17 cases, 27.4%). MRI proton density-weighted turbo spin-echo fat suppression sagittal sequences (PD-TSE-FS-SAG) revealed high-signal intensity at both the tibial tubercle and prepatellar soft tissue (termed “double high-signal”) in all DSS-positive cases (100%). In contrast, 24 patients (27.9%) were DSS-negative, with electric scooter accidents accounting for 4 cases (16.7%), motor vehicle accidents for 5 cases (20.8%), and sports injuries for 15 cases (62.5%). The prevalence of double high-signal on MRI was significantly lower in the DSS-negative group (25%). No significant differences were observed between the two groups in terms of gender, age, duration of injury, or body mass index (BMI) (P＞0.05). However, DSS-positive patients exhibited a significantly higher prevalence of double high-signal MRI findings (P＜0.001), lower knee function scores and higher pain scores compared to DSS-negative patients (P＜0.001). Conclusion DSS is strongly associated with acute PCL rupture and serves as an important clinical warning sign. It may be a valuable early diagnostic indicator, especially for patients with knee flexion impact injuries such as electric vehicle accidents, particularly in primary care settings or when imaging resources are limited. The presence of double high-signal on MRI is a reliable indirect marker of PCL rupture; however, a comprehensive evaluation incorporating injury mechanism and clinical examination is necessary to differentiate it from other knee injuries. |
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