前交叉韧带重建术后膝前疼痛的危险因素分析  

Risk factors of anterior knee pain after anterior cruciate ligament reconstruction

作　　者：崔毅鹏 李若尘 刘蔚[1] 陈曦[2] 杨佩[1] 王坤正[1] 李苗[3] Cui Yipeng;Li Ruochen;Liu Wei;Chen Xi;Yang Pei;Wang Kunzheng;Li Miao(Department of Bone and Joint Surgery,the Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China;Department of Oncology,the Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China;Department of Ultrasound,the Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China)

机构地区：[1]西安交通大学第二附属医院骨关节外科,710004 [2]西安交通大学第二附属医院肿瘤科,710004 [3]西安交通大学第二附属医院超声科,710004

出　　处：《中华关节外科杂志（电子版）》2022年第6期690-696,共7页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：国家自然科学基金(81772346)

摘　　要：目的通过基于肌骨超声和多变量logistic回归分析的回顾性研究探索前交叉韧带重建术(ACLR)后膝前疼痛(AKP)的危险因素。方法采用回顾性病例对照研究随访于西安交通大学第二附属医院行ACLR的患者,排除有同侧膝关节周围手术史及同侧膝关节慢性疾病患者,纳入18~50岁、由同一医师行自体腘绳肌腱ACLR的患者35人。根据术后症状及视觉模拟评分法(VAS)分为AKP组与无AKP组,记录两组患者的年龄、性别等资料。完善国际膝关节文献委员会膝关节评估表(IKDC)、部分费勒量表;测量胫骨前位移量、伸膝受限角度等;利用二维超声检测髌腱及髌下脂肪垫(IFP)的形态学、厚度,利用多普勒超声检测IFP血流信号,利用弹性超声检测IFP及髌腱横波传导速度。对部分变量进行相关分析后,确定回归模型,进行多变量logistic回归分析,寻找相关危险因素。结果单变量分析结果显示,AKP组中女性患者占比更高(P=0.018),AKP组患者的股四头肌肌力下降高于非AKP组(Z=2.40,P<0.05),超声检查发现AKP组IFP血流增加的患者比例更高(P=0.018),横波传导速度更快(t=7.64,P<0.05),其余指标差异无统计学意义(均P>0.05)。多变量logistic回归分析结果显示,女性[比值比(OR)=12.13,95%置信区间(CI)(1.55,94.99)]、股四头肌肌力下降[OR=7.94,95%CI(1.14,55.43)]及IFP血流增加[OR=8.90,95%CI(1.25,63.56)]是ACLR术后膝前疼痛的危险因素(均为P<0.05)。结论前交叉韧带重建术后女性发生膝前疼痛的风险高于男性,股四头肌肌力下降及IFP充血水肿是膝前疼痛发生的危险因素。Objective To investigate the possible risk factors for anterior knee pain syndrome(AKP)after the anterior cruciate ligament reconstruction(ACLR)based on multivariate logistic regression analysis and musculoskeletal ultrasound(MSKUS).Methods A retrospective case-control study was conducted to analysis patients who underwent anterior cruciate ligament reconstruction(ACLR)in the Second Affiliated Hospital of Xi’an Jiaotong University.Patients with a history of surgery or chronic disease around the ipsilateral knee were excluded.A total of 35 patients aged from 18 to 50 years who underwent ACLR with autologous hamstring tendon by the same doctor were enrolled and divided into two groups:the anterior knee pain group(the AKP group)and the non-AKP group,according to the postoperative symptoms and visual analogue scale(VAS)score.The patient baseline characteristics,such as age,gender,were recorded.The patients filled out a questionnaire about the International Knee Documentation Committee(IKDC)scale and sectional Feller scale.Anterior knee laxity and flexion contracture were measured.The morphological features and thickness of the patellar tendon and infrapatellar fat pad(IFP)were measured by two-dimensional ultrasound.The IFP blood flow signal were measured by Doppler ultrasound.The shear wave velocity of the patellar tendon and IFP were measured by ultrasonic elastography.After correlation analysis of some variates with statistical differences,the multivariate logistic regression analysis was conducted to find relevant risk factors.Results Univariate analysis showed that the proportion of female patients in the AKP group was higher(P=0.018),the reduction of quadriceps muscle strength in the AKP group was higher than that in the non-AKP group(Z=2.40,P<0.05),ultrasonography showed that the proportion of patients with increased IFP blood flow was higher in the AKP group(P=0.018),and the shear wave velocity of IFP was faster in the AKP group(t=7.64,P<0.05).There was no significant difference in other variates(all P>0.05)

关 键 词：前交叉韧带重建 髌股疼痛综合征 脂肪组织 超声检查 回归分析 

分 类 号：R687.4[医药卫生—骨科学]