外侧半月板后根部损伤对半月板外突的影响  

A Cohort Study on Patients with Lateral Meniscus Posterior Root Tears:Injury Patterns and Meniscus Extrusion

作　　者：沈杰威[1] 洪雷[1] 张辉[1] 王雪松[1] 张晋[1] 刘心[1] 李岳[1] 宋关阳[1] 冯华[1] 

机构地区：[1]北京积水潭医院运动损伤科,北京100035

出　　处：《中国运动医学杂志》2014年第6期499-504,共6页Chinese Journal of Sports Medicine

摘　　要：目的:研究外侧半月板后根部损伤对半月板外突的影响。方法:本研究为前瞻性研究。选取2011年1月至2013年9月在本院进行膝关节镜手术的连续病例。根据入选和排除标准,有52例外侧半月板后根部完全损伤的病例入选。研究内容包括:后根部损伤发生率、损伤类型、相关因素分析及对外突的影响。结果:所有入选病例均合并前交叉韧带(ACL)损伤,在1021例ACL损伤病例中,外侧半月板后根部完全损伤的发生率为5.1%(52/1021)。52例外侧半月板后根部完全损伤病例中,单纯后根部损伤发生率为36.5%(19/52),后根部联合体部放射状撕裂(联合损伤)的发生率为63.5%(33/52)。在联合损伤的病例中,将后根部损伤分为两型:A型,后根部完全损伤、半月板股骨韧带完整型(28/33,85%);B型,后根部完全损伤、半月板股骨韧带断裂(或缺失)型(5/33,15%)。在联合损伤的病例中,将半月板体部放射状撕裂分为:1型,部分损伤,未累及纤维环(30/33,91%);2型,完全损伤,累及纤维环(3/33,9%)。联合损伤与患者的身高体重指数和术前膝关节前向KT-1000的侧-侧差值具有相关性(P=0.047,P=0.023),与年龄、性别、侧别、受伤时间、伤因、轴移程度无明显相关性。半月板外突在本组病例的发生率为30.8%(16/52)。半月板股骨韧带断裂或缺失(B型)的外突发生率为100%,半月板股骨韧带完整(A型)的外突发生率为21.4%,二者相比具有显著差异(P<0.001)。体部完全损伤(2型)的外突发生率为100%,体部部分损伤(1型)的外突发生率为26.7%,二者相比具有显著差异(P=0.01)。结论:ACL损伤时,外侧半月板后根部损伤的发生率为5.1%。外侧半月板后根部完全损伤病例中的63.5%合并体部放射状撕裂;当后根部完全撕裂时,如果损伤累及半月板股骨韧带或者半月板体部纤维环会导致半月板外突。Objective The purpose of this study was to investigate the influence of lateral meniscus posterior root tears （LMPRTs）on the meniscus extrusion. Methods According to inclusion and exclusion criteria,52 patients with LMPRTs from a total of 1021 patients with ACL injury were finally selected in this study. They received knee arthroscopic surgery in our hospital from January 2011 to September 2013. The prevalence,classification,pattern of LMPRTs and the related factors contributing to meniscus extrusion were analyzed. Results The prevalence of LMPRTs in patients with ACL injury was 5.1%（52/ 1021 ）. In 52 patients with LMPRTs,there were 36.5%（19/52）of isolated posterior root tears in meniscus and 63.5% （33/52）of combined lesions in both meniscus root and body. The patients with combinedinjury in this study were classified as type A（complete tear of posterior root with intact meniscal femoral ligament） （28/33,85%）and type B （complete tear of posterior root with ruptured or absent meniscal femoral ligament （5/33,15%）,including 91% （30/33）of incomplete meniscal tear （type 1 ）and 9% （3/33） of complete meniscal tear （type 2）. The BMI and side to side KT value correlated closely with the combined lesions （P = 0.047 and P = 0.023 respectively）, and without correlation with age, sex,duration from injury to surgery and the degree of pivot-shift test. The extrusion rate of lateral meniscus was 30.8%（16/52）. The extrusion rate of type A and type B were 21.4% and 100%（P 〈 0.001）,respectively. The extrusion rate of type 1 and type 2 were 26.7% and 100% （P = 0.01）,respectively. Conclusions Patients with LMPRTs combined with ruptured MFL or with complete meniscal radial tear tend to lead to the meniscus extrusion.

关 键 词：ACL损伤 半月板后根部损伤 半月板撕裂 外侧半月板 半月板外突 发生率 

分 类 号：R684[医药卫生—骨科学]