股骨髁上骨折伴同侧膝关节半月板或韧带损伤的特点及相关危险因素分析  

Characteristics and risk factor analysis of femoral supracondylar fractures combined with meniscal and ligamentous knee injuries

作　　者：耿欣[1] 陈文欢 郭林[1] 田维[3] Geng Xin;Chen Wenhuan;Guo Lin;Tian Wei(Department of Radiology,Tianjin Hospital,Tianjin 300211,China;Third Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510504,China;Department of Orthopedics,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津医院放射科,300211 [2]广州中医药大学第三临床医学院,510504 [3]天津医院创伤骨科,300211

出　　处：《中华创伤杂志》2021年第8期694-700,共7页Chinese Journal of Trauma

摘　　要：目的探讨股骨髁上骨折伴同侧膝关节半月板或韧带损伤的特点及其相关危险因素。方法采用回顾性病例系列研究分析2016年1月至2020年12月天津医院收治的100例股骨髁上骨折伴同侧膝关节半月板或韧带损伤患者的临床资料,其中男55例,女45例;年龄22~78岁[(38.5 ± 3.3)岁]。致伤原因:交通伤45例,摔伤45例,其他10例。骨折AO分型:A1型56例,A2型33例,A3型11例。左侧60例,右侧40例。患者均行同侧膝关节MRI检查以明确膝关节半月板与韧带损伤的发生率、部位和严重程度。损伤部位包括膝关节内侧半月板(MM)、外侧半月板(LM)、前交叉韧带(ACL)、后交叉韧带(PCL)、内侧副韧带(MCL)、外侧副韧带(LCL)。采用Stoller四级法评价膝关节半月板损伤程度,Ruiz三级法评价膝关节韧带损伤程度。分析性别、年龄、致伤原因、患侧、骨折AO分型等亚组半月板与韧带损伤的发生率。采用Logistic回归分析,明确股骨髁上骨折伴同侧膝关节半月板或韧带损伤的独立危险因素。结果 76例(76.0%)伴膝关节半月板或韧带损伤(151处不同部位损伤)。29例(29.0%)同时合并半月板及韧带损伤。56例合并半月板损伤患者中,双侧半月板损伤11例。MM损伤32例(32.0%),其中Ⅰ级19例,Ⅱ级12例,Ⅲ级1例;LM损伤35例(35.0%),其中Ⅰ级19例,Ⅱ级14例,Ⅲ级2例。49例合韧带损伤患者中,单韧带损伤22例,双韧带损伤19例,三韧带损伤8例。ACL损伤33例(33.0%),其中Ⅰ级22例,Ⅱ级10例,Ⅲ级1例;PCL损伤4例(4.0%),其中Ⅰ级3例,Ⅱ级1例;MCL损伤28例(28.0%),其中Ⅰ级18例,Ⅱ级9例,Ⅲ级1例;LCL损伤19例(19.0%),其中Ⅰ级12例,Ⅱ级5例,Ⅲ级2例。性别、致伤原因、骨折类型亚组膝关节半月板损伤发生率差异有统计学意义(P < 0.05)。Logistic回归分析结果提示,性别、骨折类型与膝关节半月板损伤显著相关,其中男性(P < 0.05)、A3型骨折(P < 0.01)伴半月板损伤风险明显增高。致伤�Objective To analyze the characteristics and related risk factors of femoral supracondylar fractures combined with meniscus and ligament injuries.Methods A retrospective case series analysis was performed on clinical data of 100 patients with femoral supracondylar fractures combined with ipsilateral meniscal and ligamentous knee injuries admitted to Tianjin Hospital from January 2016 to December 2020.Fhere were 55 males and 45 females,with age of 22-78 years[(38.5±3.3)years].Causes of injury included traffic accidents in 45 patients,falls in 45 and others in 10.According to AO classification,type A1 was in 56 patients,A2 in 33 and A3 in 11.Sixty of these patients presented fractures on the left side and forty on the right side.All patients accepted MRI examination to estimate meniseal and ligamentous knee injuries concerning its prevalence,locations and severity.Locations of injury included the medial meniscus(MM),lateral meniscus(LM),anterior cruciate ligament(ACL),posterior cruciate ligamenl(PCL),medial collateral ligament(MCL)and lateral collateral ligament(LCL).Meniscal knee injuries were measured using Stoller four-level method,and ligamentous knee injuries hy Ruiz three-levc*!method.The patients wf*re subdivided based on age,sex,causes of injury,injury side and fracture AO classification to measure the prevalence of meniscal and ligamentous injuries,and to identify tlie factors related to injuries using logistic regression analysis.Results Sevenly-six patients(76.0%)were complicated with meniscal or ligamentous injuries in 151 different parts.Twenty-nine patients(29.0%)had both meniscal and ligamentous injuries.Fifty-six patients had meniscal injuries,including 11 with bilateral meniscus injuries.MM injuries were noted in 32 patients(32.0%),with severity of grade I in 19 patients,grade II in 12 and grade III in 1.LM injuries were found in 35 patients(35.0%),with severity of grade I in 19 patients,grade II in 14 and grade III in 2.Forty-nine patients had ligamentous injuries,among which 22 patients were wit

关 键 词：股骨骨折 半月板 胫骨 韧带 

分 类 号：R687.3[医药卫生—骨科学]