分析比较急性髌骨外侧脱位与膝关节多发韧带损伤后内侧髌股韧带损伤的特点

A comparison of characteristics of medial patellofemoral ligament injuries in acute lateral patellar dislocation and multiligament knee injuries

目的分析比较急性髌骨外侧脱位(lateral patellar dislocation,LPD)与膝关节多发韧带损伤(multiligament knee injuries,MLKIs)后内侧髌股韧带(medial patellofemoral ligament,MPFL)损伤的特点。方法回顾性分析急性LPD 92例和MLKIs 83例患者的MRI资料,根据患者年龄分为青少年组(年龄≤18岁)84例和成人组(年龄>18岁)91例,对LPD和MLKIs伴发MPFL损伤程度、部位进行统计学分析。结果青少年LPD组50例中,MPFL部分撕裂20例,完全撕裂25例,未损伤5例;青少年MLKIs组34例患者中,MPFL部分撕裂9例,完全撕裂6例,未损伤19例;两组比较,差异有统计学意义(χ^(2)=21.725,P<0.05)。青少年LPD组MPFL髌骨侧损伤19例,股骨侧14例,体部2例,多部位损伤10例;青少年MLKIs组MPFL髌骨侧损伤3例,股骨侧7例,多部位损伤5例;青少年LPD组和MLKIs组间MPFL髌骨侧、股骨侧、多部位损伤发生率差异均具有统计学意义(χ^(2)=19.753,9.644,8.193,P值均小于0.01)。成人LPD组42例中,MPFL部分撕裂17例,完全撕裂19例,未损伤6例;成人MLKIs组49例中,MPFL部分撕裂13例,完全撕裂7例,未损伤29例;两组比较,差异有统计学意义(χ^(2)=20.771,P<0.05)。成人LPD组MPFL髌骨侧损伤11例,股骨侧15例,体部2例,多部位损伤8例;成人MLKIs组MPFL髌骨侧损伤4例,股骨侧9例,多部位损伤7例;LPD组和MLKIs组间MPFL髌骨侧、股骨侧、多部位损伤发生率差异均具有统计学意义(χ^(2)=14.773,12.777,6.822,P均<0.01)。结论急性LPD比MLKIs更易导致MPFL损伤,MPFL髌骨侧损伤、股骨侧损伤和多部位损伤LPD也较MLKIs更常见。

Objective To explore and compare the characteristics of injuries of the medial patellofemoral ligament(MPFL)between acute lateral patellar dislocation(LPD)and multiligament knee injuries(MLKIs).Methods The MRI data on 92 cases of acute LPD and 83 cases of MLKIs was retrospectively analyzed.The concomitant injury degrees and locations of MPFL related to the LPD and MLKIs were statistically analyzed.Results There were 20 cases of partial MPFL tear,25 cases of complete tear and five cases of no injury among the 50 adolescents in the LPD subgroup.Nine cases of partial MPFL tear,six cases of complete tear and 19 cases of no injury were identified among the 34 adolescents in the MLKIs subgroup.The incidence of MPFL tear in the adolescent LPD subgroup was significantly higher than that of the adolescent MLKIs subgroup(P<0.05).MPFL injuries occurred at the isolated patellar insertion(PAT)in 19 cases,at the isolated femoral attachment(FEM)in 14 cases,at the isolated mid-substance(MID)in two cases,and more than one site of injury(COM)was identified in 10 cases in the adolescent LPD subgroup.MPFL injuries occurred at the PAT in three cases,at the FEM in seven cases and COM in five cases in the adolescent MLKIs subgroup.The incidence of MPFL tear at the PAT,FEM and COM in the adolescent LPD subgroup was significantly higher than that of the adolescent MLKIs subgroup(all P<0.01).Seventeen cases of partial MPFL tear,19 cases of complete tear and six cases of no injury were identified among the 42 adults in the LPD subgroup,compared with 13,7 and 29 among the 49 adults in the MLKIs subgroup.The adult LPD subgroup showed significantly higher incidence of MPFL tear than the adult MLKIs subgroup(χ^(2)=20.771,P<0.05).MPFL injuries occurred at the PAT in 11 cases,FEM in 15 cases,MID in two cases and COM in eight cases in the adult LPD subgroup,but at the PAT in four cases,FEM in nine cases and COM in seven cases in the adult MLKIs subgroup.The adult LPD subgroup showed significantly higher incidence of MPFL tear at the PAT,FEM and COM than the adult MLKIs subgroup(χ^(2)=14.773,12.777,6.822,all P<0.01).Conclusions Acute LPD is more likely to cause MPFL tear than MLKIs,including partial tear,complete tear,isolated femoral-sided tear,isolated patellar-sided tear and combined tear.