单独后交叉韧带断裂伴半月板和软骨损伤及其影响因素

Meniscus and cartilage injuries concomitant with isolated rupture of posterior cruciate ligament and its risk factors

目的:通过研究后交叉韧带(posterior cruciate ligament,PCL)断裂伴发的半月板和软骨损伤的临床特点,探讨其分布规律及影响因素。方法:回顾性分析2005年1月至2013年6月间收治的147例经确诊为单独PCL断裂的患者,将性别、年龄、病程、体质量指数(BMI)、关节松弛度、致伤原因、侧别等因素作为自变量,将半月板和软骨损伤的发生率、分布和严重程度作为应变量,利用卡方检验、Fisher精确概率法、CMH(Cochran-Mantel-Haenszel)检验和分类资料两属性的相关分析确定影响半月板和软骨损伤的危险因素,然后采用多因素logistic回归分析确定独立危险因素。结果:半月板总体损伤率14.3%,不同性别、年龄、侧别、病程及关节松弛度组间差异具有统计学意义(P<0.05)。软骨损伤主要集中在内侧胫股关节和髌股关节,不同性别、年龄、病程及关节松弛度组间差异具有统计学意义(P<0.05)。多因素logistic回归分析结果显示所有变量均不能被认为是影响半月板及软骨损伤的独立危险因素。结论:PCL断裂可伴发严重的关节软骨损伤和少量的半月板损伤,可能会导致髌股关节和内侧胫股关节退变加剧,早期恢复关节稳定性可能避免软骨进一步损伤,延缓退变。

Objective: To investigate the risk factors associated with meniscus and cartilage lesions concomitant with isolated rupture of posterior cruciate ligament(PCL). Methods: A total of 147 patients with rupture of PCL from January, 2005 to June, 2013 were retrospectively analyzed for associations of distribution, incidence of meniscal tears or cartilage injuries with gender, age, sides, duration, body mass index, cause or degree of instability. Results: Incidence for meniscal injuries was 14.3%, which was statistically different among groups in gender, age, sides, duration and degree of instability(P<0.05). Chondral lesions were mainly appeared in medial tibiofemoral compartment and patellofemoral compartment, and the incidence was statistically different among groups in gender, age, duration, and degree of instability(P<0.05). No independent risk factor was found to be associated with meniscal and chondral injuries. Conclusion: Severe cartilage lesions and less meniscal tears can be induced by the rupture of PCL. Medical treatment at the early stage is necessary to restore stability and reduce chondral injuries.