膝前方撞击的关节镜下病因分析

Etiological analysis of anterior knee impingement under athroscopy

目的探讨膝关节前方撞击的病因机制。方法 2007年5月～2008年5月对137例该院收治伸膝受限、膝前痛患者行关节镜手术,其中121例患者关节(占88.3%)存在撞击,对此进行回顾性分析。结果撞击病因有:膝关节退变性骨赘形成41例(包括髌骨下极骨赘、胫骨髁间嵴骨赘、髁间窝骨赘,ACL胫骨止点前缘骨赘等),半月板损伤30例,前交叉韧带(ACL)断裂26例,关节游离体22例,髌骨外侧倾斜12例、髌骨半脱位2例,胫骨髁间嵴撕脱性骨折9例,滑膜皱襞综合征6例,ACL重建术后5例,关节内肿瘤4例,ACL囊肿3例。结论膝前方撞击是导致膝前痛及伸直受限的重要因素之一。造成撞击的较常见原因为半月板、ACL损伤和膝关节退行性变的骨赘形成。

Aim To investigate the etiology of anterior knee impingement.Methods We reviewed 137 cases of arthroscopic surgery patients who suffered from either or both of knee extension limitation and anterior knee pain before operation from May 2007 to May 2008,121 cases（accounting for 88.3% of the total） of which were found of anterior knee impingement,including 68 male and 53 female and the mean age was 36.5 years old（rangine from 8 to 72 years old）.The reasons of anterior knee impingement were identified by arthroscopic examination.Results Arthroscopic findings were osteophytes formation in the femoral intercondylar notch or patella inferior pole or in the anterior marginal part of the tibial intercondylar eminence,meniscus injury,anterior cruciate ligament（ACL） injury,joint loose bodies,patellar tilt or subluxation,avulsion fracture in the tibial intercondylar eminence,plica syndrome,completed anterior cruciate ligament reconstruction,intra-articular tumor,ACL＇s cyst.Conclusion Anterior knee impingement is a very important factor of knee extension limitation and anterior knee pain.The very common causes of anterior knee impingement are meniscus injury,anterior cruciate ligament injury or osteophytes formation.