内侧半月板后角Ramp损伤在前十字韧带损伤患者中的发生率及影响因素分析

Arthroscopic prevalence of Ramp lesion of anterior cruciate ligament injury

目的研究前十字韧带损伤合并内侧半月板后角Ramp（内侧半月板后角至后内侧关节囊滑膜移行区域）损伤的发生率，并分析其影响因素。方法2002年4月至2007年10月，采用韧带重建手术治疗并确诊为前十字韧带损伤的患者868例，男609例，女259例；年龄15-55岁，平均25_2岁。根据手术记录以及术中关节镜探查，筛选其中存在内侧半月板后角Ramp损伤的病例，计算其发生率。按照性别、年龄段及受伤至手术时间分组，分析Ramp损伤发生率的影响因素。结果868例膝关节确诊为前十字韧带损伤并接受韧带重建手术的患者中，内侧半月板后角Ramp损伤的患者为144例，男113例，女31例；平均年龄24．7岁。受伤至手术时间平均29-3个月。Ramp损伤的发生率为16．59％（14/868），伤后6周、3、6、12、24个月Ramp损伤的发生率分别为12．66％、13．51％、13．17％、14．49％、15．92％；男性发生率为18．56％（113／609），女性为11．97％（31／259），两者比较差异有统计学意义；30岁以下的患者Ramp损伤发生率为21．59％（11/528），30岁以上者为8．82％（3/340），两者比较差异有统计学意义。结论内侧半月板后角Ramp损伤是前十字韧带断裂的常见合并损伤，其发生率为16．59％；伤后2年内，Ramp损伤的发生率随受伤时间延长明显增加；男性及30岁以下患者Ramp损伤发生率明显增高。

Objective To retrospectively determine the prevalence of Ramp lesion （the peripheral attachment of the posterior horn of the medial meniscus） of the posterior horn of the medial meniscus with concurrent anterior cruciate ligament （ACL） ruptures and analyze the relevant risk factors. Methods From April 2002 to October 2007, 868 consecutive knees were diagnosed as ACL injury and received arthroscopic surgery for ACL reconstruction （ACLR）. All the patients were verified for the tears of Ramp area under arthroscopy. The prevalence of Ramp lesion was evaluated respectively. Then all cases were divided into dif- ferent groups depending on the time interval from ACL injury to ACLR （TFI） and other relevant risk factors as age and gender. Results Among 868 knees underwent surgery for ACLR, 144 knees were diagnosed as Ramp lesion. The average age was 24.7 years, 113 males, 31 females. The mean TFI to ACLR was 29.3 months. The prevalence of Ramp lesion was 16.59%, which was analyzed as logarithmic correlation with TFI. Patients younger than 30-year old and male patients had significant higher prevalence of Ramp lesion. Con- clusion Ramp lesion is a common meniscus injury that can occur at the time of ACL rupture or as a result of knee laxity associated with ACL insufficiency. The prevalence of Ramp lesion is 16.59% which increases with time until 24 months after initial injury. Patients younger than 30-year old and male patients have higher prevalence of Ramp lesion.