膝关节外侧盘状半月板损伤与软骨损伤的相关性研究

Correlative research between discoid lateral meniscus injury and the articular cartilage lesions

目的探究单膝外侧盘状半月板（discoid lateral meniscus,DLM）损伤与膝关节软骨损伤的关系并分析合并单膝DLM的膝关节软骨损伤的危险因素。方法 2011年1月~2014年1月,根据纳入与排除标准笔者共收治于MRI下诊断为单膝DLM患者166例,女性103例,男性63例;年龄7~48岁,平均38岁。记录患者盘状半月板变性撕裂情况,并根据半月板损伤情况分为完整组（10例）、变性组（122例）和撕裂组（34例）,利用全器官MRI评分（whole-organ magnetic resonance imaging score,WORMS）法对膝关节软骨损伤情况进行评分,记录患者性别、年龄、BMI指数,通过单因素方差分析比较三组间一般情况以及膝关节软骨损伤评分的差异。对三组患者进行多因素Logistic回归分析,探讨其膝关节软骨损伤的危险因素。结果完整组、变性组、撕裂组三组平均年龄分别为（39.8±19.5）岁、（37.9±15.5）岁、（36.3±15.6）岁,差异均无统计学意义（P〉0.05）;BMI指数分别为23.3、23.7、24.8,差异均无统计学意义（P〉0.05）。膝关节软骨总体评分在三组间不全相等（P〈0.01）,根据最小显著差异法（least significant difference,LSD）进行两两比较,撕裂组总评分高于变性组（P〈0.01）,变性组高于完整组（P=0.005）。所有患者经多因素Logistic回归分析,性别（P=0.020;OR 1.097[0.132~3.841]）、BMI指数（P〈0.01;OR 16.048[6.042~42.628]）及DLM损伤（P=0.011;OR 6.137[1.516~24.800]）均是软骨损伤的独立危险因素。结论在伴有单膝DLM的患者中,女性、BMI〉24kg/m2及DLM损伤为膝关节软骨损伤的独立危险因素,且DLM损伤程度越高,膝关节软骨损伤程度也越高。

Objective To explore the role of isolated discoid lateral meniscus（ DLM） and the risk factors in the articular cartilage lesions in the knee. Methods From Jan. 2011 to Jan. 2014,166 consecutive patients[103females and 63 males with an average of 38（ 7- 48） years]diagnosed with isolated DLM under MRI were enrolled in this study. Tears degrees of DLM were recorded,and the patients were divided into normal group（ n = 10）,degeneration group（ n = 122） and tear group（ n = 34）. Whole organ magnetic resonance imaging score（ WORMS） was used to evaluate the degree of articular lesions in the knee. Demographic variables,including gender,age,body mass index（ BMI）,were recorded. One-way ANOVA was used to discuss the difference of demographic variables and articular lesions scores in the knee. Risk factors were analyzed through logistic regression. Results The average age of three groups was（ 39. 8 ± 19. 5） years,（ 37. 9 ± 15. 5） years,（ 36. 3 ± 15. 6） years,respectively and the average BMI of the three groups was 23. 3,23. 7 and 24. 8,respectively,showing no significantly statistical differences（ P 0. 05） among the three groups. Total scores of articular in the knee were not completely equal（ P 0. 01）,and two groups were respectively compared by LSD method. Total scores of tear group were higher than that of degeneration group（ P 0. 01）,and total scores of degeneration group were higher than that of normal group（ P = 0. 005）. Through logistic regression,gender（ P = 0. 020; OR 1. 097[0. 132-3. 841]）,BMI（ P = 0. 000; OR 16. 048[6. 042-42. 628]） and DLM injury（ P = 0. 011; OR 6. 137[1. 516-24. 800]） were analyzed as the independent risk factors of articular lesions in the knee. Conclusion BMI more than 24 kg / m2 and DLM injury are independent risk factors of the knee cartilage damage; and the degree of DLM injury is positively related to the degree of knee cartilage injury.