双膝关节前交叉韧带断裂继发膝关节软骨损伤的临床研究

Clinical Study on Articular Cartilage Injury in Patients Following Bilateral Anterior Cruciate Ligament Rupture

目的:研究关节镜下双膝关节前交叉韧带(ACL)断裂继发膝关节软骨损伤的特点。方法:2010年1月至2014年12月共有24例双膝关节ACL先后断裂的患者行关节镜下双膝ACL同期重建,根据受伤时间分为双膝关节ACL断裂先伤侧膝关节(PB-ACL)和后伤侧膝关节(SB-ACL)。按照匹配原则,单侧膝关节ACL断裂(U-ACL)并行关节镜ACL重建的63例患者作为对照。记录关节镜手术中关节软骨损伤的发生率、部位和损伤程度并进行分析对比研究。结果:膝关节ACL断裂后继发关节软骨损伤的发生率很高。在关节软骨损伤的发生率和损伤程度上,PB-ACL、SB-ACL和U-ACL之间无显著性差异(P>0.05)。在髌骨软骨、滑车软骨、股骨外髁软骨和外侧平台软骨损伤的发生率和损伤程度上,PB-ACL和SB-ACL分别与U-ACL均无显著性差异(P>0.05)。在内侧间室(股骨内髁和内侧胫骨平台)关节软骨损伤的发生率和损伤程度上,PB-ACL和SB-ACL分别与U-ACL存显著性差异(P<0.05)。结论:双膝ACL断裂膝关节在内侧间室(股骨内髁和内侧胫骨平台)软骨损伤发生率和损伤程度上均高于单膝ACL断裂,在膝关节其他部位软骨损伤发生率和损伤程度上二者未见显著差异。

Objective To study the characteristics of the articular cartilage injury in patients follow-ing bilateral anterior cruciate ligament（ACL） rupture. Method Twenty-four patients undergoing the ar-throscopic bilateral ACL（B-ACL） reconstruction between January 2010 and December 2014 were select-ed and randomly divided into a group of the primary injury of B-ACL（PB-ACL） and a secondary inju-ry of B-ACL（SB-ACL）. Another 63 patients receiving the unilateral ACL（U-ACL） reconstruction dur-ing the same time period were chosen as controls. The incidence,location and severity of ACL injurieswere recorded and compared. Results The incidence of articular cartilage injury increased significantlyafter ACL rupture. There were no significant differences among group PB-ACL,SB-ACL and U-ACLin the location and severity of articular cartilage injuries,as well as the incidence and severity of carti-lage injuries in the patellar,trochlear,lateral femoral condyle and lateral tibial plateau（P〉0.05 for all）.However,significant differences were observed among the three groups in the incidence and severity ofcartilage injuries of the medial femoral condyle cartilage and medial tibial plateau cartilage（P〈0.05）.Conclusion The incidence and severity of the medial compartment（the medial femoral condyle and me-dia tibial plateau） cartilage injuries were higher in the B-ACL group when compared with the U-ACL group,while there were no significant differences between the two groups in other locations.