前交叉韧带损伤合并内侧胫骨平台骨性关节炎患者临床特点分析

Clinical Characteristics of Patients with Anterior Cruciate Ligament Injury Complicated with Medial Tibial Plateau Osteoarthritis

目的观察分析前交叉韧带(anterior cruciate ligament,ACL)损伤的膝关节骨性关节炎(knee osteoarthritis,KOA)患者膝关节内侧胫骨平台软骨磨损特点,为早发现、早干预ACL损伤合并KOA内侧平台磨损情况的发生发展提供科学依据。方法选取2017年1月至2018年6月,于重庆九龙坡区人民医院骨科确诊合并ACL损伤的内侧间室型KOA行全膝关节置换术(TKA)患者66例为研究对象,共72膝,术前均行双侧膝关节X线、MRI检查。根据X线检查结果评估KOA程度,根据MRI检查结果并结合TKA术中所见评估ACL损伤程度,根据TKA术中所见评估KOA软骨磨损范围及程度。结果 ACL功能相对不全43膝(0级11膝,Ⅰ级15膝,Ⅱ级17膝),ACL功能绝对不全29膝(Ⅲ级19膝,Ⅳ级10膝)。ACL功能相对不全者内侧胫骨平台软骨磨损主要分布在前中区33膝(76.7%),ACL功能绝对不全者主要分布在中后区21膝(72.4%),不同ACL损伤程度内侧胫骨平台软骨磨损分布及磨损程度比较,差异有统计学意义( P <0.05)。ACL功能绝对不全者KOA严重程度显著高于ACL功能相对不全者( P <0.05)。结论 ACL功能相对不全者膝关节软骨磨损主要累及前中区,而ACL功能绝对不全者软骨磨损主要累及中后区;ACL损伤越重,软骨磨损程度越重,KOA程度亦越重,故临床早发现、早处理ACL损伤对预防合并ACL损伤后KOA发生发展具有重要意义。

Objective To observe and analyze the cartilage wear characteristics of medial tibial plateau in patients with knee osteoarthritis (KOA) complicated anterior cruciate ligament (ACL) injury so as to provide scientific basis for the early detection and intervention of ACL injury complicated with KOA medial plateau wear.Methods A total of 72 knees in 66 patients diagnosed with KOA complicated with ACL injury and treated with total knee arthroplasty (TKA) in Jiulongpo People's Hospital of Chongqing from January of 2017 to June of 2018 were selected and examined by X-ray and MRI of bilateral knee joints before operation.The degree of KOA was assessed according to the results of the X-ray examination, the degree of ACL injury was assessed according to the results of MRI and the findings during TKA, and the extent and degree of KOA cartilage wear were assessed according to the findings during TKA.Results There were 43 knees with relative ACL dysfunction including 11 knees of grade zero, 15 knees of grade Ⅰ and 17 knees of grade Ⅱ and 29 knees with absolute ACL dysfunction including 19 knees of grade Ⅲ and 10 knees of grade Ⅳ.The medial tibial plateau cartilage wear of 33 knees (76.7%) was mainly distributed in the anterior and middle regions among the ACL patients with relative ACL dysfunction, and that of 21 knees (72.4%) was mainly distributed in the middle and posterior regions among the ACL patients with absolute ACL dysfunction.The wear distribution and degree of medial tibial plateau cartilage with different degree of ACL injury were significantly different ( P <0.05), and the KOA severity of patients with absolute ACL dysfunction were significantly greater than that of patients with relative ACL dysfunction ( P <0.05).Conclusion The cartilage wear of knee joints mainly involves the anterior and middle regions in the patients with relative ACL dysfunction and the middle and posterior regions in the patients with absolute ACL dysfunction.The more severe ACL injury suggests worse cartilage wear and more severe KOA, so the early detection and treatment of ACL injury is very important to prevent the occurrence and development of KOA after ACL injury.