前交叉韧带断裂患者出现Ⅲ度轴移的高危因素分析

High Risk Factors of Ⅲ Degree Pivot Shift in Patients with Anterior Cruciate Ligament Rupture

目的探讨包括性别及股骨内、外髁宽度比在内的多个因素是否与前交叉韧带断裂患者出现高度轴移现象相关。方法回顾性分析我科2019年1月至2020年2月因前交叉韧带断裂行手术治疗患者资料共236例。术前进行轴移试验,分为0度、Ⅰ度、Ⅱ度、Ⅲ度,轴移0度和Ⅰ度89例患者为对照组,轴移Ⅱ度84例患者为病例A组、轴移Ⅲ度63例患者为病例B组。预测导致轴移Ⅲ度的危险因素包括:性别、年龄、受伤至手术时间、BMI、受伤类型、胫骨平台后倾角、股骨内外髁占比、股骨髁间窝占比、是否伤后继续变向运动、伤后参加变向运动频率、外侧半月板撕裂、全身多发关节松弛、膝过伸。卡方检验及单因素回归分析评估三组患者之间预测因素是否有明显差异,然后使用有序Logistics回归及多因素回归分析进一步确认导致Ⅲ度轴移的独立危险因素。结果卡方检验及单因素回归分析结果显示性别、年龄、股骨外髁占比、股骨内髁占比、外侧半月板撕裂、全身多发关节松弛、膝过伸在不同轴移试验组之间存在明显差异。多因素回归分析显示女性及股骨内髁占比增大、股骨外髁占比减少、膝过伸是前交叉韧带断裂患者出现Ⅲ度轴移的独立危险因素,四者的OR及95%CI指标分别为:A组vs.B组,2.546(1.134~5.717)、0.911(0.776~1.070)、1.350(1.094~1.666)、2.382(1.058~5.364);B组vs.对照组,6.313 (2.105~18.931)、0.819 (0.680~0.987)、1.669 (1.313~2.123)、2.855(1.167~6.984)。结论对于前交叉韧带断裂的患者,女性、股骨内髁占比增大、股骨外髁占比减小、膝过伸可能是导致Ⅲ度轴移的高危因素,在评估高度轴移时应更关注患者性别及股骨远端形态学异常。

Objective To investigate whether multiple factors,including gender,width ratios of femoral internal and external condyle,are related to high pivot shift in patients with anterior cruciate ligament rupture.Methods From January 2019 to February 2020,236 patients who underwent surgery for anterior cruciate ligament rupture in our department was retrospectively analyzed.Pivot shift test was performed before operation,which was divided into 0,Ⅰ,ⅡandⅢdegree.89 cases of pivot shift 0 andⅠdegree were control group,84 cases of pivot shiftⅡdegree were group A,and 63 cases of pivot shiftⅢdegree were group B.Risk factors predicted to causeⅢdegree of pivot shift,including gender、age、time from injury to operation、BMI、injury type、tibial plateau retrograde angle、proportion of femoral internal and external condyles、proportion of femoral intercondylar fossa、whether to continue to change after injury、frequency of reversing exercise after injury、torn lateral meniscus、multiple loose joints in all body and knee extension.Chi-square test and univariate regression analysis assessed whether there were significant differences in predictors among three groups,and then ordered Logistics regression and multivariate regression analysis were used to further confirm independent risk factors that led toⅢdegree pivot shift.Results Chi-square test and single factor regression analysis showed that gender、age,proportion of femoral lateral condyle、proportion of femoral medial condyle、lateral meniscus tear、multiple joint laxity,and knee hyperextension were significantly different among different pivot shift test groups.Multivariate regression analysis showed that women and proportion of femoral medial condyles increased,proportion of femoral lateral condyles decreased,and knee hyperextension were independent risk factors forⅢdegree pivot shift in patients with anterior cruciate ligament rupture that their OR and 95%CI indicators were,respectively,A group vs.B group,2.546(1.134~5.717),0.911(0.776~1.070),1.350(1.094~1.666),2.382(1.058~5.364)and B group VS control group,6.313(2.105~18.931),0.819(0.680~0.987),1.669(1.313~2.123),2.855(1.167~6.984).Conclusions For patients with anterior cruciate ligament rupture,women,proportion of femoral medial condyles increased,proportion of femoral lateral condyles decreased,and knee hyperextension may be a high-risk factor forⅢdegree pivot shift.More attention should be paid to gender and morphology abnormalities of distal femur when evaluating height pivot shift.