膝骨关节炎合并内侧副韧带慢性损伤的影响因素分析

Analysis of factors influencing chronic medial collateral ligament injuries in patients with knee osteoarthritis

目的:探讨膝骨关节炎(kneeosteoarthritis,KOA)合并内侧副韧带(medialcollateralligament,MCL)慢性损伤的影响因素。方法:以2019年1月至2020年6月在义乌市中心医院治疗的KOA患者的病例资料为研究对象,选取一般情况、诊疗记录、影像资料完整的合并或不合并MCL慢性损伤的KOA患者的病例资料,提取相关信息,分析KOA合并MCL慢性损伤的影响因素。结果:共纳入符合要求的患者159例,其中合并MCL慢性损伤患者89例(合并MCL慢性损伤组),不合并MCL损伤患者70例(不合并MCL损伤组)。2组患者的年龄、性别、骨赘生成、合并内侧半月板脱位、关节间隙狭窄类型、内侧半月板损伤分级、合并前交叉韧带损伤、合并后交叉韧带损伤情况比较,组间差异均有统计学意义[(66.87±10.92)岁,(63.19±9.82)岁,t=2.082,P=0.039;χ^(2)=5.923,P=0.015;χ^(2)=44.429,P=0.000;χ^(2)=47.481,P=0.000;χ^(2)=86.788,P=0.000;χ^(2)=31.992,P=0.000;χ^(2)=20.458,P=0.000;χ^(2)=7.372,P=0.007];2组患者的损伤侧别、体质量指数、病程比较,组间差异均无统计学意义[χ^(2)=2.659,P=0.103;(24.43±1.82)kg·m-2,(24.57±0.97)kg·m-2,t=0.982,P=0.328;(2.34±0.78)个月,(2.43±0.81)个月,t=0.372,P=0.710]。Logistic回归分析结果显示,合并内侧半月板脱位、有骨赘生成及合并前交叉韧带损伤是KOA合并MCL慢性损伤的危险因素(β=1.762,OR=5.824,P=0.004;β=3.446,OR=31.375,P=0.000;β=1.992,OR=7.330,P=0.000);相对于胫股关节内侧间隙狭窄,胫股关节外侧间隙狭窄、髌股关节间隙狭窄是KOA合并MCL慢性损伤的保护因素(β=-4.153,OR=0.016,P=0.000;β=-5.342,OR=0.005,P=0.000)。结论:合并内侧半月板脱位、骨赘生成、合并前交叉韧带损伤情况及关节间隙狭窄类型是KOA合并MCL慢性损伤的影响因素,其中合并内侧半月板脱位、有骨赘生成及合并前交叉韧带损伤是KOA合并MCL慢性损伤的危险因素;相对于胫股关节内侧间隙狭窄,胫股关节外侧间隙狭窄、髌股关节间隙狭窄是KOA合并MCL慢性损伤的保护因素。

Objective:To explore the factors influencing chronic medial collateral ligament(MCL)injuries in patients with knee osteoarthritis(KOA).Methods:The medical records of KOA patients who underwent treatment in Yiwu Central Hospital from January 2019 to June 2020 were collected.The medical records of KOA patients with or without chronic MCL injuries containing complete general condition, KARTE and images were further screened, and the relevant infomation about age, gender, height, body mass, disease course and injured side was extracted for analyzing the factors influencing chronic MCL injuries in KOA patients.Results:One hundred and fifty-nine KOA patients were included in the study, in which 89 KOA patients suffered from chronic MCL injuries(chronic MCL injury group)and 70 KOA patients didn’t(non-chronic MCL injury group).There were statistical difference in age, gender, osteophyte formation, combined medial meniscus(MM)dislocation, type of joint space narrowing(JSN),grade of MM injury, combined anterior cruciate ligament(ACL)injury and combined posterior cruciate ligament(PCL)injury between the 2 groups(66.87±10.92 vs 63.19±9.82 years, t=2.082,P=0.039;χ^(2)=5.923,P=0.015;χ^(2)=44.429,P=0.000;χ^(2)=47.481,P=0.000;χ^(2)=86.788,P=0.000;χ^(2)=31.992,P=0.000;χ^(2)=20.458,P=0.000;χ^(2)=7.372,P=0.007);while no statistical difference in injured side, body mass index and disease course between the 2 groups(χ^(2)=2.659,P=0.103;24.43±1.82 vs 24.57±0.97 kg/m(2),t=0.982,P=0.328;2.34±0.78 vs 2.43±0.81 months, t=0.372,P=0.710).The results of logistic regression analysis revealed that the combined MM dislocation, osteophyte formation and combined ACL injury were the risk factors for chronic MCL injury in KOA patients(β=1.762,OR=5.824,P=0.004;β=3.446,OR=31.375,P=0.000;β=1.992,OR=7.330,P=0.000);while lateral tibiofemoral(TF)JSN and patellofemoral(PF)JSN were the protective factors for chronic MCL injury compared to medial TF JSN in KOA patients( β =-4. 153,OR = 0. 016,P = 0. 000;β =-5. 342,OR = 0. 005,P =0. 000). Conclusion: The combined MM dislocation,osteophyte formation,combined ACL injury and JSN type are the factors influencing chronic MCL injury in KOA patients,in which the combined MM dislocation,osteophyte formation and combined ACL injury are the risk factors for chronic MCL injury;while lateral TF JSN and PF JSN are the protective factors for chronic MCL injury compared to medial TF JSN in KOA patients.