非接触性急性前交叉韧带撕裂骨挫伤分布特点及与其他关节伴随损伤的相关性分析

The Analysis on the Distribution Characteristics of Bone Bruise in Acute Noncontact Anterior Cruciate Ligament Tears and Association with Other Concomitant Articular Injuries

目的:探讨非接触性急性前交叉韧带(ACL)撕裂者的骨挫伤分布特点,并分析骨挫伤部位与内外侧半月板(MM、LM)、内外侧副韧带(MCL、LCL)及关节软骨损伤的相关性。方法:回顾性分析201例经临床证实为非接触性ACL撕裂患者的MRI资料。201例病例均行常规MRI斜矢状位T1WI、T2WI,冠状位和横断位PDWI序列扫描。对所有患者损伤部位进行分类统计,并采用独立卡方检验对其进行统计分析。结果:在201例病例中,发现骨挫伤172例(85.6%),其中单纯内侧间室骨挫伤6例(3.0%),单纯外侧间室骨挫伤50例(24.9%),联合间室骨挫伤116例(57.7%),29例(14.4%)未见骨挫伤。无骨挫伤组、单纯外侧间室骨挫伤组、联合间室骨挫伤组并伴发LM损伤发生率、MCL损伤发生率和关节软骨发生率逐步提升(20.7%、44.0%、53.4%,P=0.006;10.3%、24.0%、37.9%,P=0.008;0、12.0%、23.3%,P=0.006)。对伴发MCL损伤:无骨挫伤组与联合间室骨挫伤组间发生率有显著差异(P=0.005),单纯外侧间室骨挫伤组与无骨挫伤组、联合间室骨挫伤组间无明显差异(P=0.136、0.082);对伴发LM损伤:联合间室骨挫伤者和单纯外侧间室骨挫伤者其发生率较无骨挫伤者均有显著差异(P=0.002、0.037),联合间室骨挫伤组和单纯外侧间室骨挫伤组间无明显差异(P=0.264);对伴发关节软骨损伤:无骨挫伤组与联合间室骨挫伤组间有显著差异(P=0.004),单纯外侧间室骨挫伤组和联合间室骨挫伤组间及无骨挫伤组间均无明显差异(P=0.095、0.052)。结论:非接触性急性ACL撕裂后骨挫伤常见,骨挫伤分布部位与伴发LM损伤、MCL损伤及关节软骨损伤具有一定的相关性,随着骨挫伤范围的扩大,LM、MCL和关节软骨损伤的发生率逐步增高。联合间室骨挫伤者和单纯外侧间室骨挫伤者较无骨挫伤者更易于伴发LM损伤,联合间室骨挫伤者较无骨挫伤者更易于伴发MCL损伤和关节软骨损伤。

Purpose: To evaluate the distribution characteristics of bone bruise in acute noncontact anterior cruciate ligament tears and its association with injuries of the medial meniscus(MM), lateral meniscus(LM), medial collateral ligament(MCL), lateral collateral ligament(LCL), and articular cartilage of knee joint.Methods: The MRI data of 201 patients with clinically proved acute noncontact ACL tears were retrospectively analyzed. Routine MR scanning was performed in oblique sagittal planes with T1WI, T2WI sequence, and coronal and axial planes with fatsaturated PDWI sequence. Bone bruise sites and other types of concomitant injuries was recorded in all patients, and independent chi-square test was used for statistical analysis.Results: Bone bruises were observed in 172(85.6%) of201 patients. The prevalence of bone bruises was 3.0%(6 cases), 24.9%(50 cases), and 57.7%(116 cases) on the isolated medial compartment, isolated lateral compartment, and both the medial and lateral compartments of the knee(combined compartments), respectively. Twenty-nine cases(14.4%) were with no bone bruises. The prevalence of LM, MCL, and articular cartilage injuries increased as the bone contusion progressed from being absent, to involving only the lateral compartment, and finally to combined compartments(20.7%, 44.0%, 53.4%, P=0.006;10.3%,24.0%, 37.9%, P=0.008;0, 12.0%, 23.3%, P=0.006). Compared with the subgroup of absent bone bruise, the subgroups of combined compartments bruises and the isolated lateral compartment bruises showed significantly higher prevalence rate of LM injury(P=0.002, 0.037). There was no significant difference in the incidence of LM injury between the subgroups of combined compartments bruises and the isolated lateral compartment bruises(P=0.264). Compared with the subgroup of absent bone bruise, the subgroup of combined compartments bruises showed significantly higher prevalence rates of MCL injury and articular cartilage injury(P=0.005, 0.004). There was no significant difference in the incidences of MCL injury and articular cartilage injury between the subgroups of combined compartments bruises and the isolated lateral compartment bruises, and the subgroups of the isolated lateral compartment bruises and absent bone bruise(P>0.05). Conclusion: The bone bruises are common sequelae after acute noncontact ACL rupture. Distribution of bone bruise is correlated with LM injury, MCL injury and articular cartilage injury. With the expansion of bone bruise, the incidence rates of LM, MCL and articular cartilage injury increase gradually. ACL rupture with bone bruises in the combined compartments or the isolated lateral compartment predispose to LM injury. ACL rupture with bone bruises in the combined compartments predispose to MCL injury and articular cartilage injury.