多间室和内侧单间室严重骨关节炎内侧半月板突出及后根撕裂的特点分析

Characteristics of Medial Meniscus Extrusion and Posterior Root Tear of Patients with Severe Multicompartment or Medial Unicompartmental Osteoarthritis

目的:探究多间室和内侧单间室严重骨关节炎(OA)患者内侧半月板突出(MME)及内侧半月板后根撕裂(MMPRT)的特点。方法:回顾性分析2020年6月至2021年11月我科收治的117例终末期OA患者的基线资料、X线和磁共振(MRI)图像,其中多间室严重OA患者60例67膝(M-OA组),均行全膝关节置换;内侧单间室严重OA患者57例68膝(mU-OA组),均行内侧单髁置换。在MRI上测量患膝MME程度,判定是否存在MMPRT,并在X线片上测量髋膝踝角(HKA)、胫骨近端内侧角(MPTA)、机械轴股骨远端外侧角(mLDFA)、胫股关节线夹角(JLCA),在MRI上测量内侧胫骨平台后倾角(mPTS)。对基线资料、病理性MME和MMPRT发生率、MME程度、HKA、MPTA、mLDFA、JLCA和m PTS进行统计学分析。结果:两组患者年龄、体质指数(BMI)和患膝侧别等无显著性差异(P>0.05),M-OA组患者女性比例高于mU-OA组(78.33%vs 56.14%,P<0.05)。M-OA组病理性MME发生率高于m U-OA组(79.1%vs52.94%,P<0.01),且MME程度显著大于mU-OA组(4.72±1.88 mm vs 3.24±1.25 mm,P<0.01)。MOA组HKA和JLCA显著大于mU-OA组(分别为10.7°±4.5°vs 7.5°±2.3°,P<0.01;-4.3°±1.8°vs-2.1°±0.9°,P<0.05)。两组间MMPRT发生率、MPTA、mLDFA和m PTS无差异(P>0.05)。结论:多间室严重骨关节炎患者的内侧半月板突出程度和病理性内侧半月板突出发生率较高,女性比例高、髋膝踝角和胫股关节线夹角的角度大可能是其原因。

Objective To explore the characteristics of medial meniscus extrusion(MME)and medial meniscus posterior root tear(MMPRT)of patients with severe multicompartment or medial unicompart⁃mental osteoarthritis(OA).Methods The baseline data,X-ray and magnetic resonance images(MRI)of 117 patients with end-stage OA and admitted to our department between June 2020 and November 2021 were retrospectively analyzed.Among them,60 patients(67 knees)with severe multicompartment OA(Group M-OA)underwent total knee arthroplasty,and 57 patients(68 knees)with severe medial unicompartmental osteoarthritis(Group mU-OA)received medial unicompartmental knee arthroplasty.MME was measured and the presence of MMPRT was determined on MRI.Moreover,the hip-knee-ankle angle(HKA),medial proximal tibial angle(MPTA),mechanical lateral distal femoral angle(mLD⁃FA),and joint line convergence angle(JLCA)were measured on X-ray images,while the medial pos⁃terior tibial slope(mPTS)was detected on MRI.Baseline data,the incidence of pathological MME and MMPRT,the degree of MME and the degree of HKA,MPTA,mLDFA,JLCA and mPTS were ana⁃lyzed statistically.Results There were no significant differences in the age,body mass index and knee side between the M-OA and mU-OA groups(P>0.05),and the proportion of female patients in M-OA group was higher than that in Group mU-OA(78.33%vs 56.14%,P<0.05).The incidence of pathologi⁃cal MME and the degree of MME of Group M-OA were significantly higher than Group mU-OA(79.1%vs 52.94%,P<0.01;4.72±1.88 mm vs 3.24±1.25 mm,P<0.01).Moreover,the angle of HKA and JLCA in Group M-OA was significantly higher than Group mU-OA(10.7°±4.5°vs 7.5°±2.3°,P<0.01 and-4.3°±1.8°vs-2.1°±0.9°,P<0.05).However,no significant differences were found in the average MMPRT incidence,MPTA,mLDFA and mPTS between the two groups(P>0.05).Conclusion The incidence of MME and pathological MME were higher among patients with severe mul⁃ticompartment osteoarthritis,which may be due to higher proportion of females,greater HKA and JL⁃CA values.