前交叉韧带断裂后半月板和软骨损伤的临床研究

Clinical study on meniscal and cartilage injuries following rupture of anterior cruciate ligament

目的 研究前交叉韧带 (ACL)断裂所致的膝关节不稳对关节半月板及软骨的影响。方法 回顾分析 1992～ 2 0 0 2年间收治的 4 8例ACL断裂患者半月板和软骨损伤的分布、程度、发生率与伤后不同时段的关系。 结果 半月板损伤率从急性期组→亚慢性期组→慢性期组分别为6例 (5 5 % ,6 11)、13例 (6 8% ,13 19)、17例 (94 % ,17 18) ,差异具有显著性意义 (P <0 .0 5 ) ;各组中内侧半月板损伤率明显高于外侧半月板 ;慢性期组内侧半月板后角损伤 10例 (5 6 % ,10 18) ,是该期半月板损伤的主要类型 ;亚慢性期、慢性期组内髁软骨损伤率明显高于外髁 ;随病程延长软骨损伤程度加重 ,至慢性期组 ,Ⅲ度软骨损伤达 32处 (6 8% ,32 4 7) ;内髁软骨损伤与内侧半月板并内髁软骨损伤发病率差异无显著性意义 ,而外髁软骨损伤与外侧半月板并外髁软骨损伤发病率差异具有显著性意义 (P <0 .0 5 )。 结论 ACL断裂后可并发半月板及软骨损害 ,并随病程延长而加重 ,ACL损伤后胫骨向前半脱位和过度内旋是造成内髁软骨损伤的主要原因 ,而外髁软骨损伤主要是由于外侧半月板损伤所致。

Objective To investigate the influence of knee joint instability induced by the rupture of anterior cruciate ligament (ACL) on the meniscus and cartilage. Methods Forty-eight consecutive patients with rupture of ACL from 1998 to 2002 were retrospectively studied upon the relationship of distribution, severity and incidence of meniscal tears and cartilage injuries with different period of time post injury. Results The incidence of meniscal injury was increased from six cases (55%, 6/11) in acute period, 13 (68%, 13/19) in subchronic period to 17 (94%, 17/18) in chronic period with a significant difference (P<0.05). The incidence of medial menisci tear was significantly higher than that of lateral meniscal tear in each group. Peripheral posterior horn tears of the medial meniscus occurred in 10 cases (56%, 10/18) were the main types of tear by a statistically significant amount in chronic period. The incidence of cartilage injuries was much higher in medial condyle than that in lateral condyle in chronic and sub-chronic groups. The extent of cartilage damage also became worse with time and the incidence of type Ⅲ even reached 68% (32/47) in chronic group. There was no significant difference between incidence of medial condylar cartilage injury and medial meniscal tear. However, there was significant difference between incidence of lateral condylar cartilage injury and that of lateral meniscal injury complicated by lateral condylar cartilage injury (P<0.05). Conclusions The cartilage and meniscal injuries can be induced by the rupture of ACL and go worse with the prolongation of history. Prorsad semiluxation and over internal rotation after ACL rupture may mainly contribute to the medial condylar cartilage injury, while the lateral condylar cartilage injury is mainly due to lateral meniscal tear.