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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2021, Vol. 07 ›› Issue (02) : 73 -78. doi: 10.3877/cma.j.issn.2096-0263.2021.02.002

所属专题： 文献；

骨与创伤

前交叉韧带损伤形式与胫骨平台后侧骨损伤的相关性分析
劳子胤1, 张炳耀2, 冯青2,†()   
  1. 1. 067000　承德医学院研究生学院
    2. 061000　沧州市人民医院骨四科
  • 收稿日期:2020-04-14 出版日期:2021-04-05
  • 通信作者: 冯青
  • 基金资助:
    河北省科技计划项目(162777235)

Correlation analysis between anterior cruciate ligament injury and posterior tibial plateau injury

Ziyin Lao1, Bingyao Zhang2, Qing Feng2,†()   

  1. 1. The Graduate School of Chengde Medical University, Chengde 067000, China
    2. The Fourth Department of Orthopedics, Cangzhou people's hospital, Cangzhou 061000, China
  • Received:2020-04-14 Published:2021-04-05
  • Corresponding author: Qing Feng
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劳子胤, 张炳耀, 冯青. 前交叉韧带损伤形式与胫骨平台后侧骨损伤的相关性分析[J/OL]. 中华老年骨科与康复电子杂志, 2021, 07(02): 73-78.

Ziyin Lao, Bingyao Zhang, Qing Feng. Correlation analysis between anterior cruciate ligament injury and posterior tibial plateau injury[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(02): 73-78.

目的

分析前交叉韧带（ACL）损伤、断裂及撕脱骨折与胫骨平台（TP）后侧骨损伤的关系。

方法

回顾性检索沧州市人民医院2017年6月至2019年3月收治的膝关节MRI表现为ACL损伤、断裂及撕脱骨折的患者219例，平均年龄（41±14）岁，男性122例（55.71%），女性97例（44.29%），分析所有患者的膝关节MRI影像学资料，记录胫骨平台后侧骨损伤情况与ACL损伤情况。本研究胫骨平台后侧骨损伤分为三种形式，分别为无损伤、骨挫伤与骨折。ACL损伤情况分为三种，分别为ACL损伤组、断裂组及撕脱骨折组。最终入选病例ACL损伤组147例，ACL断裂组48例，ACL撕脱骨折组24例。比较三组患者的胫骨平台后侧骨损伤发生情况，分析患者ACL损伤与胫骨平台后侧骨损伤之间的关系。

结果

219例ACL损伤患者中，131例出现胫骨平台后侧骨挫伤或（和）胫骨平台后侧骨折，其中后侧骨折33例（25.2%），后侧骨挫伤98例（74.8%）。胫骨平台后侧骨损伤发生率由高至低依次为ACL撕脱骨折组（91.6%），ACL断裂组（85.4%）和ACL损伤组（46.2%）。ACL损伤程度与胫骨平台后侧骨损伤等级之间存在线性趋势（χ2=0.433，P<0.05）。

结论

随着ACL损伤程度的加重，胫骨平台后侧骨损伤发生的概率增大，诊治该类患者应行术前MRI和CT检查，避免漏诊漏治。

关键词: 前交叉韧带损伤, 胫骨, 相关性分析
Objective

To analyse the relationship between the anterior cruciate ligament (injury, rupture, and avulsion fracture) and the posterior bone injury of the tibial plateau.

Methods

A retrospective search of 219 patients with ACL injuries, ruptures, and avulsion fractures on knee MRI were admitted to our hospital from June 2017 to March 2019, with an average age of (41±14) years, 122 males (55.71%), females in 97 cases (44.29%), the knee MRI imaging data of all patients were analyzed, and the posterior tibial plateau bone injury and ACL injury were recorded. In this study, there are three types of bone injury on the posterior of the tibial plateau: normal, bone contusion and fracture. ACL injuries are divided into three group, namely ACL injury group, fracture group and avulsion fracture group. Finally, 147 cases were in the ACL injury group, 48 cases were in the ACL rupture group, and 24 cases were in the ACL avulsion fracture group. The occurrence of bone injury on the posterior tibial plateau of the three groups was compared, and the relationship between the ACL injury and the posterior tibial plateau bone injury of patients was analyzed.

Results

Among the 219 ACL injuries, 131 had posterior tibial plateau bone injury, of which 33 (25.2%) were fractures and 98 (74.8%) were posterior bone contusions. The incidence of bone injury on the posterior side of the tibial plateau was followed by ACL avulsion fracture group (91.6%), ACL rupture group (85.4%) and ACL injury group (46.2%). There is a linear trend between the degree of ACL damage and the grade of bone damage on the posterior side of the tibial plateau (χ2=0.433, P<0.05).

Conclusions

With the severity of ACL injury, the probability of bone injury on the posterior side of the tibial plateau increases. Preoperative MRI and CT examinations should be performed to diagnose and treat such patients to avoid missed diagnosis and treatment.

Key words: Anterior cruciate ligament injuries, Tibial, Correlation analysis
表1 三种前交叉韧带损伤患者的一般资料比较
组别 年龄（岁，±s） BMI（kg/cm2，±s） 性别（例，男/女） 侧别（例，左/右） 是否吸烟（例，是/否） 是否饮酒（例，是/否）
ACL断裂组 40±13 23.1±2.2 27/21 18/30 26/22 30/18
ACL损伤组 41±14 23.3±2.0 82/65 56/91 78/69 86/61
ACL撕脱骨折组 43±15 23.1±2.5 13/11 11/13 13/11 14/10
F/χ2值 0.317 0.333 0.167 0.565 0.024 0.251
P值 0.729 0.717 0.92 0.754 0.998 0.882
图8~9 典型病例2，女，39岁，前交叉韧带断裂合并胫骨平台后侧骨挫伤，MRI影响可见ACL异常信号影，连续性中断胫骨平台外后方可见片状异常信号，在矢状位PD-SPAIR上呈高信号
表2 ACL损伤不同情况下胫后平台后侧骨损伤情况[例（%）]
ACL损伤情况 胫骨平台损伤情况
无骨折及骨挫伤 后侧骨挫伤 后侧骨折
损伤 79（53.74%） 57（38.78%） 11（7.48）
断裂 7（14.53%） 27（56.25%） 14（29.17%）
撕脱骨折 2（8.33%） 14（58.33%） 8（33.33%）
χ2值 0.433
P值 <0.01
1
丁明，徐虎，王迎春,等.前交叉韧带断裂并发膝关节软骨损伤的影响因素[J].中华创伤杂志, 2015, 31(6): 512-516.
2
Mandalia V, Henson JH. Traumatic bone bruising--a review article [J]. Eur J Radiol, 2008, 67(1): 54-61.
3
袁帅，丁喆如，吴宇黎,等.膝关节镜下前交叉韧带重建术后冰敷对患者早期康复效果的影响[J].中华老年骨科与康复电子杂志, 2019, 5(4):190-195.
4
张洪涛，朱鹤飞，梅继文,等.关节镜治疗老年膝关节骨关节炎合并腘窝囊肿的疗效分析[J].中华老年骨科与康复电子杂志, 2018, 4(01):33-37.
5
Sahoo K, Garg A, Saha P, et al. Study of imaging pattern in bone marrow oedema in MRI in recent knee injuries and its correlation with type of knee injury [J]. J Clin Diagn Res, 2016, 10(4): TC06-TC11.
6
迪力夏提·多力坤，郑龙坡.顺势复位治疗胫骨平台骨折的临床研究[J].中华老年骨科与康复电子杂志, 2018, 4(03):163-167.
7
Uhorchak JM, Scoville CR, Williams GN, et al. Risk factors associated with noncontact injury of the anterior cruciate ligament: a prospective four-year evaluation of 859 West Point cadets [J]. Am J Sports Med, 2003, 31(6): 831-842.
8
路世勇，李光磊，王宝鹏.前交叉韧带股骨止点的临床解剖学研究进展[J].中华创伤杂志, 2010, 26(9): 861-864.
9
Song GY, Zhang H, Wang QQ, et al. Bone contusions after acute noncontact anterior cruciate ligament injury are associated with knee joint laxity, concomitant meniscal lesions, and anterolateral ligament abnormality [J]. Arthroscopy, 2016, 32(11): 2331-2341.
10
毛玉江，张伯松，公茂琪,等. 200例胫骨平台骨折的骨折形态及损伤机制分析[J].中华创伤骨科杂志, 2016, 18(1): 47-51.
11
Thomas AC, Palmieri-Smith RM, Mclean SG. Isolated hip and ankle fatigue are unlikely risk factors for anterior cruciate ligament injury [J]. Scand J Med Sci Sports, 2011, 21(3): 359-368.
12
Zhang L, Hacke JD, Garrett WE, et al. Bone bruises associated with anterior cruciate ligament injury as indicators of injury mechanism: a systematic review [J]. Sports Med, 2019, 49(3): 453-462.
13
Berger N, Andreisek G, Karer AT, et al. Association between traumatic bone marrow abnormalities of the knee, the trauma mechanism and associated soft-tissue knee injuries [J]. Eur Radiol, 2017, 27(1): 393-403.
14
Kaeding CC. Léger-St-Jean B, magnussen RA. Epidemiology and diagnosis of anterior cruciate ligament injuries [J]. Clin Sports Med, 2017, 36(1): 1-8.
15
王成林，王海丽，康巍,等.前交叉韧带断裂的MRI征象研究[J].中华创伤杂志, 2010, 26(3): 261-264.
16
程相允，张升校，路雁惠,等.胫骨平台前外侧撕脱骨折合并ACL损伤的诊治[J].中华关节外科杂志:电子版, 2018 (04): 534-538.
17
Pedersen DR, El-Khoury GY, Thedens DR, et al. Bone contusion progression from traumatic knee injury: association of rate of contusion resolution with injury severity [J]. Open Access J Sports Med, 2017, 8: 9-15.
18
Panjwani T, Mok YR, Wong KL, et al. The presence of concomitant intra-articular injuries and bone bruise does not affect pre-operative knee pain and symptoms in patients undergoing anterior cruciate ligament Reconstruction [J]. Knee Surgery Sports Traumatology Arthroscopy, 2019, 27(3): 893-897.
19
Shaikh H, Herbst E, Rahnemai-Azar AA, et al. The segond fracture is an avulsion of the anterolateral complex [J]. Am J Sports Med, 2017, 45(10): 2247-2252.
20
Brown CN, Yu B, Kirkendall DT, et al. Effects of increased body mass index on lower extremity motion patterns in a stop-jump task: National Athletic Trainers Association annual meeting [J]. J Athl Train, 2005, 40(2): S32.
21
王锴，董雪，林剑浩.影响膝关节骨关节炎患者生活质量预后因素的队列研究[J].中华骨科杂志, 2019, 39(18): 1149-1156.
22
Ulusoy GR, Kızılgöz V, Sivrioğlu AK. Relationship between Body Mass Index and Articular Injuries Accompanying Primary Anterior Cruciate Ligament Tear in Male Knees: A Retrospective Observational Study [J]. J Knee Surg, 2020, 33(11): 1157-1162.
23
Stephen YC. An ease and effective method for reattaching an anterior cruciate ligament avulsion fracture from the tibial eminence. Arthroscopy, 2004, 20:96-100.
24
Arneja SS, Furey MJ, Alvarez CM, et al. Segond fractures:notnecessarily pathognemonic of anterior cruciate ligament injury in the pediatric population [J]. Sports Health, 2010, 2(5): 437-439.
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