内侧半月板外突与半月板损伤及膝内翻的相关性研究

摘要

目的：探讨内侧半月板外突与半月板损伤部位、类型及膝内翻的相关性。方法2014年3月至2015年3月接受关节镜检查及手术的内侧半月板损伤患者97例，男40例，女57例；年龄32~66岁，平均（51.2±10.71）岁。于膝关节冠状面MRI上测量半月板外突≥3 mm者38例，无半月板外突者59例。在X线片上测量股胫角，＜182°记录为膝内翻。在关节镜下观察半月板撕裂类型（纵裂、水平裂、斜裂、横裂、复杂裂）、撕裂部位（前角撕裂、体部撕裂、后角撕裂、根部撕裂）。比较内侧半月板外突组和无内侧半月板外突组半月板不同撕裂类型和部位的发生率，采用多因素非条件Logistic回归分析方法筛选半月板外突的危险因素。结果内侧半月板外突组与无内侧半月板外突组的患者年龄（t=-1.511，P=0.135）、性别（χ2=0.208，P=0.648）、体重指数（t=0.249，P=0.650）及侧别（χ2=0.052，P=0.820）的差异均无统计学意义。膝内翻患者半月板外突的发生率为89%（25/28），半月板根部撕裂患者半月板外突的发生率为78%（18/23）。内侧半月板外突组与无内侧半月板外突组根部撕裂（χ2=19.329，P=0.000）、复杂裂（χ2=5.111，P=0.024）、膝内翻（χ2=41.481，P=0.000）发生率的差异有统计学意义；而半月板前角撕裂（χ2=0.044，P=1.000）、体部撕裂（χ2=0.261，P=0.661）、后角撕裂（χ2=3.722，P=0.086）、纵裂（χ2=0.054，P=0.816）、水平裂（χ2=0.317，P=0.790）、斜裂（χ2=0.198，P=0.819）、横裂（χ2=1.188，P=0.385）发生率的差异均无统计学意义。多因素回归分析结果显示膝内翻的OR值为101.976，95%CI（15.973，651.041），P=0.000；根部撕裂的OR值为35.517，95%CI（6.804，185.399），P=0.000；复杂裂的OR值为0.949，95%CI（0.211，4.267），P=0.945。结论膝内翻和内侧半月板根部撕裂是造成内侧半月板外突的主要危险因素。%Objective To investigate the correlation of medial meniscus extrusion with meniscus injury location, type and genu varum. Methods From March 2014 to March 2015, a total of 97 patients with injury of medial meniscus undergoing ar⁃throscopy and surgery were selected as subjects, including 40 males and 57 females, aged 32-66 years, with a mean age of 51.2± 10.71 years. Based on the MRI of knee, there were 38 cases with medial meniscus extrusion≥3 mm (extrusion group) and 59 cases without medial meniscus extrusion (non⁃extrusion group). Genu varus was measured on X⁃ray (Femur⁃Tibia⁃Angle<182°). The me⁃dial meniscus tear type was observed under arthroscopy (longitudinal tear, horizontal tear, oblique tear, radial tear, complex tear), as well as the meniscus tear location (anterior tear, body tear, posterior tear, root tear). The age, gender, BMI and involved side were compared between two groups. Multifactor unconditioned Logistic regression analysis was employed to analyze risk factors of medial meniscus extrusion. Results Two groups of patient showed no statistically significant difference in age (t=-1.511, P=0.135), gender (χ2=0.208, P=0.648), BMI (t=0.249, P=0.650) and side (χ2=0.052, P=0.820). The incidence of meniscus extru⁃sion in patients with genu varum was 89% (25/28), and the incidence of meniscus extrusion in patients with meniscus root tear was 78% (18/23). Significant difference could be spotted in the analysis of meniscal root tear (χ2=19.329, P=0.000), complex tear (χ2=5.111, P=0.024), genu varus (χ2=41.481, P=0.000) between patients with medial meniscus extrusion or without medial meniscus extrusion. Meanwhile, meniscus anterior tear (χ2=0.044, P=1.000), body tear (χ2=0.261, P=0.661), posterior tear (χ2=3.722, P=0.086), longitudinal tear (χ2=0.054, P=0.816), horizontal tear (χ2=0.317, P=0.790), oblique tear (χ2=0.198, P=0.819), radial tear (χ2=1.188, P=0.385) no statistical significance. By multifactor analysis, OR values of genu varus and root tear were 101.976 (95%CI:15.973, 651.041, P=0.000) and 35.517 (95%CI:6.804, 185.399, P=0.000), respectively. Conclusion Menis⁃cal root tear and genu varum were risk factors of medial meniscus extrusion.