半月板撕裂和切除对前交叉韧带断裂力学稳定性的影响

doi:10.3877/cma.j.issn.1674-134X.2019.04.008

中华关节外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (04) : 432 -436. doi: 10.3877/cma.j.issn.1674-134X.2019.04.008

所属专题：文献；

临床论著

半月板撕裂和切除对前交叉韧带断裂力学稳定性的影响

李立国¹, 付红光², 周宇³^,^†(

), 李恩耀⁴, 原丹²

^1. 450000　郑州卫生健康职业学院健康工程研究所，郑州大学第五附属医院康复科
^2. 450000　郑州卫生健康职业学院健康工程研究所
^3. 450052　郑州市骨科医院关节科
^4. 450000　郑州大学第五附属医院康复科

收稿日期:2019-08-22 出版日期:2019-08-01
通信作者: 周宇
基金资助:
河南省骨干教师项目(2018GGJS297); 河南省中医药科学研究专项课题(2018ZY3023); 河南省职业教育教学改革研究项目(ZJC18051); 2020河南高校教育重点项目(20A360017)

Effects of meniscus tear and excision on mechanical stability of anterior cruciate ligament injury of knee joint

Liguo Li¹, Hongguang Fu², Yu Zhou³^,^†(), Enyao Li⁴, Dan Yuan²

^1. Zhengzhou Vocational College of Health and Health Institute of Health Engineering, The Fifth Affiliated Hospital of Zhengzhou University, Rehabilitation Department, Zhengzhou 450000, China
^2. Zhengzhou Vocational College of Health and Health Institute of Health Engineering, Zhengzhou 450000, China
^3. Zhengzhou Orthopedics Hospital Osteoarticular Surgery, Zhengzhou 450052, China
^4. The Fifth Affiliated Hospital of Zhengzhou University Rehabilitation Department, Zhengzhou 450000, China

Received:2019-08-22 Published:2019-08-01
Corresponding author: Yu Zhou
About author:
Corresponding author: Zhou Yu, Email: zhouyu7601802@126.com

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引用本文：

李立国, 付红光, 周宇, 李恩耀, 原丹. 半月板撕裂和切除对前交叉韧带断裂力学稳定性的影响[J/OL]. 中华关节外科杂志(电子版), 2019, 13(04): 432-436.

Liguo Li, Hongguang Fu, Yu Zhou, Enyao Li, Dan Yuan. Effects of meniscus tear and excision on mechanical stability of anterior cruciate ligament injury of knee joint[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2019, 13(04): 432-436.

目的

探讨半月板对前交叉韧带断裂及重建术后胫骨前向稳定性的影响。

方法

收集2017年1月至2018年10月期间前交叉韧带重建患者，排除前交叉韧带部分断裂和多发韧带损伤病例。所有不稳定半月板撕裂均行半月板部分切除术，根据半月板损伤部位及程度进行分组。采用KT-1000测量术前、术后3个月和6个月的胫骨前平移量(ATT)。组间对照采用独立样本t检验。

结果

共纳入158例前交叉韧带断裂患者，其中半月板正常组61例，内侧半月板后角撕裂组49例(19例为撕脱<总宽度40%；30例为撕脱≥总宽度40%)；外侧半月板撕裂组35例(12例为撕脱<总宽度40%；23例为撕脱≥总宽度40%)；内侧半月板前角或体部撕裂组13例(6例为撕脱<总宽度40%；7例为撕脱≥总宽度40%)。术前内侧半月板后角撕裂≥总宽度40%患者的胫骨前平移量较半月板正常患者明显增加，差异有统计学意义(t＝12.141，P<0.01)。术后3个月及6个月，各个半月板撕裂组的ATT值与半月板正常患者相比均无差异(P >0.05)。

结论

内侧半月板后角撕裂与前交叉韧带断裂可增加膝关节的不稳定性，半月板部分切除术对前交叉韧带重建术后患者的膝关节稳定性无影响。

关键词: 半月板，胫骨, 前交叉韧带, 关节镜检查, 膝关节, 生物力学

Objective

To investigate the effect of meniscus on the stability of knee joint after anterior cruciate ligament rupture and reconstruction.

Methods

From January 2017 to October 2018, patients undergone anterior cruciate ligament reconstruction were included in the research prospectively. Partial anterior cruciate ligament rupture and multiple ligaments injury cases were excluded. Unstable meniscus tears diagnosed by arthroscopy were recorded and treated with partial meniscus resection. All the cases were divided into several groups according to the position and degree of the injury meniscus. KT-1000 test was used to quantify the anterior translation of the tibia (ATT) before surgery and at three and six months postoperatively. Independent t test was used to compare quantitative data between groups.

Results

A total of 158 patients with anterior cruciate ligament reconstruction were included in the research in which including 61 patients with a normal meniscus, 49 patients with a posterior horn of the medial meniscus (PHMM) tear (19 cases of avulsion <total width 40%; 30 cases of avulsion ≥total width 40%), 35 patients with lateral meniscus tear (12 cases of avulsion <total width 40%; 23 cases of avulsion ≥total width 40%) and medial meniscus tear (six cases of avulsion <total width 40% ; seven cases of avulsion≥total width 40%). Only the ATT of PHMM avulsion (>40% of the total width) group was significantly different from those of patients with normal meniscus (t=12.141; P<0.01). At the time of three and six months after surgery, there was no significant difference in KT-1000 test between the patients with meniscus tear and those with normal meniscus (P>0.05).

Conclusion

Tear of posterior horn of medial meniscus and rupture of anterior cruciate ligament can increase the instability of knee joint, and partial meniscectomy has no effect on the stability of knee joint after anterior cruciate ligament reconstruction.

Key words: Meniscus, tibial, Anterior cruciate ligament, Arthroscopy, Knee joint, Biomechanics

图1 应用关节镜下刻度探针测量半月板损伤跨度，示该患者半月板撕裂宽度为75%

表1 各组患者术前KT-1000测量ATT值(±s)

分组	例数	ATT(mm)	t值^*	P值^*
半月板完整	61	4.8±2.5	?	?
PHMM<40%	19	5.4±2.2	1.123	>0.05
PHMM≥40%	30	7.1±2.8	12.141	<0.01
LM<40%	12	5.7±2.5	1.572	>0.05
LM≥40%	23	5.9±2.2	1.834	>0.05
M <40%	6	5.4±2.2	1.118	>0.05
MM≥ 40%	7	5.8±2.2	1.237	>0.05

表1 各组患者术前KT-1000测量ATT值(±s)

分组	例数	ATT(mm)	t值^*	P值^*
半月板完整	61	4.8±2.5	?	?
PHMM<40%	19	5.4±2.2	1.123	>0.05
PHMM≥40%	30	7.1±2.8	12.141	<0.01
LM<40%	12	5.7±2.5	1.572	>0.05
LM≥40%	23	5.9±2.2	1.834	>0.05
M <40%	6	5.4±2.2	1.118	>0.05
MM≥ 40%	7	5.8±2.2	1.237	>0.05

表2 部分半月板切除术对膝关节稳定性的影响(±s)

分组	例数	ATT(mm)术后3个月	t值^*	P值^*	分组	例数	ATT(mm)术后6个月	t值^*	P值^*
半月板完整	61	2.31±0.11	?	?	半月板完整	61	2.08±0.13	?	?
PHMM<40%	19	2.26±0.21	0.2452	>0.05	PHMM<40%	19	2.16±0.22	0.2763	>0.05
PHMM≥40%	30	2.65±0.21	0.9735	>0.05	PHMM≥40%	30	2.40±0.18	0.9733	>0.05
LM<40%	12	2.27±0.20	0.2267	>0.05	LM<40%	12	2.07±0.19	0.1972	>0.05
LM≥40%	23	2.27±0.25	0.1875	>0.05	LM≥40%	23	2.07±0.17	0.1433	>0.05
MM<40%	6	2.55±0.32	0.6036	>0.05	MM<40%	6	1.91±0.26	0.5756	>0.05
MM≥40%	7	2.07±0.17	0.6214	>0.05	MM≥40%	7	2.14±0.21	0.1532	>0.05

表2 部分半月板切除术对膝关节稳定性的影响(±s)

分组	例数	ATT(mm)术后3个月	t值^*	P值^*	分组	例数	ATT(mm)术后6个月	t值^*	P值^*
半月板完整	61	2.31±0.11	?	?	半月板完整	61	2.08±0.13	?	?
PHMM<40%	19	2.26±0.21	0.2452	>0.05	PHMM<40%	19	2.16±0.22	0.2763	>0.05
PHMM≥40%	30	2.65±0.21	0.9735	>0.05	PHMM≥40%	30	2.40±0.18	0.9733	>0.05
LM<40%	12	2.27±0.20	0.2267	>0.05	LM<40%	12	2.07±0.19	0.1972	>0.05
LM≥40%	23	2.27±0.25	0.1875	>0.05	LM≥40%	23	2.07±0.17	0.1433	>0.05
MM<40%	6	2.55±0.32	0.6036	>0.05	MM<40%	6	1.91±0.26	0.5756	>0.05
MM≥40%	7	2.07±0.17	0.6214	>0.05	MM≥40%	7	2.14±0.21	0.1532	>0.05

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