膝关节内侧滑膜皱襞和半月板后角损伤的相关性

doi:10.3877/cma.j.issn.1674-134X.2022.05.016

目的

探讨内侧半月板后角损伤的相关因素，为早期预防及诊疗提供依据。

方法

回顾性研究2018年4月至2021年12月期间，在福建省立医院治疗的半月板损伤患者共226例。根据内侧半月板后角有无损伤分为病例组(内侧半月板后角损伤)73例和对照组(半月板其他部位损伤)153例。收集患者性别、年龄、患侧、身体质量指数(BMI)、膝内侧滑膜皱襞(MPP)、胫骨平台后倾角(PTS)、膝内翻、内侧半月板外凸情况等基本资料。使用SPSS 22.0统计软件完成统计学分析，将单因素分析有统计学意义的因素纳入到二分类logistic回归分析内侧半月板后角的独立危险因素。

结果

单因素分析显示，两组间胫骨平台后倾(χ²＝37.062)、膝内翻(χ²＝30.652)、MPP(χ²＝6.355)、内侧半月板外凸(χ²＝6.962)差异有统计学意义(均为P<0.05)；二分类logistic回归分析显示MPP与内侧半月板后角损伤存在明显相关性[比值比(OR)＝18.560，P＝0.006]。

结论

MPP是导致其内侧半月板后角撕裂的独立危险因素。

关键词: 滑膜, 胫骨半月板损伤, 膝损伤, 危险因素

Objective

To investigate the related factors of medial meniscus posterior horn injury, so as to provide evidence for early prevention, diagnosis and treatment.

Methods

A total of 226 patients with meniscus injury treated in the Fujian Provincial Hospital from April 2018 to December 2018 were retrospectively studied. According to the presence or absence of medial meniscus posterior horn injury, the patients were divided into case group (73 cases) and control group (153 cases). Basic data such as gender, age, affected side, body mass index (BMI), medial synovial plica (MPP), posterior angle of tibial plateau (PTS), genu varus and meniscus protrusion were collected. SPSS 22.0 statistical software was used to complete statistical analysis, and the factors with statistical significance in univariate analysis were included in binary logistic regression analysis to analyze the independent risk factors of the posterior horn of medial meniscus.

Results

Univariate analysis showed that the posterior inclination of tibial plateau(χ²=37.062), genu varus(χ²=30.652), MPP(χ²=6.355), and meniscus protrusion (χ²=6.962)were statistically significant differences between the two groups (all P<0.05); binary logistic regression analysis showed that MPP was significantly correlated with posterior horn injury of medial meniscus[odds ratio(OR)=18.560, P=0.006].

Conclusion

MPP is an independent risk factor for medial meniscus posterior horn tear.

Key words: Synovial membrane, Tibial meniscus injuries, Knee injuries, Risk factors

图1 膝关节侧位X线片测量胫骨平台后倾注：于膝关节侧位片做通过胫骨干长轴线的垂线，再做胫骨平台的切线，两线夹角为胫骨平后倾角PTS，PTS大于13°为胫骨平台后倾

图2 双下肢全长X线片测量膝内翻注：于下肢全长片做髋关节中心和踝关节中心的连线为下肢力线，膝关节中心位于力线外侧距离2 mm以上称膝内翻

图3 膝关节MRI冠状位测量内侧半月板外凸注：于膝关节MRI冠状位胫骨棘最大面积层，分别做内侧半月板外缘切线和内侧胫骨平台外缘切线，两切线相互平行且垂直于水平面，两线距离大于3 mm称内侧半月板外凸

图4 膝关节镜探查情况。图A为A型皱襞，示膝关节腔侧壁小而薄的索条状突起；图B为B型皱襞，示"棚架"样凸起，但外侧缘并未包盖在股骨内侧髁的前软骨面；图C为C型皱襞，示"棚架"样凸起，部分或完整地覆盖在股骨内侧髁前方的软骨面；图D为D型皱襞，示在C型基础上，皱襞中央缺如；图E为合并股骨髁损伤，示股股髁表面软骨剥脱；图F为半月板后角撕裂

表1 膝内侧半月板后角损伤的单因素分析

组别	例数	年龄[岁，(±s)]	性别[例(男/女)]	BMI[kg/m²，(±s)]	患侧[例(左/右)]
病例组	73	56.3±17.0	30/43	24.1±2.9	41/32
对照组	153	55.5±13.7	61/92	23.7±3.8	77/76
统计值		t＝0.116	χ²＝0.031	t ＝0.266	χ²＝0.675
P值		>0.05	>0.05	>0.05	>0.05
组别	例数	内侧滑膜皱襞[例(有/无)]	胫骨平台后倾[例(有/无)]	膝内翻[例(有/无)]	内侧半月板外凸[例(有/无)]
病例组	73	25/48	33/40	41/32	20/53
对照组	153	29/124	15/138	30/123	20/133
χ²值		6.355	37.062	30.652	6.962
P值		0.012	<0.001	<0.001	0.008

表1 膝内侧半月板后角损伤的单因素分析

组别	例数	年龄[岁，(±s)]	性别[例(男/女)]	BMI[kg/m²，(±s)]	患侧[例(左/右)]
病例组	73	56.3±17.0	30/43	24.1±2.9	41/32
对照组	153	55.5±13.7	61/92	23.7±3.8	77/76
统计值		t＝0.116	χ²＝0.031	t ＝0.266	χ²＝0.675
P值		>0.05	>0.05	>0.05	>0.05
组别	例数	内侧滑膜皱襞[例(有/无)]	胫骨平台后倾[例(有/无)]	膝内翻[例(有/无)]	内侧半月板外凸[例(有/无)]
病例组	73	25/48	33/40	41/32	20/53
对照组	153	29/124	15/138	30/123	20/133
χ²值		6.355	37.062	30.652	6.962
P值		0.012	<0.001	<0.001	0.008

表2 膝内侧半月板后角损伤的多因素logistic分析

变量	B值	标准误差	Wald的χ²值	P值	OR	OR的95%CI
MPP	2.91	1.066	7.504	0.006	18.560	(2.296，150.041)
膝内翻	－4.119	1.050	15.398	<0.001	0.016	(0.002，0.127)
常量	1.346	0.198	46.037	<0.001	3.844	－

表2 膝内侧半月板后角损伤的多因素logistic分析

变量	B值	标准误差	Wald的χ²值	P值	OR	OR的95%CI
MPP	2.91	1.066	7.504	0.006	18.560	(2.296，150.041)
膝内翻	－4.119	1.050	15.398	<0.001	0.016	(0.002，0.127)
常量	1.346	0.198	46.037	<0.001	3.844	－

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Relationship between medial patellar plica and posterior meniscal angle injury of knee

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Relationship between medial patellar plica and posterior meniscal angle injury of knee