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前交叉韧带断裂股骨髁间窝形态学变化与半月板损伤的研究
王成
2016-11-25
导师敖英芳
专业运动医学
授予单位北京大学
授予地点北京大学第三临床医学院
学位博士
关键词前交叉韧带 断裂 病程时长 髁间窝 半月板 损伤率 缝合率
其他题名Association of time to anterior cruciate ligament reconstruction with morphological changes of femoral intercondylar notch and occurrence of meniscal tears
分类号R873
摘要

目的:探讨前交叉韧带(Anterior Cruciate Ligament,ACL)断裂后随着病程延长股骨髁间窝的形态学变化,以及断裂病程时长对于半月板损伤与手术缝合的影响。

方法:收集2014年7月--2015年6月间的膝关节镜手术患者,根据ACL是否断裂及ACL断裂病程时长,分为未断对照组(Non-Injured,NI)、初伤对照组(Acute Rupture,AR,<3月)、陈旧断裂一组(Chronic Rupture 1,CR1,3-12月)、陈旧断裂二组(Chronic Rupture 2,CR2,1-5年)、陈旧断裂三组(Chronic Rupture 3,CR3,>5年)共计五组。记录患者的性别、年龄、体重、身高、体重指数(BMI)、关节松弛度评分(Beighton评分)和ACL断裂病程时长,及半月板损伤情况和处理方式。术前在膝关节核磁片上测量股骨髁宽度(FCW)和髁间窝宽度(ICW),术中使用关节镜下专门的测量尺测量股骨髁间窝底部、中部和顶部的宽度(ICWb、ICWm、ICWt)和髁间窝高度(ICH)。计算髁间窝宽度指数(NWI)和髁间窝形态指数(NSI),分析各组之间髁间窝形态变化是否存在显著性差异,重点关注ACL断裂病程时长对髁间窝形态改变的影响,以及断裂病程时长因素对于半月板损伤及其手术缝合的影响。

结果:共计272例患者入选研究,其中未断对照组(NI)89例、初伤对照组(AR)84例、陈旧断裂一组(CR1)51例、二组(CR2)30例、三组(CR3)18例。统计学分析显示ICW、ICWb、ICH、NWI和NSI,未断对照组和初伤对照组之间具有显著统计学差异(P<0.05);ICWb、ICWt和NWI,初伤对照组、陈旧断裂一组、二组与陈旧断裂三组之间有显著统计学差异(P<0.05)。断裂病程时长对外侧半月板损伤无显著影响(P>0.05),但对内侧半月板损伤则有显著性差异;内侧半月板损伤率初伤对照组、陈旧断裂一组与陈旧断裂二组、三组之间有显著统计学差异(P=0.000),内侧半月板缝合率初伤对照组与陈旧断裂一组、二组、三组之间有显著统计学差异(P=0.000)。性别、年龄、BMI、Beighton评分等因素对内、外侧半月板损伤均无显著性影响(P>0.05)。

结论:ACL断裂患者较ACL完好患者的髁间窝先天狭窄,ACL断裂后随病程延长,髁间窝逐渐出现增生变狭窄,5年以上者会出现显著的继发性髁间窝狭窄变形。ACL断裂病程时长对内侧半月板损伤率和缝合率有显著影响,3月以上内侧半月板损伤的缝合率显著降低,1年以上内侧半月板损伤率显著增加。

英文摘要

Purpose: The primary purpose was to arthroscopically evaluate the morphological changes of femoral intercondylar notch after ACL rupture. The secondary purpose was to verify the correlation of time to ACL reconstruction with the occurrence of meniscal tears.

Methods: Demographic data for patients with or without ACL injury between July 2014 and June 2015 were recorded including age, gender, height, weight, BMI, Beighton Score, time to ACL reconstruction, and occurrence of meniscal tears. According to time to ACL reconstruction, these patients were divided into five groups, Non-Injured (NI), Acute Rupture (AR, <3 months), Chronic Rupture 1 (CR1, 3-12 months), Chronic Rupture 2 (CR2, 1-5 years) and Chronic Rupture 3 (CR3, >5 years). We measured intercondylar notch dimensions using MRI and arthroscopy. MRI measurements of femoral condylar width (FCW) and intercondylar width (ICW) were undertaken before the surgery. The widths at the base, dle and top intercondylar notch (ICWb, ICWm, ICWt) and intercondylar notch height (ICH) were measured during arthroscopic surgery. Then intercondylar notch width index (NWI) and notch shape index (NSI) were calculated. Statistical analysis was performed to estimate the changes of intercondylar notch morphology with time to ACL recontruction. The analysis was also focused on association between the occurrence of meniscal tears and independent variables of sex, age, BMI, Beighton Score and time to ACL recontruction.

Results: A total of 272 patients were allocated to Group NI (n = 89), AR (n = 84), CR1 (n = 51), CR2 (n = 30) or CR3 (n = 18). Statistical analysis showed significant differences in ICW, ICWb, ICH, NWI and NSI between Group NI and AR, in ICWb, ICWt and NWI among Group AR, CR1, CR2 and CR3. Significant differences were found between the occurrence of medial meniscal tears and time to ACL recontruction, but no significant difference was found for lateral meniscus. There were no significant differences between the occurrence of meniscal tears and independent variables of sex, age, BMI and Beighton Score.

Conclusions: The most important finding of the present study was that notch width was narrower in patients with ACL injury, and would develop more significant stenosis with prolongation of course over 5 years. Secondly, there was the close association between the injury rate and repair rate of medial meniscus and time to ACL recontruction. Thus, ACL reconstruction within 3 months of injury can significantly reduce the risk of medial meniscal tears and increase the repair rate of medial meniscus.

语种中文
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文献类型学位论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/124738
专题北京大学第三临床医学院
作者单位北京大学第三临床医学院
推荐引用方式
GB/T 7714
王成. 前交叉韧带断裂股骨髁间窝形态学变化与半月板损伤的研究[D]. 北京大学第三临床医学院. 北京大学,2016.
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