CAJ | 학술논문

目的探讨膝关节骨关节炎患者内侧半月板突出的病因及影响.方法选取2011年1月至2012年3月诊断为膝关节退行性骨关节炎并经MRI确认有内侧半月板突出的60例患者为半月板突出组,无突出的60例为对照组.在MRI上测量内侧半月板突出距离、胫股角,分析突出组胫股角与突出距离的相关性,比较两组膝内翻、内侧半月板及胫股关节软骨损伤的发生率,分析内侧半月板突出对半月板损伤、膝内翻对半月板突出的影响.结果突出组:半月板突出距离平均(8.30±1.79) mm；60例有膝内翻,胫股角平均179.0°±2.2°；内侧半月板损伤发生率:前角50.0％ (30/60),体部93.3％ (56/60),后角93.3％ (56/60)；内侧半月板后角根部撕裂14例,发生率23.3％(14/60)；胫股内侧关节软骨退变发生率:胫骨内侧平台100％(60/60),股骨内髁100％(60/60)；胫股角与内侧半月板突出距离呈负相关.对照组:内侧半月板超出胫骨内侧平台边缘的距离平均(0.57±0.80) mm；4例膝内翻；内侧半月板损伤发生率:前角0,体部16.7％(10/60),后角70.0％ (42/60)；无内侧半月板后角根部撕裂；胫股内侧关节软骨退变发生率:胫骨内侧平台26.7％(16/60),股骨内髁30.0％ (18/60).半月板突出组与对照组半月板损伤比值比为6.0、膝内翻例数比值比为15.0.半月板突出组内侧半月板各部位及胫股内侧关节软骨损伤的发生率和严重程度高于对照组.结论膝内翻可能是内侧半月板突出的原因之一,内侧半月板突出显著增加半月板损伤的发生率,其对膝胫股内侧关节骨关节炎的发生、发展有重要影响.
목적 탐토슬관절골관절염환자내측반월판돌출적병인급영향.방법 선취2011년1월지2012년3월진단위슬관절퇴행성골관절염병경MRI학인유내측반월판돌출적60례환자위반월판돌출조,무돌출적60례위대조조.재MRI상측량내측반월판돌출거리、경고각,분석돌출조경고각여돌출거리적상관성,비교량조슬내번、내측반월판급경고관절연골손상적발생솔,분석내측반월판돌출대반월판손상、슬내번대반월판돌출적영향.결과 돌출조:반월판돌출거리평균(8.30±1.79) mm；60례유슬내번,경고각평균179.0°±2.2°；내측반월판손상발생솔:전각50.0％ (30/60),체부93.3％ (56/60),후각93.3％ (56/60)；내측반월판후각근부시렬14례,발생솔23.3％(14/60)；경고내측관절연골퇴변발생솔:경골내측평태100％(60/60),고골내과100％(60/60)；경고각여내측반월판돌출거리정부상관.대조조:내측반월판초출경골내측평태변연적거리평균(0.57±0.80) mm；4례슬내번；내측반월판손상발생솔:전각0,체부16.7％(10/60),후각70.0％ (42/60)；무내측반월판후각근부시렬；경고내측관절연골퇴변발생솔:경골내측평태26.7％(16/60),고골내과30.0％ (18/60).반월판돌출조여대조조반월판손상비치비위6.0、슬내번례수비치비위15.0.반월판돌출조내측반월판각부위급경고내측관절연골손상적발생솔화엄중정도고우대조조.결론 슬내번가능시내측반월판돌출적원인지일,내측반월판돌출현저증가반월판손상적발생솔,기대슬경고내측관절골관절염적발생、발전유중요영향.
Objective To investigate causes and effects of medial meniscus extrusion in patients with knee osteoarthritis.Methods A total of 120 patients diagnosed as knee osteoarthritis between January 2011 and March 2012 were enrolled in this study,including 60 patients with medial meniscal extrusion confirmed by MRI (extrusion group) and other 60 patients without medial meniscal extrusion (control group).The extrusion distance of medial meniscus and tibiofemoral angle were measured on MRI.The correlation between tibiofemoral angle and extrusion distance were analyzed.The incidences of genu varum,medial meniscus injury and cartilage lesion of medial tibiofemoral joint were compared between two groups.The effect of medial meniscal extrusion on meniscus injury and effect of genu varum on meniscal extrusion were analyzed.Results In extrusion group,the extrusion distances of medial menisci ranged from 3.76 to 11.6 mm (average,8.3±1.79 mm); all patients had genu varum,and the tibiofemoral angle ranged from 174°to 181°(average,179.0°±2.2°); the incidence of medial meniscus injury was 50.0％ (30/60) in the anterior horn,93.3％ (56/60) in the body,and 93.3％ (56/60) in the posterior horn; the incidence of medial meniscus tear in the root of the posterior horn was 23.3％ (14/60); the incidences of cartilage degeneration in medial tibial plateau and medial femoral condyle both were 100％ (60/60); a significant negative correlation was observed between dimension of tibiofemoral angle and extrusion distance of medial meniscus.In control group,the extrusion distances of medial menisci ranged from 0 to 2.61 mm (average,0.57±0.80 mm); four patients had genu varum,and the tibiofemoral angle in all patients was 180°; the incidence of medial meniscus injury was 0 in the anterior horn,16.7％ (10/60) in the body,and 70.0％ (42/60) in the posterior horn; no medial meniscus tear was found in the root of the posterior horn; the incidence of cartilage degeneration was 26.7％(16/60) in medial tibial plateau and 30.0％ (18/60) in medial femoral condyle.The odd ratio of meniscus injury and the number of genu varum (extrusion group/control group) was 6.0 and 15.0,respectively.Compared with the control group,the incidences and severities of medial meniscus injury and cartilage lesion of medial tibiofemoral joint were higher in extrusion group.Conclusion Genu varum may be one cause of medial meniscal extrusion.Medial meniscal extrusion increases incidence of medial meniscus injury and has a significant influence on generation and development of osteoarthritis in medial tibiofemoral joint.