内侧半月板后根撕裂加速内翻型膝关节炎软骨损伤独立因素分析

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摘要目的本研究同时考虑了膝内翻和内侧半月板后根撕裂(medial meniscus posterior root tears，MMPRT)两种因素对软骨损伤的影响，旨在明确MMPRT是否为内翻型膝关节炎(knee osteoarthritis，KOA)软骨损伤的独立危险因素。方法自2018年2月至2020年8月共纳入了82例内翻型KOA患者，根据镜下软骨损伤Outerbridge/ICRS分级分别分为中度、重度软骨损伤组。中度组45例，男12例，女33例；年龄53~67岁，平均年龄(60.62±6.18)岁。重度组47例，男11例，女36例；年龄55~67岁，平均年龄(61.51±5.09)岁。测量两组的内翻角度、膝关节损伤和骨关节炎评分(knee injury and osteoarthritis outcome score，KOOS)，并根据关节镜下探查结果明确其MMPRT分型，最终利用多因素线性回归寻找影响软骨损伤的独立因素。结果重度组的软骨损伤ICRS得分、膝内翻角度、MMPRT发生率和除了KOOS症状之外的其余项得分均显著高于中度组，但两组发生MMPRT的程度差异无统计学意义。多因素线性回归分析发现内翻角度、MMPRT发生率均为影响ICRS得分的独立因素。结论对于膝内翻角度≥5°KOA患者的软骨损伤而言，MMPRT是独立于膝内翻的危险因素，可直接促进软骨损伤。

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关键词 ：半月板后根, 内侧半月板后根撕裂, 软骨损伤, 膝内翻, 膝关节炎

Abstract：Objective To determine whether MMPRT is an independent factor for the cartilage damage in varus KOAby studyingthe influences of both the knee varus and medial meniscus posterior root tears(MMPRT) on the cartilage damage in knee osteoarthritis (KOA) patients.Methods From February 2018 to August 2020，a total of 92 subjects were enrolled.The KOA patients with knee varus were divided into the moderate and severe group according to the Outerbridge/ICRS classification.The moderate group contained 45 cases (12 males，33 females)，with an average age of (60.62±6.18)years old，and the sever group contained 47 cases (11 males，36 females)，with an average age of (61.51±5.09)years old.The varus angle was measured and Knee Injury and Osteoarthritis Outcome Score (KOOS) were performed respectively.MMPRT was confirmed under the arthroscopy.Multivariate linear regression was performedfor the cartilage damage. Results In the severe group，the ICRS score，the knee varus angle，the MMPRT incidence，and the KOOS items except for the KOOS-symptomwere significantly higher than those of the moderate group，but there was no difference in the MMPRT grade between the two groups.Multiple linear regression analysis found that the varus angle and the MMPRT incidence were independent factors of ICRS score.Conclusion In KOA patients with knee varus more than 5°，MMPRT is an independent risk factor that promotes the cartilage damage.

Key words： meniscus posterior root tears medial meniscus posterior root tears cartilage damage knee varus knee osteoarthritis

基金资助:江苏青年医学人才基金(QNRC2016411)

通讯作者: 刘巍，龚熹

作者简介: 逸弘(1984－ )，男，主治医师，南通市第一人民医院骨科，226000。

引用本文:

逸弘 1，2，朱新辉 1，范建波 1，刘巍 1*，龚熹 2*. 内侧半月板后根撕裂加速内翻型膝关节炎软骨损伤独立因素分析[J]. 实用骨科杂志, 2021, 27(4): 310-319.
Yi Hong 1，2，Zhu Xinhui 1，Fan Jianbo 1，et al. The Medial Meniscus Posterior Root Tears is an Independent Risk Factor of Cartilage Damagein Varus Knee Osteoarthritis. sygkzz, 2021, 27(4): 310-319.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2021/V27/I4/310

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