摘要
目的分析前十字韧带 (anterior cruciate ligament， ACL)断裂继发膝关节软骨损伤的原因及规律 ,探讨早期重建 ACL的意义。方法应用膝关节镜观察继发的膝关节软骨损伤的病理改变、发生部位、损害程度，并对损伤发生率、发生时间、损伤程度与 ACL损伤后病程的关系以及股骨髁软骨损伤与半月板损伤的关系等进行统计学分析与对比研究。结果 ACL陈旧性断裂合并软骨损伤发生率 (75％ )明显高于急性损伤组 (26％ )，差异有非常显著性意义 (P< 0.01)；软骨损伤的病理改变不同，但以股骨髁软骨“垄沟”状病损为特征性改变；病程在 1年以内者软骨损伤发生率为 60％， 1年以上者为 79.6％；病程 1年以上者软骨重度损伤发生率 (44.9％ )明显高于 1年以内者 (4.76％ )，差异有非常显著性意义 (P< 0.01)；有股骨髁软骨损伤的 43例 (67.2％ )，其中伴有半月板损伤者 55.8％，无半月板损伤者 44.2％。结论 ACL断裂后膝关节软骨损伤发生率明显增高；软骨损伤程度随病程延长而加重；关节软骨损伤以股骨髁软骨负重区受累最重，但与半月板损伤无明显关系，主要因 ACL断裂后膝关节不稳所致。 ACL断裂后应尽早手术重建，恢复膝关节稳定性，改善功能，预防和中止对软骨的损害。
Objective To study the reasons, patterns of the injury and methods of early reconstruction of the articular cartilage injuries associated with the rupture of anterior cruciate ligament(ACL). Methods The pathologic change, location, degree of articular cartilage lesion were observed in 64 old ACL ruptures and 23 fresh ones by arthroscopy. The relationship between the incidence， duration of the injury, degree of cartilage injury and ACL ruptures, the correlation between the cartilage injury of femoral condyles and meniscus injury were studied. Results The incidence of articular cartilage injury in old ACL rupture group(75％ ) was significantly higher than that in fresh group(26％ )(P< 0.01),the various injured pathologic changes of cartilage injuries were seen in knee joint, the furrow type injury of femoral condyle was the characteristic lesion in ACL rupture. The incidence of articular cartilage injury in the group that the ACL rupture was more than 1 year was 79.6％ , in the group less than one year was 60％ . Serious injury incidence(44.9％ ) in more than one year group was significantly higher than that in less than one year group(4.76％ )(P< 0.01). Incidence of articular cartilage injury of femoral condyle was 67.2％ . Meniscus injury occurred in 55.8％ and normal meniscus in 44.2％ .Conclusion The incidence of articular cartilage injury following ACL rupture was significantly raised. The longer the duration of ACL rupture, the more serious the cartilage injury was. There was no statistically significant correlation between the cartilage injury of the femoral condyle and meniscus injury. Clinical investigated results indicated that articular cartilage injuries in the ACL deficient knee were mainly resulted from instability and the ACL should be reconstructed as soon as possible to restore the stability and improve the function of knee joint, as well as to prevent the cartilage damage.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2001年第5期290-293,共4页
Chinese Journal of Orthopaedics
