急性前十字韧带撕裂位置对骨挫伤面积的影响

目的探讨急性前十字韧带损伤患者MRI上韧带撕裂位置对矢状面上骨挫伤最大面积的影响。方法对2019年1至6月收治的前十字韧带损伤患者的MRI进行回顾性分析,根据前十字韧带撕裂在其远端到近端全长上的位置分为五型:Ⅰ型,>90%;Ⅱ型,75%~90%;Ⅲ型,25%~75%;Ⅳ型,10%~25%;Ⅴ型,<10%。比较五型患者的性别、体重、体质指数、股骨外侧髁切迹凹陷深度、内外侧半月板有无损伤。选取ePDWSPIRCLEAR序列矢状面图像,分别截取股骨、胫骨骨挫伤面积最大的层面。使用Image J 1.52t软件测量挫伤面积最大层面的最大骨挫伤面积。结果63例急性前十字韧带损伤中,Ⅰ型撕裂3例(4.8%)、Ⅱ型撕裂14例(22.2%)、Ⅲ型撕裂40例(63.5%)、Ⅳ型撕裂2例(3.2%)、Ⅴ型撕裂4例(6.3%)。其中Ⅰ型和Ⅳ型未发现股骨外侧髁及外侧胫骨平台骨挫伤。股骨外侧髁骨挫伤面积Ⅱ型为0(0,64.12)mm^2、Ⅲ型为182.34(86.58,334.38)mm^2、Ⅴ型为38.64(0,193.36)mm^2,差异有统计学意义(H=21.665,P=0.000);外侧胫骨平台骨挫伤最大面积Ⅱ型为76.78(28.25,205.57)mm^2、Ⅲ型为120.93(51.78,239.37)mm^2、Ⅴ型为190.51(80.86,238.75)mm^2,差异有统计学意义(H=11.939,P=0.018)。内侧半月板损伤发生率分别为66.6%(2/3)、35.7%(5/14)、37.5%(15/40)、100%(2/2)、25%(1/4),差异无统计学意义(χ^2=4.413,P=0.353);外侧半月板损伤发生率分别为33.3%(1/3)、35.7%(5/14)、77.5%(31/40)、50%(1/2)、25%(1/4),差异有统计学意义(χ^2=11.481,P=0.022)。内侧半月板损伤组外侧胫骨平台最大骨挫伤面积为48.0(0,105.97)mm^2,小于未损伤组的185.67(54.36,257.41)mm^2,差异有统计学意义(H=8.848,P=0.003);外侧半月板损伤组股骨外侧髁最大骨挫伤面积为162.19(63.03,301.33)mm^2,大于未损伤组的0(0,103.37)mm^2,差异有统计学意义(H=11.554,P=0.001)。结论前十字韧带断裂最常发生在中段,合并外侧半月板损伤的概率最大,股骨外侧髁骨挫伤面积大;发生在最远端的断裂导致外侧胫骨平台骨挫伤的面积最大,合并内侧半月板损伤的概率最低。

The effects of the location of acute anterior cruciate ligament rupture on areas of bone bruises

Objective To investigate the relationship between the location of anterior cruciate ligament rupture(ACL)and the areas of bone bruises in patients with an acute ACL injury.Methods A retrospective study was conducted on MRI of patients with ACL injuries from January to June 2019.According to the location of the ACL rupture on the distal to proximal length,the patients were divided into 5 groups,namely Type I,>90%;Type II,75%-90%;Type III,25%-75%;Type IV,10%-25%,Type V,<10%.Gender,weight,body mass index,depth of lateral femoral condyle notch,and medial meniscus injury were compared among the five groups.The sagittal plane images of ePDWSPIRCLEAR sequence were selected to define the layer with the largest contusion areas of femur and tibia respectively.The maximum bone contusion areas of these two layers was measured using Image J 1.52t software.Results Among the 63 cases of acute ACL injury,three cases(4.8%)were with type I tear,14 cases(22.2%)with type II tear,40 cases(63.5%)with type III tear,2 cases(3.2%)with type IV tear,and 4 cases(6.3%)with Type V tear.There was no contusion of lateral femoral condyle or lateral tibial plateau bone in type I and type IV.The lateral femoral condyle bone contusion areas was 0(0,64.12)mm^2 in type II,182.34(86.58,334.38)mm^2 in Type III,38.64(0,193.36)mm^2 in Type V with statistically significant difference(H=21.665,P=0.000).The largest areas of bone contusion in the lateral tibial plateau was 76.78(28.25,205.57)mm^2 in type II,120.93(51.78,239.37)mm^2 in Type III,190.51(80.86,238.75)mm^2 in Type V with statistically significant difference(H=11.939,P=0.018).The maximum bone contused areas of the lateral tibial plateau in the medial meniscus injury group was 48.0(0,105.97)mm^2,which was smaller than that in the non-injury group 185.67(54.36,257.41)mm^2(H=8.848,P=0.003).The maximum bone contusion areas of the lateral femoral condyle in the injured group was 162.19(63.03,301.33)mm^2,which was greater than 0(0,103.37)mm^2 in the uninjured group(H=11.554,P=0.001).Conclusion ACL rupture often occurs in the middle segment.The middle segment ACL fracture combined with lateral meniscus injury had with the highest probability and with the largest area of bone contusion of lateral femoral condyle.The fracture of the ACL at the farthest terminal has the largest bone contusion areas of the lateral tibial plateau and with the lowest probability of combined injury of the medial meniscus.