单纯后交叉韧带断裂继发关节内损伤的临床研究

自 1 973年至 2 0 0 2年间我所诊治单纯后交叉韧带断裂共 5 4例 ,其中进行了关节内探查的有 40例 ,急性伤 9例 (≤ 6周 ) ,慢性伤 3 1例 ( >6周 )。分别对这 40例病例的关节软骨损伤发生率、损伤部位和损伤程度及半月板损伤的发生率、损伤部位及损伤类型进行了统计学研究 ,同时对前、后交叉韧带断裂之间和运动员与非运动员之间的继发关节内损伤进行了统计学比较 ,对创伤机制也进行了相应的研究。结果显示 ,后交叉韧带断裂最常见创伤机制为胫前伤 ( 5 1 85 % )。非运动员中摩托车伤最多见 ( 2 3 5 3 % )。伤后慢性期软骨损伤发生率明显高于急性期 (P <0 0 5 )。前、后交叉韧带断裂后急性期与慢性期之间及运动员与非运动员之间软骨损伤发生率无明显差异。后交叉韧带断裂后软骨损伤最易发生于髌股关节 (P <0 0 1 ) ,其次为股骨内髁负重区 ,与前交叉韧带断裂更易发生于内、外髁相比 ,明显不同。非运动员软骨损伤程度要重于运动员 (P <0 0 5 )。后交叉韧带断裂后急慢性期半月板损伤发生率相近。慢性期外侧半月板损伤居多 (P <0 0 1 )。运动员更易发生半月板损伤 (P <0 0 1 )。后交叉韧带断裂后内外侧半月板损伤均少于前交叉韧带 ,慢性期尤甚 (P <0 0 0 1 )。后交叉韧带断裂后半月板损伤的部位以外侧

Clinical Study on Intraarticular Injuries Associated with Isolated Posterior Cruciate Ligament Rupture

A total of 54 patients with isolated PCL rupture were treated in our institute from 1973 to 2002. 40 of the 54 had experienced exploration of knee joints including 9 acute (less then 6 weeks) and 31 chronic patients (more than 6 weeks). The incidence, mechanics, location, degree and type of articular cartilage and meniscus injury were statistically analyzed. We compared acute and chronic intraarticular injuries secondary to ACL and PCL rupture in athlete and non-athlete manner. The result showed that the most common mechanics of PCL rupture was pretibial trauma (51.85%) and motorcyclist ranked the highest incidence in non-athletes (23.53%). The incidence of cartilage injury was higher in chronic patients than in acute patients ( P <0.05). There was no difference between the incidence of cartilage injury in acute and chronic patients, as well as in athletic and non-athletic patients with PCL/ACL rupture. The cartilage injury associated with PCL rupture mainly occurred in patellofemoral joint ( P <0.01) followed by the weight bearing area of medial condyle. It apparently differed from the cartilage injury associated with ACL rupture that mainly occurred in medial and lateral condyle. Chondral injury was more serious in non-athletes than in athletes ( P <0.05). Athletes suffered more meniscus injuries than non-athlete ( P <0.01). Meniscal injuries associated with PCL rupture were less than ACL rupture ( P <0.001) especially in chronic patients, mainly in lateral meniscus. More anterior horn longitudinal tears of lateral meniscus happened in our study. Apparent correlation between meniscus and cartilage injury in the same compartment was not found. The result indicated that the intraarticular injuries associated with PCL rupture occurred more in cartilage and less in meniscus. Posterior instability and increase of contact pressure in patellofemoral joint and medial compartment were the main causes of injury. Osteoarthropathy of knee could be effectively avoided if earlier PCL reconstruction performed.