半月板撕裂和切除对前交叉韧带断裂力学稳定性的影响

目的探讨半月板对前交叉韧带断裂及重建术后胫骨前向稳定性的影响。 方法收集2017年1月至2018年10月期间前交叉韧带重建患者，排除前交叉韧带部分断裂和多发韧带损伤病例。所有不稳定半月板撕裂均行半月板部分切除术，根据半月板损伤部位及程度进行分组。采用KT-1000测量术前、术后3个月和6个月的胫骨前平移量(ATT)。组间对照采用独立样本t检验。 结果共纳入158例前交叉韧带断裂患者，其中半月板正常组61例，内侧半月板后角撕裂组49例(19例为撕脱<总宽度40%；30例为撕脱≥总宽度40%)；外侧半月板撕裂组35例(12例为撕脱<总宽度40%；23例为撕脱≥总宽度40%)；内侧半月板前角或体部撕裂组13例(6例为撕脱<总宽度40%；7例为撕脱≥总宽度40%)。术前内侧半月板后角撕裂≥总宽度40%患者的胫骨前平移量较半月板正常患者明显增加，差异有统计学意义(t＝12.141，P<0.01)。术后3个月及6个月，各个半月板撕裂组的ATT值与半月板正常患者相比均无差异(P >0.05)。 结论内侧半月板后角撕裂与前交叉韧带断裂可增加膝关节的不稳定性，半月板部分切除术对前交叉韧带重建术后患者的膝关节稳定性无影响。

Effects of meniscus tear and excision on mechanical stability of anterior cruciate ligament injury of knee joint

ObjectiveTo investigate the effect of meniscus on the stability of knee joint after anterior cruciate ligament rupture and reconstruction. MethodsFrom January 2017 to October 2018, patients undergone anterior cruciate ligament reconstruction were included in the research prospectively. Partial anterior cruciate ligament rupture and multiple ligaments injury cases were excluded. Unstable meniscus tears diagnosed by arthroscopy were recorded and treated with partial meniscus resection. All the cases were divided into several groups according to the position and degree of the injury meniscus. KT-1000 test was used to quantify the anterior translation of the tibia (ATT) before surgery and at three and six months postoperatively. Independent t test was used to compare quantitative data between groups. ResultsA total of 158 patients with anterior cruciate ligament reconstruction were included in the research in which including 61 patients with a normal meniscus, 49 patients with a posterior horn of the medial meniscus (PHMM) tear (19 cases of avulsion 40% of the total width) group was significantly different from those of patients with normal meniscus (t=12.141; P<0.01). At the time of three and six months after surgery, there was no significant difference in KT-1000 test between the patients with meniscus tear and those with normal meniscus (P>0.05). ConclusionTear of posterior horn of medial meniscus and rupture of anterior cruciate ligament can increase the instability of knee joint, and partial meniscectomy has no effect on the stability of knee joint after anterior cruciate ligament reconstruction.