内侧半月板不同部位突出危险因素的MRI 评价

目的:探讨应用MRI 评价内侧半月板突出的危险因素、分析多部位突出的原因及半月板突出程度与胫股内侧关节退变 程度的相关性。方法:本研究纳入2019 年2 月—2020 年3 月因膝关节内侧间室慢性疼痛来我院就诊行患侧膝关节MRI 检查 的成年患者387例，对照组104 名。分别记录内侧半月板前角、体部、后角突出的距离。比较内侧半月板前角、体部、后角突出组 与对照组间内侧半月板前角、体部、后角、后角根部和前交叉韧带损伤程度的差别。比较单纯内侧半月板体部突出组、体部伴前 角突出组和体部伴后角突出组间上述结构的损伤程度的差别。应用Spearman相关分析评价半月板突出距离与股骨内髁和胫骨 内侧平台关节软骨软化程度的关系。结果:内侧半月板前角、体部、后角突出组分别与对照组在内侧半月板前角、体部、后角、后 角根部和前交叉韧带损伤程度的比较差异有统计学意义（Z=-4.517、-5.793、-3.676、-3.174、-3.346， 均P<0.01；Z=-3.162、- 9.966、-6.923、-6.318、-4.479，均P<0.01；Z=-2.870、-6.522、-7.196、-3.021、-0.866、P=0.004、0.000、0.000、0.003、0.386）。内侧半 月板突出组半月板前角、体部、后角、后角根部及前交叉韧带的损伤程度总体上较对照组严重。单纯内侧半月板体部突出组、体 部伴前角突出组和体部伴后角突出组间上述结构的损伤程度差异有统计学意义（F=5.053、6.642、21.172、2.991、1.609，P=0.007、 0.002、0.000、0.052、0.202）。内侧半月板体部伴前角突出者半月板前角、体部的损伤程度较单纯体部突出者为重，而体部伴后角 突出者半月板体部、后角的损伤程度较单纯体部突出为重。内侧半月板突出与股骨内髁和胫骨内侧平台关节软骨软化程度 呈正相关（r=0.526、0.581；均P=0.000）。结论:内侧半月板及前交叉韧带损伤为内侧半月板突出的危险因素。内侧半月板突出者 多为体部突出，并可随前角、后角的损伤加重同时伴有前角和后角突出。内侧半月板突出程度越重，胫股内侧间室关节软骨软 化的程度越重。

Evaluation on risk factors of medial meniscus extrusion in different portions using MRI

Objective:To explore the risk factors of medial meniscus extrusion evaluated by MRI，analyze the causes of multiple sites of meniscus extrusion and the correlation between the degree of meniscus extrusion and the degree of medial tibiofemoral joint degeneration. Methods: A total of 387 adult patients with chronic pain in the medial compartment of the knee joint who underwent MRI examination on the affected side of the knee joint from February 2019 to March 2020 were included，and 104 patients in the control group. The extrusion distances of the anterior horn，body and posterior horn of the medial meniscus were recorded respectively. The injury degrees of anterior horn，body，posterior horn，root of posterior horn and anterior cruciate ligament of medial meniscus were compared between the extrusion group of anterior horns，bodies，and posterior horns and the control group. The damage degrees of the above structures were compared among the simple medial meniscus body extrusion group，the body and anterior horn extrusion group and the body and posterior horn extrusion group. Spearman correlation analysis was used to evaluate the relationship between the distance of meniscus extrusion and the degree of chondromalacia of the medial femoral condyle and medial tibial platform. Results: Comparison of injury degree of anterior horn， body part，posterior horn，root of posterior horn and anterior cruciate ligament of medial meniscus between the extrusion group of anterior horns，bodies，and posterior horns and the control group，the differences were significan（t Z=-4.517，-5.793，-3.676，-3.174，-3.346，all P<0.01； Z=-3.162，-9.966，-6.923，-6.318，-4.479，all P<0.01；Z=-2.870，-6.522，-7.196，-3.021，-0.866，P=0.004，0.000，0.000，0.003，0.386）. The injury degree of anterior horn，body，posterior horn，root of posterior horn and anterior cruciate ligament in the medial meniscus extrusion group were more serious than those in the control group. The damage degree of the above structures among simple medial meniscus body extrusion group，body and anterior horn extrusion group and body and posterior angle extrusion group were compared and the differences were significant （F=5.053，6.642，21.172，2.991，1.609，P=0.007，0.002，0.000，0.052，0.202）.The injury degree of the anterior horn and body of medial meniscus in the body and anterior horn extrusion group were more severe than those in the simple body extrusion group，while the injury degree of the body and posterior horn of medial meniscus in the body and posterior horn extrusion group were more severe those that in the simple body extrusion group. The extrusion of medial meniscus was positively correlated with the degree of chondromalacia of the medial femoral condyle and medial tibial platform（r=0.526，0.581；both P=0.000）. Conclusion:The injury of medial meniscus and anterior cruciate ligament are the risk factors of medial meniscus extrusion. Most of the patients with medial meniscus extrusion are extruding of the body，and can be accompanied by protruding anterior and posterior horns with the aggravation of the injury of the anterior and posterior horns. The more serious the extruding degree of the medial meniscus is，the more severe the chondromalacia of the medial tibiofemoral compartment is.