关节退变情况及其与膝关节疼痛的相关性研究

Arthroscopic features of knee degeneration and its relationship with knee pain

摘要:

目的 探讨中老年膝关节疼痛患者膝关节内的病变特点及其临床意义。方法 2012年1月至2012年12月间年龄＞40岁患者膝关节镜检查证实具有Ⅳ度软骨退变性损伤的病例纳入前瞻性序贯研究，剔除重度滑膜炎需做滑膜切除的病例；术前记录性别、年龄、侧别、体质量指数（BMI）和Lysholm评分；术中记录Ⅳ度软骨退变性损伤累及的关节面部位，是否存在内外侧半月板退变性损伤、是否存在游离体、是否存在陈旧性前后交叉韧带断裂。对全部数据进行统计学分析，P＜0.05为差异有统计学意义。结果 共161例纳入研究，男31例，女130例；年龄（62.98±7.93）岁，BMI（26.39±3.41）kg/m2，术前Lysholm评分（45.34±15.65）分。关节间室至少一侧关节面有Ⅳ度软骨退变性损伤：髌股间室88.8%、内侧间室57.8%、外侧间室24.8%；内侧半月板退变性损伤70.8%；外侧半月板退变性损伤25.5%；关节游离体47.8%；陈旧性前交叉韧带断裂3.7%；陈旧性后交叉韧带断裂0.6%。术前Lysholm评分与性别（P＝0.006）、年龄（P＝0.040）、股骨内髁Ⅳ度软骨退变性损伤（P＝0.032）统计学相关；BMI与内侧半月板退变性损伤（P＝0.002，r＝0.246）、股骨内髁Ⅳ度软骨退变性损伤（P＝0.004，r＝0.223）存在统计学相关性。结论 在与退变有关的膝关节疼痛病例中，髌股间室软骨退变性损伤是较多见的病变，陈旧性前后交叉韧带断裂是较少见的病变。除了软骨退变性损伤之外，内侧半月板退变性损伤可能是疼痛显著的另一重要因素。女性、年龄较高者和股骨内髁发生Ⅳ度软骨退变性损伤者术前评分较低，症状更显著。BMI较高者内侧半月板和股骨内髁Ⅳ度软骨退变性损伤发生率较高。

Abstract:

Objective To investigate the pathological features and their clinical significances in knee joints of middle-aged and elderly patients with knee pain. Methods A prospective sequential study was carried out on over-40-year-old patients undergoing arthroscopy due to knee pain in our department from January to December 2012. All cases were identified to be suffering from cartilage lesion (grade Ⅳ) by arthroscopy. Those with severe synovitis and needing synovectomy were excluded. Gender, age, affected side, body mass index (BMI) and Lysholm scores were recorded preoperatively. The joint surfaces where cartilage lesion (grade Ⅳ) existed on, medial/lateral meniscus tears, loose bodies, and anterior cruciate ligament (ACL) and/or posterior cruciate ligament (PCL) rupture were noted intraoperatively. All above items were statistically analyzed; and there was statistical significance when P＜0.05. Results There were 161 cases enrolled in the cohort. There were 31 males and 130 females (80.7%), with an age of (62.98±7.93) years, BMI of (26.39±3.41)kg/m2, and preoperative Lysholm scores of (45.34±15.65). For articular surface with grade Ⅳ cartilage degenerative lesion, patellofemoral compartment accounted for 88.8%, medial compartment for 57.8%, and lateral compartment for 24.8%. In the cohort, there were 70.8% patients suffering from medial meniscus tear, and 25.5% having lateral tear. In addition, the percentage of loose bodies, old ACL rupture and old PCL rupture were 47.8%, 3.7%, and 0.6%, respectively. Statistical analysis indicated that gender (P＝0.006), age (P＝0.040) and cartilage lesions (grade Ⅳ) on medial femoral condyle (MFC) (P＝0.032) were correlated with preoperative Lysholm scores. Medial meniscus tear (P＝0.002, r＝0.246) and grade Ⅳ cartilage lesion on medial femoral condyle (MFC) (P＝0.004, r＝0.223) had positive correlation with BMI. Conclusion In this cohort of knee pain patients with degenerative changes, cartilage lesion on patellofemoral compartment is the most common, while, old ACL/PCL ruptures are the least. Besides the cartilage degenerative lesion, the medial meniscus tear is probably one of the key factors that aggravate knee pain. Female, older-aged and suffering from grade Ⅳ cartilage lesion on MFC usually have lower preoperative Lysholm scores and more worse symptoms. The patients with higher BMI have high risk of medial meniscus tear and grade Ⅳ cartilage on MFC.