青少年急性膝关节创伤性骨髓异常与创伤机制及软组织损伤的关系

Relationship between Traumatic Bone Marrow Abnormality and Trauma Mechanism and Soft Tissue Injury in Adolescents with Acute Knee Joint Injury

投稿时间：2017-10-20

DOI：

中文关键词:青少年膝关节创伤性骨髓异常创伤机制磁共振成像

英文关键词:knee joint traumatic bone marrow abnormality trauma mechanism magnetic resonance imaging

基金项目:国家自然科学基金(81401455)；上海市体育局2014年科技综合计划项目（14ZH002）

作者	单位	E-mail
刘玉	上海交通大学医学院附属第九人民医院	yliu9y@126.com
王燎	上海交通大学医学院附属第九人民医院
刘晓娜	滨州医学院烟台附属医院
周燕	滨州医学院烟台附属医院
高维青	上海交通大学医学院附属第九人民医院
曾勇	海南西部中心医院
李开成	上海交通大学医学院附属第九人民医院；海南西部中心医院	likaicheng128@163.com

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中文摘要:

目的：初步探讨青少年急性膝关节创伤性骨髓异常与创伤机制及软组织损伤的关系。方法：回顾性分析69例青少年急性膝关节损伤患者的临床及影像学资料。通过膝关节磁共振成像（MRI）评估创伤性骨髓异常的部位及前交叉韧带、后交叉韧带、内侧副韧带、外侧副韧带及内、外侧支持带等软组织的损伤，根据临床资料汇总创伤机制。结果：69例患者包括19例轴移损伤，17例髌骨外侧脱位，12例过伸伤，11例外翻损伤和10例仪表盘损伤。轴移损伤引起创伤性骨髓异常部位多位于股骨外侧髁后区（94.7%）、股骨外侧髁前区（84.2%）和胫骨外侧平台后区（78.9%），常伴有前交叉韧带撕裂（94.7%）。髌骨外侧脱位多位于髌骨（100%）、股骨外侧髁后区（100%）和股骨外侧髁前区（94.1%），常伴有内侧支持带撕裂（88.2%）。过伸伤主要累及胫骨内侧平台前区（83.3%）、胫骨外侧平台前区（75%）和股骨内侧髁前区（66.7%），常伴有前交叉韧带（91.7%）和后交叉韧带损伤（58.3%）。外翻损伤主要累及股骨，包括股骨外侧髁后区（72.7%），股骨外侧髁前区（54.5%）和股骨内侧髁前区（45.5%），常伴有内侧副韧带损伤（90.9%）。仪表盘损伤主要累及胫骨，包括胫骨外侧平台前区（100%）、胫骨内侧平台前区（90%），常伴有后交叉韧带损伤（70%）。结论：青少年急性膝关节创伤性骨髓异常在MRI上的分布代表了特定的创伤机制的足迹，并能够精准地预测特定的软组织损伤。

英文摘要:

Objective: To investigate the relationship between traumatic bone marrow abnormalities and the mechanism of trauma and soft tissue injury in adolescents with acute knee joint injury. Method: The clinical and imaging data of 69 adolescents with acute knee joint injuries were analyzed retrospectively. The position of traumatic bone marrow abnormalities, anterior and posterior cruciate ligaments, medial and lateral collateral ligaments, medial and lateral retinacula injuries of knee joint were evaluated by MRI. And the trauma mechanism was collected according to the clinical data. SPSS 13 chi-square test was used for statistical analysis, and P<0.05 was statistically different. Result: 69 patients, including 19 with pivot shift, 17 with lateral patellar dislocation, 12 with hyperextension, 11 with valgus injury and 10 with dashboard injury, were taken as the subjects. Traumatic bone marrow abnormality caused by pivot shift is mainly in the posterior parts of lateral femoral condyle（94.7%）, anterior parts of lateral femoral condyle（84.2%）and posterior parts of lateral tibial plateau（78.9%）, often accompanied by anterior cruciate ligament tears（94.7%）. Abnormality in lateral patellar dislocation is found in patella（100%）, posterior parts of lateral femoral condyle（100%）and anterior parts of the lateral femoral condyle (94.1%), often with medial retinacula injuries（88.2%）. Hyperextension injury includes anterior parts of medial tibial plateau（83.3%）, lateral tibial plateau（75%）and medial femoral condyle（66.7%）, often associated with anterior cruciate ligament（91.7%）and posterior cruciate ligament injuries（58.3%）. Valgus injury mainly links with femur, including posterior parts of lateral femoral condyle（72.7%）, anterior parts of lateral femoral condyle（54.5%）and anterior parts of medial femoral condyle（45.5%）, often accompanied by medial collateral ligament injuries（90.9%）. Dashboard injury mainly involves tibia, including anterior parts of lateral tibial plateau（100%） and medial tibial plateau（90%）, and often with posterior cruciate ligament injuries（70%）. Conclusion: The distribution of traumatic bone marrow abnormality on MRI in adolescents with acute knee joint injuries represents a footprint of specific traumatic mechanism and can be used to predict accurately the presence of specific soft tissue injuries.

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