  本期目录: 1. 前交叉韧带功能不全时后交叉韧带的倾斜角度更大 2. 开发和验证列线图，用于预测开放楔形胫骨高位截骨术后即刻发生深静脉血栓的风险 3. 髌骨下极骨折的形态学特征和新的分类:基于CT的研究 4. 预测外侧胫骨平台骨折后发生早期骨关节炎的因素：73 名接受手术治疗的患者的中期临床和放射学结果 5. 双髁胫骨平台骨折双钢板固定:与单侧入路相比，双髁胫骨平台骨折双入路固定的并发症发生率和临床结果相似，但影像学结果有所改善 6. 牛津单间室膝关节置换术胫骨部分的内翻置位可降低术后胫骨骨折的风险 7. 影像学骨性关节炎、骨髓病变、较高的体重指数和内侧半月板根撕裂与内侧半月板挤压合并骨性关节炎或内侧半月板撕裂显著相关:一项系统回顾和荟萃分析   前交叉韧带功能不全时后交叉韧带的倾斜角度更大 译者：冯斌 徐炜 目的：磁共振成像（MRI）是诊断前交叉韧带（ACL）损伤的金标准影像学检查。我们的假设是，使用核磁共振成像图像测量后交叉韧带倾斜角（PCLIA）可能是帮助识别前交叉韧带损伤的辅助工具。本研究的目的是比较前交叉韧带损伤者和非前交叉韧带损伤者核磁共振成像中 PCLIA 的测量结果。 方法：由两名放射科医生分别测量前交叉韧带完好患者（对照组）和前交叉韧带损伤患者（研究组）的65张膝关节MRI图像中的 PCLIA 值。两组患者的后交叉韧带均完好无损。对照组包括35名男性（53.8%）和30名女性（46.1%）。患者平均年龄为 38.7 岁（15-75 岁不等；SD±14.8 岁）。在这组患者中31例（47.6%）磁共振成像来自右膝，34例（52.3%）来自左膝。研究组中有 45 名男性（69.2%）和20名女性（30.7%）。患者平均年龄为36.8岁（14-55 岁不等；SD±10.3 岁）。这组患者中有33人（50.7%）为右膝，32人（49.2%）为左膝。PCLIA由核磁共振矢状图上两条线的交点构成，第一条线与胫骨髁的关节面相切，在PCL实质部近端勾勒第二条线与第一条线相交。 结果：对照组的平均PCLIA为 44.2±3.8°，研究组为78.9±8.6°。统计分析显示，前交叉韧带损伤组的PCLIA更高（P < 0.05）。 结论：前交叉韧带损伤者的 PCLIA 明显更高。利用核磁共振图像测量该角度可检测出前交叉韧带功能不全，从而有助于对前交叉韧带损伤采取个体化和精确的治疗方法。 临床意义：PCLIA可能是检测前交叉韧带功能不全的一种方法，从而帮助外科医生决定哪些患者可能需要进行前交叉韧带重建。 关键词：前交叉韧带 前交叉韧带；缺损；磁共振成像；后交叉韧带。
The posterior cruciate
ligament inclination angle is higher in anterior cruciate ligament
insufficiency Purpose:Magnetic
resonance imaging (MRI) is the gold standard image examination for anterior
cruciate ligament (ACL) lesion diagnosis. Our hypothesis was that measuring the
posterior cruciate ligament inclination angle (PCLIA) using MRI images may be
an auxiliary tool to aid the recognition of ACL insufficiency. The purpose of
this study was to compare the PCLIA measurement in MRIs of individuals with and
without ACL injury. Methods:The
PCLIA was measured by two radiologists in 65 knee MRIs of patients with intact
ACL (control group) and in 65 knee MRIs of people with ACL injury (study
group). In both groups, the posterior cruciate ligament was intact. The control
group was included 35 men (53.8%) and 30 women (46.1%). The patients' average
age was 38.7 years (range 15-75; SD ± 14.8 years). In this group, 31 (47.6%)
MRIs were from right knees and 34 (52.3%) were from left knees. The study group
consisted of 45 men (69.2%) and 20 women (30.7%). The patients' average age was
36.8 years (range 14-55; SD ± 10.3 years). In this group, 33 (50.7%) were right
knees and 32 (49.2%) were left knees. PCLIA was formed by the intersection of
two lines drawn in MRI sagittal images. The first passed tangentially to the
articular surface of the tibial condyle and the second was drawn over the
fraction of the ligament that originated where the first crossed the PCL,
outlined proximally. Results:The
average PCLIA was 44.2 ± 3.8° in the control group and 78.9 ± 8.6° in the study
group. Statistical analyses showed that the PCLIA was higher in the group with
ACL injury (p < 0.05). Conclusion The PCLIA was significantly higher in
individuals with ACL injuries. The measurement of this angle using MRI images
may allow for detection of ACL insufficiency and thus assist in an
individualized and precise approach to the treatment of injuries to the ACL. Clinical
relevance:PCLIA may be a way to detect ACL
insufficiency and thus help surgeons to decide which patient might need ACL
reconstruction. Keywords:Anterior cruciate ligament; Insufficiency;
Magnetic resonance imaging; Posterior cruciate ligament. 文献出处：Julio
Cesar Gali；Knee Surg Sports Traumatol
Arthrosc; 2022 Jan; PMID: 34787689; DOI: 10.1007/s00167-021-06789-0 开发和验证列线图，用于预测开放楔形胫骨高位截骨术后即刻发生深静脉血栓的风险 译者：孟悦峰 徐炜 目的：本研究旨在确定开放楔形胫骨高位截骨术 (OWHTO) 患者术后即刻发生深静脉血栓 (DVT) 的独立危险因素，并开发和验证预测列线图。 方法：对2017年6月至2021年12月因膝骨关节炎（KOA）接受OWHTO的患者进行回顾性分析。收集基线数据和实验室检查结果，术后即刻发生DVT作为研究结果事件。多变量逻辑回归确定了与术后即刻 DVT 发生率较高相关的独立危险因素。根据分析结果构建预测列线图。本研究使用 2022年 1 月至 9 月的患者作为外部验证集，进一步评估了模型的稳定性。 结果：741 名患者参与了该研究，其中 547 名患者用于训练队列，另外 194 名患者用于验证队列。多变量分析显示，Kellgren–Lawrence (K–L) 等级较高（III
vs. I–II OR 3.09，95% CI 0.93–10.23。IV vs. I–II OR
5.23，95% CI 1.27–21.48。）与血红蛋白比率 (PHR) > 2.25 (OR 6.10, 95% CI 2.43–15.33)、低水平白蛋白 (ALB) (OR 0.79, 95% CI 0.70–0.90)、LDL-C > 3.40 (OR 3.06, 95% CI 1.22–7.65)、d-二聚体 > 1.26 (OR 2.83, 95% CI 1.16–6.87) 和 BMI ≥ 28 (OR
2.57, 95% CI 1.02–6.50) 是术后即刻DVT 的独立危险因素。训练集中列线图的一致性指数（C-index）和 Brier 得分分别为 0.832 和0.036，内部验证后的校正值分别为 0.795 和0.038。受试者工作特征 (ROC) 曲线、校准曲线、Hosmer-Lemeshow检验和决策曲线分析 (DCA) 在训练和验证队列中均表现良好。 结论：这项研究开发了具有六个预测因子的个性化预测列线图，使外科医生能够对风险进行分层，并建议对具有任何这些因素的患者立即进行超声扫描。 Development and
validation of a nomogram for predicting the risk of immediate
postoperative deep vein thrombosis after open wedge high tibial osteotomy Purpose This study aimed to identify
independent risk factors for immediate postoperative deep vein thrombosis (DVT)
in patients with open wedge high tibial osteotomy (OWHTO) and to develop and
validate a predictive nomogram. Methods Patients who underwent OWHTO for
knee osteoarthritis (KOA) from June 2017 to December 2021 were retrospectively
analyzed. Baseline data and laboratory test results were collected, and the
occurrence of DVT in the immediate postoperative period was regarded as the
study outcome event. Multivariable logistic regression identified independent
risk factors associated with a higher incidence of immediate postoperative DVT.
The predictive nomogram was constructed based on the analysis results. The
stability of the model was further assessed in this study using patients from
January to September 2022 as an external validation set. Results 741 patients were enrolled in the
study, of which 547 were used in the training cohort and the other 194 for the
validation cohort. Multivariate analysis revealed a higher Kellgren–Lawrence
(K–L) grade (III vs. I–II OR 3.09, 95% CI 0.93–10.23. IV vs. I–II OR 5.23, 95%
CI 1.27–21.48.), platelet to hemoglobin ratio (PHR) > 2.25 (OR 6.10, 95% CI
2.43–15.33), Low levels of albumin (ALB) (OR 0.79, 95% CI 0.70–0.90), LDL-C
> 3.40 (OR 3.06, 95% CI 1.22–7.65), d-dimer > 1.26 (OR 2.83, 95% CI
1.16–6.87) and BMI ≥ 28 (OR 2.57, 95% CI 1.02–6.50) were the independent risk factors of immediate postoperative
DVT. The concordance index (C-index) and Brier score of the nomogram were 0.832
and 0.036 in the training set, and the corrected values after internal validation
were 0.795 and 0.038, respectively. The receiver-operating characteristic (ROC)
curve, the calibration curve, the Hosmer–Lemeshow test, and the decision curve
analysis (DCA) performed well in both the training and validation cohorts. Conclusion This study developed a
personalized predictive nomogram with six predictors, which allows surgeons to
stratify risk and recommended immediate ultrasound scans for patients with any
of these factors. 文献出处：Guo H, Wang T, Li C, Yu J, Zhu R,
Wang M, Zhu Y, Wang J. Development and validation of a nomogram for predicting
the risk of immediate postoperative deep vein thrombosis after open wedge high
tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2023
Nov;31(11):4724-4734. doi: 10.1007/s00167-023-07488-8. Epub 2023 Jun 28. PMID:
37378681. 髌骨下极骨折的形态学特征和新的分类:基于CT的研究 译者：肖家正 佘昶 目的:本研究的目的是测量髌骨下极骨折(IPFP)的形态学特征，并开发一个实用的分类系统，以确定针对不同类型的IPFP的相应治疗方案。 方法:对71例IPFP患者的影像学资料进行回顾性分析。采用图像处理软件对术前CT数据进行采集和测量。分析骨折碎片数目、最大骨折碎片前后长度(MFFAL)、最大骨折碎片横向长度(MFFTL)、骨折碎片冠状角(FFCA)、骨折碎片矢状角(FFSA)、最大骨折碎片高度(MFFH)和最大横断面积(MTSA)。 结果:平均骨折碎片数为3.8块。平均MFFAL为14.9 mm，平均MFFTL为23.5 mm，平均FFCA为92.1◦，平均FFSA为93.0◦，平均MFFH为13.6 mm，平均MTSA为299.3 mm2。提出了一种新的IPFP分类体系，概括为(I)简单IPFP;(II)粉碎IPFP;(III)单纯IPFP伴单纯髌骨体骨折;(IV)髌骨粉碎性骨折累及下极。在4型分类系统中，I型12个，II型22个，III型21个，IV型16个，各有特定的形态学特征。 结论: IPFPs表现出多样化的模式，表明可能需要完整固定。这四种分类可能为帮助骨科医生制定个体化治疗方案提供一个有价值的方法。
Morphological
characteristics and a new classification system of the inferior
pole fracture of the patella: A computer-tomography–based study Purpose: The
objective of this study was to measure the morphological characteristics of
inferior pole fracture of the patella (IPFP) and develop a practical
classification system to determine the corresponding treatment pro tocols for different IPFPs with specific patterns. Methods: A
retrospective radiographic review was performed on a series of 71 patients with
IPFP. The preoperative CT data were collected and measured using image
processing software. The number of fragments, maximum fracture fragment
anteroposterior length (MFFAL), maximum fracture fragment transverse length (MFFTL),
fracture fragment coronal angle (FFCA), fracture fragment sagittal angle
(FFSA), maximum fracture fragment height (MFFH) and maximum transverse
sectional area (MTSA) were analysed. Results: The mean number of fracture fragments was 3.8. The average MFFAL
was 14.9 mm, the average MFFTL was 23.5 mm, the average FFCA was 92.1◦, the
average FFSA was 93.0◦, the average MFFH was 13.6 mm, and the average MTSA was
299.3 mm2. A new classification system was introduced to describe the varied
patterns of IPFP, summarized as (I) simple IPFP; (II) comminuted IPFP; (III)
simple IPFP with simple patellar body fracture; and (IV) comminuted patellar
fracture involving the inferior pole. With the four-type classification system,
12 type I, 22 type II, 21 type III, and 16 type IV lesions were observed, each
with specific morphological characteristics. Conclusion: Most IPFPs exhibited a diversiform pattern, demonstrating that
coverage fixation was likely needed.The four-type classification system might
offer a valuable approach to help orthopaedic surgeons make individual
treatment plans. 文献出处：Liu CD, Hu SJ, Chang SM, Du SC, Chu YQ. Morphological characteristics and a new classification system of the inferior pole fracture of the patella: A computer-tomography-based study. Injury. 2023 Dec 1:111256. doi: 10.1016/j.injury.2023.111256. Epub ahead of print. PMID: 38049367. 预测外侧胫骨平台骨折后发生早期骨关节炎的因素：73 名接受手术治疗的患者的中期临床和放射学结果 译者：周钊鑫 佘昶 背景和目的:外侧胫骨平台骨折手术治疗的适应证仍存在争议。本研究的目的是确定采用钢板内固定治疗的外侧胫骨平台骨折的残余关节面凹陷和外翻畸形是否影响中期随访时相关患者的临床和影像学结果。 方法: 对 2002 年至 2008 年间入住本院并且经过手术治疗（AO B3.1 型）胫骨平台骨折的患者进行了回顾性分析。在 123 名患者中，有 73 名进行了临床和放射学随访检查，纳入本研究。平均随访时间为 54 个月。患者接受临床评估并完成 Lysholm 膝关节评分以及西安大略大学和麦克马斯特大学骨关节炎指数（Western Ontario and McMaster Universities Osteoarthritis Index.）。通过站位X光片评估最大关节面凹陷、机械轴和创伤后骨关节炎的程度。 结果: 随访时外翻畸形大于或等于5度的患者比机械轴正常的患者出现更严重的骨关节炎（Kellgren-Lawrence
3-4 级）（p = 0.006）。同样，与关节凹陷小于或等于2 毫米的患者相比，随访时关节凹陷大于 2 毫米的患者也出现更严重的骨关节炎 (p = 0.001)。外翻畸形或关节凹陷的程度对西安大略大学和麦克马斯特大学骨关节炎指数（Western Ontario and McMaster Universities Osteoarthritis Index.）或 Lysholm 评分没有影响。 结论: 接受钢板内固定手术后的外侧胫骨平台骨折的患者的术后关节面的一致性和正常机械轴对预防创伤后关节炎有一定作用，但似乎不能预测中期随访的临床结果。初始脱位和相关软骨损伤在这些骨折后骨关节炎发展中的作用仍不清楚。 Factors predicting the development of early
osteoarthritis following lateral tibial plateau fractures: mid-term clinical
and radiographic outcomes of 73 operatively treated patients Background
and Aims: The
indications for operative treatment of lateral tibial plateau fractures are
still controversial. The objective of this study was to deter -mine whether
residual articular surface depression and valgus malalignment of plated lateral
tibial plateau fractures at medium-term follow-up affect the clinical and
radiographic outcomes. Material and
Methods: A
chart review of patients with operatively treated (AO type B3.1) tibial plateau
fractures that were admitted to our level I trauma center between 2002 an2008
was performed. Out of 123 patients, 73 were available to participate in a
clinical and radiographic follow-up examination. The mean follow-up time was 54
months. Patients were clinically assessed and completed the Lysholm knee score
and Western Ontario and McMaster Universities Osteoarthritis Index. Maximal
articular surface depression,radiological mechanical axis, and degree of
posttraumatic osteoarthritis were evaluated from standing radiographs. Results: Patients with
valgus malalignment of 5° or greater at follow-up developed more advanced
osteoarthritis (Kellgren–Lawrence grade 3–4) than patients with a normal
mechanical axis (p = 0.006). Similarly, patients with articular depression
greater than 2 mm at follow-up also developed more advanced osteoarthritis
compared to patients with a depression of 2 mm or less (p = 0.001). The degree
of valgus malalignment or articular depression had no effect on the Western
Ontario and McMaster Universities Osteoarthritis Index or Lysholm scores. Conclusions: The
postoperative articular congruity and normal mechanical axis of the lower leg
after plate fixation in lateral tibial plateau fractures seem to have a role in
prevention of posttraumatic osteoarthritis but does not appear to predict
clinical outcome at medium-term follow-up. The role of initial dislocation and
associated cartilage damage in the development of osteoarthritis following
these fractures is still unknown. 文献出处：Parkkinen M,
Madanat R, Mustonen A, Koskinen SK, Paavola M, Lindahl J. Factors predicting
the development of early osteoarthritis following lateral tibial plateau
fractures: mid-term clinical and radiographic outcomes of 73 operatively
treated patients. Scand J Surg. 2014 Dec;103(4):256-62. doi:
10.1177/1457496914520854. Epub 2014 Apr 15. PMID: 24737855. 双髁胫骨平台骨折双钢板固定:与单侧入路相比，双髁胫骨平台骨折双入路固定的并发症发生率和临床结果相似，但影像学结果有所改善 译者：胡正辉 李柳炳 简介：与单一正中入路相比，后内侧和前外侧联合入路可以提高骨折线的可视性，并优化双髁胫骨平台骨折复位。本研究旨在比较经单侧入路或双侧入路双钢板固定后的术后并发症发生率、功能和影像学结果。研究假设，与单一入路相比，采用双侧入路的双钢板固定可提供同等的并发症发生率，且影像学结果有所改善。 材料和方法:2016年1月至2020年12月，一项回顾性的2级中心研究比较了双髁胫骨平台骨折单侧入路双钢板固定与双侧入路双钢板固定的疗效。比较的重点是需要手术的主要并发症、放射学测量结果、胫骨内侧近端角 (MPTA) 和胫骨后侧近端角 (PPTA)；与各自基线值 87° 和 83° 相比的变化（deltaMPTA和 deltaPPTA），以及 KOOS 的功能结果、SF12 和 EQ5D-3L 自我报告问卷的功能结果。 结果:20例单侧入路组患者中有2例(10%)发生主要并发症[1例手术部位感染(SSI)(5%)， 1例皮肤并发症(5%)]，39例双侧入路组患者中有3例发生主要并发症(7.69%)(p = 0.763)，平均随访29个月。在矢状面，双入路的deltaPPTA显著低于单入路(分别为4.67°
和7.43° （P = 0.0104)。末次随访时，组间deltaMPTA或功能结果无显著差异。 结论:本研究提示双髁胫骨平台骨折单、双侧入路双钢板手术在主要并发症方面无显著差异。在平均29个月的随访中，双侧入路可以改善矢状面解剖复位，但在冠状平面或功能评分上没有显著差异。 Bicondylar tibial plateau fracture
osteosynthesis with double-plate fixation: Similar complication rates and
clinical results but improved radiographic outcomes with dual compared to
single approach Abstract Introduction: Associating
posteromedial and anterolateral approaches should improve fracture line
visu-alization and optimize bicondylar tibial plateau fracture reduction
compared to a single midline approach.The present study aimed to compare
postoperative complications rates and functional and radiographic results after
double-plate fixation via either a single or a dual approach. The study
hypothesis was that double-plate fixation using a dual approach provides
equivalent complications rates with improved radiographic results compared to a
single approach. Material and Methods: A
retrospective 2-center study compared bicondylar tibial plateau fractures
treated by double-plate fixation on a single versus a dual approach between
January 2016 and December 2020. Comparison focused on major complications
requiring surgical revision, radiographic measurements of medial proximal
tibial angle (MPTA) and posterior proximal tibial angle (PPTA); change from
their respective baseline values of 87◦ and 83◦ (deltaMPTA and deltaPPTA), and
functional results on KOOS, SF12 and EQ5D-3L self-reported questionnaires. Results: Major complications
occurred in 2 of the 20 single approach group patients (10%) [1 surgical site
infection (SSI) (5%), and 1 skin complication (5%)], and in 3 of the 39 dual
approach group patients (7.69%) (p = 0.763), at an average 29 months’ follow-up.
In the sagittal plane, deltaPPTA was significantly lower with dual than single
approach (respectively, 4.67◦ versus 7.43◦; p = 0.0104). There were no
significant intergroup differences in deltaMPTA or functional results at last
follow-up. Conclusions: The present study
suggests an absence of significant difference in major complications, between
single and dual approach for double-plate osteosynthesis of bicondylar tibial
plateau fractures. Using a dual approach enabled improved anatomic restoration
in the sagittal plane, without significant differences observed in the frontal
plane or functional scores at an average 29 months’follow-up. 文献出处：Emile Dobellea, Maxime Fabre-Aubrespya, Bastien
Mandona, Xavier Flechera, Matthieu Olliviera, Jean-Noël Argensona, Christophe
Jacquet/DOI: 10.1016/j.otsr.2023.103655 牛津单间室膝关节置换术胫骨部分的内翻置位可降低术后胫骨骨折的风险 译者：吴韦成 李柳炳 目的：胫骨内侧平台骨折是牛津移动轴承单间室膝关节置换术（OUKA）的严重并发症。据报道，当使用具有较长龙骨-皮层距离（KCD）的组件时，这些骨折的风险较低。这项研究的目的是在临床上检查轻微的胫骨内翻位置对KCD 和胫骨平台骨折发生率的影响。 方法: 这项回顾性研究包括 255 例患者，他们接受了 305 例无骨水泥胫骨成分的 OUKA。有52名男性和203名女性。他们的平均年龄为73.1岁(47至91岁) ，平均随访时间为1.9年(1.0至2.0年)。在常规组 187 名患者的 217个膝关节中，胫骨切口与胫骨轴线成直角。内翻组包括68名患者88个膝关节，采用新的截骨指南进行轻微内翻切口。术后一周应用三维 CT 扫描评估前、后 KCD 及骨折线起点。比较两组 KCD 及骨折发生率。 结果：常规组15例患者(15个OUKA)术后发生胫骨内侧骨折，而内翻组仅1例患者(1个OUKA)术后发生胫骨内侧骨折。这种差异是显着的(6.9% vs1.1% ; p = 0.029)。常规组的平均后部KCD（5.0 mm（SD 1.7））明显短于内翻组（6.1 mm（SD 2.1）;p =
0.002）。 结论：在OUKA中，对于胫骨组件轻度内翻的患者，KCD距离较长，这似乎降低了术后胫骨骨折的风险。 Varus placement of the tibial component of
Oxford unicompartmental knee arthroplasty decreases the risk of postoperative
tibial fracture Aims: A fracture of
the medial tibial plateau is a serious complication of Oxford mobile-bearing
unicompartmental knee arthroplasty (OUKA). The risk of these fractures is
reportedly lower when using components with a longer keel-cortex distance
(KCDs). The aim of this study was to examine how slight varus placement of the
tibial component might affect the KCDs, and the rate of tibial plateau
fracture, in a clinical setting. Methods: This
retrospective study included 255 patients who underwent 305 OUKAs with
cementless tibial components. There were 52 males and 203 females. Their mean
age was 73.1 years (47 to 91), and the mean follow-up was 1.9 years (1.0 to
2.0). In 217 knees in 187 patients in the conventional group, tibial cuts were
made orthogonally to the tibial axis. The varus group included 88 knees in 68
patients, and tibial cuts were made slightly varus using a new osteotomy guide.
Anterior and posterior KCDs and the origins of fracture lines were assessed
using 3D CT scans one week postoperatively. The KCDs and rate of fracture were
compared between the two groups. Results: Medial tibial
fractures occurred after surgery in 15 patients (15 OUKAs) in the conventional
group, but only one patient (one OUKA) had a tibial fracture after surgery in
the varus group. This difference was significant (6.9% vs 1.1%; p = 0.029). The
mean posterior KCD was significantly shorter in the conventional group (5.0 mm
(SD 1.7)) than in the varus group (6.1 mm (SD 2.1); p = 0.002). Conclusion: In OUKA, the
distance between the keel and posterior tibial cortex was longer in our
patients with slight varus alignment of the tibial component, which seems to
decrease the risk of postoperative tibial fracture 出处：Suda Y,
Hiranaka T, Kamenaga T, Koide M, Fujishiro T, Okamoto K, Matsumoto T. Varus
placement of the tibial component of Oxford unicompartmental knee arthroplasty
decreases the risk of postoperative tibial fracture. Bone Joint J. 2022
Oct;104-B(10):1118-1125. doi: 10.1302/0301-620X.104B10.BJJ-2021-1508.R2. PMID:
36177640. 影像学骨性关节炎、骨髓水肿、较高的体重指数及内侧半月板根撕裂与骨性关节炎合并内侧半月板外凸或内侧半月板撕裂显著相关:一项系统回顾和荟萃分析 译者：夏飞镖
徐炜 目的：内侧半月板外凸(MME)是指内侧半月板向周缘突出超过胫骨边缘超过3mm，导致半月板环向应变不足。MME通常与骨关节炎(OA)或内侧半月板撕裂(MMT)一起发生。然而，与OA或MMT患者合并MME相关的因素尚未得到系统的回顾。本研究旨在进行系统回顾和荟萃分析，以确定OA或MMT伴发MME的相关因素。 方法：根据PRISMA对文献进行系统综述。在4个数据库中进行文献检索。所有原始人类研究报告了OA或MMT患者伴发MME相关因素的现有证据。合并二元变量采用比值比(OR)和95% CI进行分析，合并连续变量采用均差(MD)和95% CI进行评价。 结果：10项OA研究(5993例)和8项MMT研究(872例)符合纳入标准。骨性关节炎MME的总发生率为43% (95% CI, 37-50%)， MMT为61% (95% CI 43-77%)，内侧半月板根撕裂(MMRT)为85% (95% CI 72-94%)。对于骨性关节炎患者，与MME显著相关的因素包括影像学骨性关节炎[OR 4.24;95% CI 3.07-5.84;P < 0.0001]，骨髓水肿[OR, 3.35;95% CI 1.61-6.99;P = 0.0013]，软骨损伤[OR,
3.25;95% CI 1.60-6.61;P = 0.0011]和较高的身体质量指数(BMI) [MD,
1.81;95% CI 1.15-2.48;P < 0.0001]。与MMT的MME风险增加密切相关的因素包括内侧半月板根[OR, 8.39;95% CI
2.84-24.82;P < 0.0001]和放射状撕裂[OR, 2.64;95% CI
1.18-5.92;P < 0.0001]。 结论：骨性关节炎、骨髓水肿、软骨损伤及较高的BMI与骨性关节炎合并MME显著相关。此外，内侧半月板根和放射状撕裂与MMT患者MME风险增加显著相关。 Radiographic OA, bone
marrow lesions, higher body mass index and medial meniscal root tears are
significantly associated with medial meniscus extrusion with OA or medial
meniscal tears: a systematic review and meta‑analysis Purpose: Medial meniscus extrusion (MME) refers to the protrusion of the medial
meniscus beyond the tibial edge by more than 3 mm, leading to a deficiency of
the hoop strain. MME commonly occurs in conjunction with osteoarthritis (OA) or
medial meniscal tears (MMT). However, factors associated with concomitant MME
in patients with OA or MMT have not been systematically reviewed. This study
aims to perform a systematic review and meta-analysis to identify factors
associated with concomitant MME in OA or MMT. Methods: The systematic review of the literature was performed according to
PRISMA. A literature search was conducted in 4 databases. All original human
studies that reported the available evidence on factors associated with
concomitant MME in patients with OA or MMT were included. Pooled binary
variables were analyzed by odds ratios (OR) and 95% CIs, and pooled continuous
variables were evaluated by mean difference (MD) and 95% CIs. Results: Ten studies on OA (5993 patients) and eight studies on MMT (872 patients)
met the inclusion criteria. The overall pooled incidence of MME was 43% (95%
CI, 37–50%) for OA, 61% (95% CI 43–77%) for MMT, and 85% (95% CI 72–94%) for
medial meniscal root tears (MMRT). For the population with OA, Factors
significantly associated with MME included radiographic OA [OR 4.24; 95% CI
3.07–5.84; P < 0.0001], bone marrow lesions [OR,
3.35; 95% CI 1.61–6.99; P = 0.0013], cartilage damage
[OR, 3.25; 95% CI 1.60–6.61; P = 0.0011], and higher
body mass index (BMI) [MD, 1.81; 95% CI 1.15–2.48; P
< 0.0001]. Factors strongly associated with increased risk of MME for MMT
included medial meniscal root [OR, 8.39; 95% CI 2.84–24.82;
P < 0.0001] and radial tears [OR, 2.64; 95% CI 1.18–5.92;
P < 0.0001]. Conclusions: Radiographic OA, bone marrow lesions, cartilage damage, and higher BMI
were significantly associated with concomitant MME with OA. Furthermore, medial
meniscal root and radial tears were significantly associated with an increased
risk of MME in patients with MMT. 文献出处：Zhan H, Liu Z, Wang Y, Chen Y, Teng F, Yang A, Tang Y, Xia Y, Wu M, Jiang
J. Radiographic OA, bone marrow lesions, higher body mass index and medial
meniscal root tears are significantly associated with medial meniscus extrusion
with OA or medial meniscal tears: a systematic review and meta-analysis. Knee
Surg Sports Traumatol Arthrosc. 2023 Aug;31(8):3420-3433. doi:
10.1007/s00167-023-07418-8. Epub 2023 Apr 26. PMID: 37099153.   |
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