摘要
背景:膝关节前交叉韧带损伤作为高发运动损伤之一,常合并骨挫伤、半月板损伤及内侧副韧带损伤等,其中骨挫伤是由高能量负荷所导致的骨小梁微细结构损伤,其分布模式与前交叉韧带撕裂定位及膝关节损伤机制间存在特异性关联,然而,针对骨挫伤的分布模式、生物力学机制及其与联合损伤的相关性仍需进一步探索。目的:探讨前交叉韧带损伤中骨挫伤的分布模式、特征及与损伤机制的联系,同时探讨骨挫伤与其他联合损伤的相关性及对功能的影响,旨在为临床治疗和康复策略的制定提供参考。方法:第一作者在2024年3月进行首次检索,并在2024年8-10月补充文献,检索PubMed、Embase和中国知网数据库中膝关节骨挫伤的相关研究,检索采用主题词与自由词相结合的方式,英文检索词包括“bone bruise,bone contusion,anterior cruciate ligament,ACL,cartilage damage,meniscus injury,medial collateral ligament,MRI”;中文检索词包括“骨挫伤,骨损伤,前交叉韧带,软骨损伤,半月板损伤,内侧副韧带,磁共振成像,MRI”。文献检索时限为2000-01-01/2024-10-01。结果与结论:共纳入88篇文献进行综述分析。骨挫伤是前交叉韧带损伤后常见的伴随损伤,主要分布在胫骨外侧平台和股骨外侧髁;骨挫伤的分布模式与前交叉韧带损伤的力学机制密切相关,外翻应力、胫骨前移和内旋被认为是主要的损伤机制;骨挫伤的严重程度通常反映了膝关节在损伤时的力学负荷,与膝关节的松弛度和功能障碍密切相关;骨挫伤的存在常常与联合损伤相关,如半月板损伤、软骨损伤和内侧副韧带损伤;骨挫伤严重程度的增加和联合损伤的存在可能显著降低功能评分,延缓康复进程,影响患者的长期预后。骨挫伤不仅是前交叉韧带损伤的重要影像学表现,也是评估损伤机制、预测联合损伤和膝关节长期预后的关键指标,为精准评估损伤严重程度、制定个体化临床治疗方案提供多方面的生物力学证据。
BACKGROUND:Anterior cruciate ligament injury,one of the most prevalent sports-related injuries,is often accompanied by bone bruises,meniscal tears,and medial collateral ligament damage.Bone bruises,caused by high-energy loading-induced microstructural damage to trabecular bone,exhibit specific distribution patterns that are correlated with anterior cruciate ligament tear locations and knee injury mechanisms.However,further exploration is required to elucidate the distribution patterns,biomechanical mechanisms of bone bruises,and their associations with combined injuries.OBJECTIVE:To investigate the distribution patterns and characteristics of bone bruises in anterior cruciate ligament injuries,their relationship with injury mechanisms,and their correlations with combined injuries and functional outcomes,thereby providing evidence-based insights to formulate clinical treatment and rehabilitation strategies.METHODS:The first author conducted an initial literature search in March 2024,supplemented by additional searches from August 2024 to October 2024.Databases including PubMed,Embase,and CNKI were queried for studies on knee bone bruises using a combination of subject headings and free-text terms.The search terms included“bone bruise,bone contusion,anterior cruciate ligament,ACL,cartilage damage,meniscus injury,medial collateral ligament,MRI”in English as well as“bone contusion,bone injury,anterior cruciate ligament,cartilage damage,meniscus injury,medial collateral ligament,magnetic resonance imaging,MRI”in Chinese.The search timeframe spanned from January 1,2000,to October 1,2024.RESULTS AND CONCLUSION:Based on the inclusion and exclusion criteria,88 articles were selected for analysis.Bone bruises are common concomitant injuries following anterior cruciate ligament damage,predominantly localized in the lateral tibial plateau and lateral femoral condyle.Their distribution patterns are closely linked to anterior cruciate ligament injury mechanisms,with valgus stress,anterior tibial translation,and internal rotation identified as primary contributors.The severity of bone bruises reflects the mechanical load sustained during injury and correlates significantly with knee laxity and functional impairment.Additionally,bone bruises are strongly associated with combined injuries,including meniscal tears,cartilage damage,and medial collateral ligament injuries.Increased bone bruise severity and the presence of combined injuries may markedly reduce functional scores,delay rehabilitation,and adversely affect long-term patient outcomes.Bone bruises serve not only as critical imaging markers of anterior cruciate ligament injuries but also as key indicators for evaluating injury mechanisms,predicting combined injuries,and assessing long-term knee prognosis.These findings provide multifaceted biomechanical evidence to support precise injury severity assessments and individualized clinical management strategies.
作者
张树昂
黄子帅
王健
Zhang Shuang;Huang Zishuai;Wang Jian(Shandong First Medical University,Jinan 250000,Shandong Province,China;Department of Orthopedics,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250000,Shandong Province,China)
出处
《中国组织工程研究》
北大核心
2026年第10期2491-2502,共12页
Chinese Journal of Tissue Engineering Research
关键词
前交叉韧带损伤
骨挫伤
半月板损伤
软骨损伤
内侧副韧带损伤
生物力学
MRI
anterior cruciate ligament
bone bruise
meniscal injury
cartilage injury
medial collateral ligament injury
biomechanics
MRI
