本文關(guān)鍵詞：大收肌腱轉(zhuǎn)位重建內(nèi)側(cè)髕股韌帶的應(yīng)用解剖研究　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 髕骨脫位 大收肌腱 內(nèi)側(cè)髕股韌帶 重建

【摘要】：目的通過(guò)對(duì)30側(cè)尸體標(biāo)本膝關(guān)節(jié)內(nèi)側(cè)區(qū)域進(jìn)行解剖,觀測(cè)膝關(guān)節(jié)內(nèi)側(cè)區(qū)域大收肌腱和內(nèi)側(cè)髕股韌帶形態(tài)及其周?chē)苌窠?jīng)毗鄰關(guān)系,評(píng)估大收肌腱轉(zhuǎn)位重建內(nèi)側(cè)髕股韌帶治療髕骨脫位的術(shù)式可行性及可能的風(fēng)險(xiǎn),并在尸體標(biāo)本上采用兩種方式(帶線錨釘、絲線縫合)模擬手術(shù)探討轉(zhuǎn)位肌腱固定方法。臨床上使用此種方法后,評(píng)價(jià)手術(shù)方法的實(shí)用性,進(jìn)一步探討該如何改善手術(shù)方法。方法解剖觀察30側(cè)尸體標(biāo)本膝關(guān)節(jié)的大收肌腱及內(nèi)側(cè)髕股韌帶形態(tài)及其周?chē)苌窠?jīng)等毗鄰關(guān)系;測(cè)量大收肌腱長(zhǎng)度(收肌結(jié)節(jié)至收肌裂孔距離)、大收肌腱寬度、大收肌腱厚度、內(nèi)側(cè)髕股韌帶軸長(zhǎng)長(zhǎng)度、收肌結(jié)節(jié)至內(nèi)側(cè)髕股韌帶股骨止點(diǎn)距離、收肌結(jié)節(jié)至大收肌腱移行部距離;拍攝解剖區(qū)域相關(guān)照片留取資料,并在尸體標(biāo)本上模擬手術(shù)。臨床上設(shè)計(jì)在關(guān)節(jié)鏡輔助下使用大收肌腱轉(zhuǎn)位重建內(nèi)側(cè)髕股韌帶治療髕骨脫位患者4例,采用雙切口技術(shù),術(shù)后石膏托固定并行股四頭肌鍛煉,通過(guò)門(mén)診隨訪和電話隨訪收集術(shù)后恢復(fù)情況資料,評(píng)價(jià)手術(shù)方法的實(shí)用性。結(jié)果在對(duì)30側(cè)尸體標(biāo)本膝關(guān)節(jié)內(nèi)側(cè)區(qū)域解剖后,可見(jiàn)大收肌腱有兩種形態(tài):(1)腱膜型;(2)錐狀。伴隨大收肌腱的重要組織包括:穿過(guò)收肌裂孔的膝降動(dòng)脈及其分支、隱神經(jīng);在尸體標(biāo)本解剖中100%見(jiàn)內(nèi)側(cè)髕股韌帶,內(nèi)側(cè)髕股韌帶位于膝關(guān)節(jié)內(nèi)側(cè)軟組織結(jié)構(gòu)第二層,關(guān)節(jié)囊外的韌帶結(jié)構(gòu),呈扇形,附著于股內(nèi)側(cè)斜肌深面,由股骨止點(diǎn)(股骨內(nèi)側(cè)髁與收肌結(jié)節(jié)間)向髕骨內(nèi)側(cè)走形,走形過(guò)程中越來(lái)越寬,形成兩功能束:上斜束和下直束。使用游標(biāo)卡尺(精確度為0.01mm)反復(fù)測(cè)量3次后取平均值得到數(shù)據(jù)如下:大收肌腱長(zhǎng)度(收肌結(jié)節(jié)至收肌裂孔距離)為105±14mm(77-129mm),大收肌腱寬度為9±2mm(5-17mm),大收肌腱厚度為2±0.4mm(1-3mm),內(nèi)側(cè)髕股韌帶軸長(zhǎng)長(zhǎng)度為46±6mm(33-57mm),收肌結(jié)節(jié)至內(nèi)側(cè)髕股韌帶股骨止點(diǎn)距離為9±2mm(6-13mm),收肌結(jié)節(jié)至大收肌腱移行部距離為124±11mm(102-144mm)。模擬手術(shù)使用帶線錨釘(強(qiáng)生公司提供)和絲線,重建內(nèi)側(cè)髕股韌帶固定于髕骨內(nèi)側(cè)緣止點(diǎn),手術(shù)效果滿意,未見(jiàn)對(duì)膝關(guān)節(jié)內(nèi)側(cè)區(qū)域重要組織(膝降動(dòng)脈及其分支、隱神經(jīng))有所損傷,拍取照片記錄模擬手術(shù)操作過(guò)程并留取資料。4例患者術(shù)后切口愈合佳,未見(jiàn)切口有感染現(xiàn)象,術(shù)后均獲得隨訪,時(shí)間為2-19個(gè)月。結(jié)果如下:術(shù)后復(fù)查拍攝膝關(guān)節(jié)髕骨軸位X片示髕骨在位,錨釘內(nèi)固定在位見(jiàn),所有患者出院后1個(gè)月膝關(guān)節(jié)基本上沒(méi)有了疼痛感,在去除石膏托固定后,鼓勵(lì)患者行股四頭肌鍛煉并下地行走,術(shù)后2-3個(gè)月隨訪膝關(guān)節(jié)功能基本恢復(fù)正常,術(shù)后均未再次出現(xiàn)髕骨脫位,Lysholm評(píng)分較術(shù)前明顯改善。結(jié)論對(duì)內(nèi)側(cè)髕股韌帶的修復(fù)或者重建成為治療髕骨脫位的重要方法,最大限度恢復(fù)其解剖結(jié)構(gòu)是手術(shù)成功的關(guān)鍵,通過(guò)對(duì)膝關(guān)節(jié)內(nèi)側(cè)區(qū)域進(jìn)行解剖并在尸體標(biāo)本上行模擬手術(shù),我們認(rèn)為一個(gè)長(zhǎng)約55mm的大收肌腱移植物通過(guò)轉(zhuǎn)位固定于髕骨內(nèi)側(cè)緣重建內(nèi)側(cè)髕股韌帶可行,術(shù)中成功的避免了分離切取大收肌腱時(shí)對(duì)其周?chē)徑M織(膝降動(dòng)脈及其分支、隱神經(jīng))的損傷,在考慮和避免解剖風(fēng)險(xiǎn)的基礎(chǔ)上,大收肌腱作為重建內(nèi)側(cè)髕股韌帶的移植物是一個(gè)良好的選擇。在臨床實(shí)踐中使用大收肌腱轉(zhuǎn)位重建內(nèi)側(cè)髕股韌帶治療髕骨脫位后,術(shù)后膝關(guān)節(jié)功能恢復(fù)好,未見(jiàn)明顯并發(fā)癥發(fā)生,此種手術(shù)方法在臨床值得推廣。
[Abstract]:The anatomy of the 30 specimens of knee joint medial area, observation of medial knee region of great adductor muscle tendon and the medial patellofemoral ligament morphology and surrounding blood vessels and nerves adjacent relationship evaluation operation feasibility of great adductor muscle tendon transposition for reconstruction of medial patellofemoral ligament for the treatment of patellar dislocation and risk, and the two ways in cadavers on (with anchor and suture fixation method) tendon transposition surgery simulation study. After the clinical use of this method, the practicability of the surgical method is evaluated and how to improve the operation method is further discussed. Methods anatomic observation of 30 cadaver specimens of knee joint of the adductor magnus tendon and medial patellofemoral ligament morphology and peripheral vascular nerve adjacent relationship; measurement of great adductor muscle tendon length (adductor tubercle to the adductor hiatus distance), great adductor magnus muscle tendon width, thickness, axial length, the length of the medial patellofemoral ligament to the adductor tubercle the medial patellofemoral ligament femoral insertion distance and the adductor tubercle to the adductor magnus tendon migration distance; shooting photos taken from the anatomical region, and simulation operation in the specimens. The clinical design of great adductor muscle tendon transposition for reconstruction of medial patellofemoral ligament for the treatment of patients with patellar dislocation in 4 cases under arthroscopy, using double incision technique, postoperative plaster fixation in femoral head four parallel muscle exercise, data recovery were collected through outpatient follow-up and telephone follow-up, practical evaluation of surgical methods. Results after the anatomy of the medial knee joint of 30 sides of the cadaver specimens, there were two forms of the large adductor tendon: (1) aponeurosis type; (2) conical. With an organization of great adductor muscle tendon includes: through the adductor hiatus of descending genicular artery and its branches, saphenous nerve; in cadaver dissection in 100% medial patellofemoral ligament, the medial patellofemoral ligament in the knee joint medial soft tissue structure of second layers, ligament structure, joint capsule and fan-shaped, attached to the vastus medialis oblique deep from the surface, the femur (medial femoral condyle and the adductor tubercle to the medial patella between shape, shape) plays a more and more wide, the formation of two functions: oblique beam and straight beam. Use vernier caliper (accuracy 0.01mm) after repeated measurements of 3 average data is as follows: the great adductor muscle tendon length (adductor tubercle to the adductor hiatus distance) was 105 + 14mm (77-129mm), great adductor muscle tendon width was 9 + 2mm (5-17mm), great adductor muscle tendon thickness was 2 + 0.4mm (1-3mm), medial patellofemoral ligament axis length was 46 + 6mm (33-57mm), the adductor tubercle to the medial patellofemoral ligament femoral insertion distance was 9 + 2mm (6-13mm), the adductor tubercle to the adductor magnus tendon migration distance was 124 + 11mm (102-144mm). Simulated surgery using suture anchors (Johnson company) and silk, reconstruction of the medial patellofemoral ligament fixed on the patella medial border check point, the surgical results were satisfactory, no important knee medial area (descending genicular artery and its branches, saphenous nerve injury), take photographs to simulate the operation process and take the data. The incision healed well in 4 cases and no infection was found in the incision. All patients were followed up after 2-19 months. The results are as follows: after review of shooting patellar axial X film showed patella in anchor screw fixation in, all patients were discharged after 1 months of knee basically no pain after removal of plaster fixation, the patients were encouraged to unit four biceps exercise and ambulation, 2-3 months follow up the knee joint function returned to normal after surgery, postoperative had no relapse of patellar dislocation, Lysholm scores were improved significantly. The conclusion of the medial patellofemoral ligament repair or reconstruction has become an important method for the treatment of patellar dislocation, maximize the restoration of the anatomic structure is the key to successful operation, through the anatomy of the medial knee region and surgical simulation in cadaver specimens upward, we believe that a length of about 55mm by transposition of great adductor muscle tendon graft fixed in medial patella margin of medial patellofemoral ligament reconstruction surgery is feasible and successful in avoiding separation cut to the surrounding tissue adjacent to the adductor magnus tendon (when descending genicular artery and its branches, saphenous nerve injury) in considering and avoid the risk on the basis of anatomy, great adductor muscle tendon as reconstruction of medial patellofemoral ligament graft is a good the choice of. In the clinical practice, the use of adductor muscle tendon transposition and reconstruction of medial patellofemoral ligament for patellar dislocation, postoperative knee function recovery is good, no obvious complications occur. This surgical method is worth promoting in clinical practice.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R687;R322

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