本文選題：髕骨脫位 + 滑車發(fā)育��； 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:髕骨脫位屬于髕股關(guān)節(jié)疾病,也是髕骨不穩(wěn)的一種,臨床較多發(fā),多見于青少年,女性多于男性。CT掃描技術(shù)對髕股關(guān)節(jié)疾病的診斷有著很高的價值。CT不僅能夠顯示髕骨和股骨的形態(tài),還能輔助測量髕股關(guān)節(jié)疾病中的很多重要參數(shù),用于評價髕股關(guān)節(jié)的對合關(guān)系是否正常。此次動物實驗我們通過CT測量的正是幼兔膝關(guān)節(jié)的TT-TG(Tibial Tubercle-Trochlear Groove Distance,脛骨結(jié)節(jié)-股骨滑車間距)和脛骨結(jié)節(jié)外移比例,因為在人體當中這兩個參數(shù)值對研究髕骨脫位有著十分重要的意義。本動物實驗的目的是研究早期髕骨脫位對脛骨結(jié)節(jié)-股骨滑車間距離、脛骨結(jié)節(jié)位置的影響。方法:40只一個月齡大的新西蘭白兔(共80膝,由河北醫(yī)科大學動物中心提供)體重300-500g,分成2組(N=40/組)即:設(shè)立左膝對照組(a)和右膝髕骨脫位組(b)。a組行單純假手術(shù)(單純進行術(shù)前稱重,麻醉,皮膚切開縫合),b組行髕骨脫位術(shù)(術(shù)前稱重,均使用氯胺酮(20mg/kg)聯(lián)合甲苯噻嗪(5mg/kg)于幼兔耳緣靜脈處進行注射麻醉,麻醉后對兔子兩后腿膝關(guān)節(jié)進行備皮準備(剪除兔毛),行標準常規(guī)消毒,無菌單平鋪于術(shù)區(qū)表面,沿著幼兔膝關(guān)節(jié)正中行一長2cm左右的切口,逐層切開皮膚及皮下組織,并分離軟組織,將關(guān)節(jié)囊暴露。動作輕柔避免損傷神經(jīng)血管。分別沿髕骨內(nèi)側(cè)緣、外側(cè)緣做一長約2cm切口,外推髕骨,測試髕骨外移度,造成髕骨向外側(cè)脫位,用可吸收一號線(absorbablethread No.1)暫時縫合外側(cè)關(guān)節(jié)囊,觀察髕骨位置外移,活動膝關(guān)節(jié)發(fā)現(xiàn)髕骨不能在股骨滑車溝內(nèi)正常運動,再用一號可吸收線(absorbable thread No.1)將外側(cè)關(guān)節(jié)囊重疊縫合3~4針,逐層縫合皮下組織及皮膚,無菌輔料及繃帶包扎傷口)。術(shù)后行丁諾菲肌肉注射(2/日)緩解疼痛,口服環(huán)丙沙星(10mg/kg)預防感染,為期3天。為避免關(guān)節(jié)粘連,手術(shù)3日之后再開始促使兔子雙膝關(guān)節(jié)活動。手術(shù)進行之前以及手術(shù)后6個月對實驗兔子的膝關(guān)節(jié)進行CT掃描檢查,測量TT-TG(Tibial Tubercle-Trochlear Groove Distance,脛骨結(jié)節(jié)-股骨滑車間距)以及脛骨結(jié)節(jié)外移比值,對比研究兩組兔子的TT-TG(Tibial TubercleTrochlear Groove Distance,脛骨結(jié)節(jié)-股骨滑車間距)以及脛骨結(jié)節(jié)外移比值的變化情況。結(jié)果:CT檢查測量結(jié)果顯示,術(shù)前對照組(a)和髕骨脫位組(b)的CT測量值之間沒有統(tǒng)計學意義。行膝關(guān)節(jié)髕骨脫位術(shù)后6個月,經(jīng)統(tǒng)計學分析結(jié)果可見:對照組(a)的TT-TG測量值為1.01mm±0.35,髕骨脫位組(b)則為2.98±0.66mm(P0.05);對照組(a)脛骨結(jié)節(jié)外移比值為0.46±0.08,髕骨脫位組脛骨結(jié)節(jié)外移比值為0.55±0.05(P0.05)。結(jié)論:早期髕骨脫位能夠?qū)е耇T-TG的增大以及脛骨結(jié)節(jié)外置,同樣也具有重要的臨床意義,那就是我們應該更加關(guān)注青少年髕骨脫位,在其髕骨脫位的早期就加以干預,給予保守或手術(shù)治療,盡早改善青少年髕骨脫位患者膝關(guān)節(jié)的髕股對合關(guān)系,阻止發(fā)育不良的進一步發(fā)展。
[Abstract]:Objective: patellar dislocation is a disease of patellofemoral joint and a kind of patellar instability. The diagnostic value of CT scanning in women is higher than that in men. Ct can not only show the shape of patella and femur, but also help to measure many important parameters of patellofemoral joint disease. Used to evaluate whether the involution of the patellofemoral joint is normal. In this animal experiment, we measured the TT-TG(Tibial Tubercle-Trochlear Groove distance (the distance between the tibial nodule and the femoral trochlea) and the proportion of the tibial nodule moving out of the knee joint of the young rabbit by CT. These two parameters are of great significance in the study of patellar dislocation. The purpose of this animal experiment was to study the effect of early patellar dislocation on the distance between the tibial tubercle and the trochlear and the location of the tibial tubercle. Methods A total of 40 one-month-old New Zealand white rabbits (80 knees in total) were studied. The body weight of 300-500g was given by Animal Center of Hebei Medical University, divided into two groups: control group with left knee (group A) and group B with dislocation of patella of right knee (group A) with simple sham-operation (weighing before operation and anaesthesia). The patella dislocation group (weighing 20 mg / kg before operation) and toluene thiazide (5 mg / kg) were injected into the auricular vein of young rabbits. After anesthesia, the rabbit's hind leg knee joint was prepared for skin preparation (cut off rabbit hair, disinfected by standard routine, sterile single tile on the surface of the operation area, along the middle of the knee joint of the young rabbit by a long 2cm incision, layer by layer incision of the skin and subcutaneous tissue, The soft tissue was separated and the joint capsule was exposed. Gentle movement to avoid damage to the nerve and blood vessels. A long 2cm incision was made along the medial and lateral edge of the patella, and the patella was extrapolated. The lateral dislocation of the patella was induced by measuring the degree of patellar displacement. The lateral articular sac was temporarily sutured with absorbable line 1 (absorbable line 1) to observe the location of the patella. The patella was found to be unable to move normally in the trochlear sulcus of the femur. The lateral articular capsule was sutured with three or four stitches with absorbable thread No. 1. The subcutaneous tissue and skin were sutured layer by layer, sterile excipients and bandages were used to bind the wound. After operation, buprofen intramuscular injection 2 / d was used to relieve pain and ciprofloxacin 10 mg / kg was given orally for 3 days to prevent infection. In order to avoid joint adhesion, the operation 3 days later began to promote bilateral knee movement in rabbits. The knee joints of experimental rabbits were examined with CT before and 6 months after operation to measure the TT-TG(Tibial Tubercle-Trochlear Groove distance, the distance between the tibial nodule and the trochlear, and the ratio of tibial nodule displacement. The changes of TT-TG(Tibial TubercleTrochlear Groove distance (tibial tuberculus-femoral trochlear distance) and the ratio of tibial nodule displacement were compared between the two groups. Results there was no significant difference in CT measurements between the preoperative control group and the patellar dislocation group. Six months after patellar dislocation of the knee joint, the results of statistical analysis showed that the TT-TG value of the control group was 0.35 鹵0.35, and that of the patellar dislocation group was 2.98 鹵0.66mmP0.05, while that of the control group was 0.46 鹵0.08, and that of the patellar dislocation group was 0.55 鹵0.05P0.05. Conclusion: early patellar dislocation can lead to the enlargement of TT-TG and the external insertion of tibial tubercle. It is also of great clinical significance that we should pay more attention to juvenile patellar dislocation and intervene at the early stage of patellar dislocation. Conservative or surgical treatment was given to improve patellofemoral involution of knee joint of juvenile patellar dislocation patients as early as possible to prevent the further development of dysplasia.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R684

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