量化脛骨前移度評(píng)估前交叉韌帶重建術(shù)后膝關(guān)節(jié)穩(wěn)定性的研究
發(fā)布時(shí)間：2019-05-06 18:12
【摘要】：研究目的： 本研究旨在觀察膝關(guān)節(jié)前交叉韌帶(Anterior Cruciate Ligament ACL)重建術(shù)前及術(shù)后隨訪的脛骨前移度、膝關(guān)節(jié)功能水平,探討量化脛骨前移度在評(píng)估ACL斷裂及重建術(shù)后膝關(guān)節(jié)穩(wěn)定性的意義。通過(guò)數(shù)據(jù)的收集、統(tǒng)計(jì)初步提出診斷ACL斷裂的脛骨前移度診斷參考數(shù)值,評(píng)估ACL重建術(shù)后膝關(guān)節(jié)穩(wěn)定性及關(guān)節(jié)功能的變化情況。 研究方法： 選擇2012.01—2014.03于廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院四骨科行關(guān)節(jié)鏡下前交叉韌帶重建手術(shù)的患者58例,55例患者完成1年以上隨訪,沒(méi)有發(fā)生相關(guān)并發(fā)癥。其中男31例,女24例；年齡19-46歲,平均30.8歲。致傷原因：運(yùn)動(dòng)損傷為46例,交通事故5例,工傷4例。損傷情況(關(guān)節(jié)鏡下確認(rèn))：其中單純ACL斷裂30例,ACL斷裂合并半月板損傷21例,ACL斷裂合并內(nèi)側(cè)副韌帶損傷4例。所有病例采用腰硬聯(lián)合麻醉、關(guān)節(jié)鏡下重建前交叉韌帶,移植物為自體胭繩肌腱(半腱肌肌腱、半膜肌肌腱)或者同種異體肌腱,所有患者手術(shù)由同一組醫(yī)生完成,術(shù)后采取一致的康復(fù)計(jì)劃。全部病例于術(shù)前應(yīng)用Kneelax3關(guān)節(jié)測(cè)量?jī)x(荷蘭,MONITORED REHABSYSTEMSB. V.型號(hào)：KNEELAX3)測(cè)量雙膝脛骨前移度,術(shù)后1年內(nèi)每隔3個(gè)月返院復(fù)查一次,每次復(fù)查時(shí)均使用Kneelax3關(guān)節(jié)測(cè)量?jī)x進(jìn)行術(shù)后重建交叉韌帶膝關(guān)節(jié)穩(wěn)定性的評(píng)估及行Lysholm膝關(guān)節(jié)功能評(píng)分,并作統(tǒng)計(jì)學(xué)比較分析。 研究結(jié)果： 膝關(guān)節(jié)屈曲30。下測(cè)量雙膝前移度,術(shù)前測(cè)試結(jié)果：44N拉力,患膝平均前移(3.35±1.90)mm,雙膝平均前移差值(0.64±0.13)mm。66N拉力,患膝平均前移(4.73±1.70)mm,雙膝平均前移差值(0.88±0.12)mm。88N拉力,患膝平均前移(6.36±1.21)mm,雙膝平均前移差值(1.57±0.22)mm。132N拉力,患膝平均前移(8.63±2.32)mm,雙膝平均前移差值(2.51±0.24)mm。在132N拉力時(shí),95%患膝脛骨前移值8.91mm,95%雙側(cè)脛骨前移差值2.52mm;95%患膝索引1.63mm,95%雙側(cè)索引差值0.68mm�；颊咝g(shù)后膝關(guān)節(jié)脛骨前移度小于術(shù)前,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。在ACL重建術(shù)后1年內(nèi),術(shù)后膝關(guān)節(jié)的脛骨前移度有一定的上升趨勢(shì),提示關(guān)節(jié)穩(wěn)定性隨時(shí)間推移有一定下降,但差異無(wú)統(tǒng)計(jì)學(xué)意義。Lysholm評(píng)分由術(shù)前的63.58±3.61分增加到術(shù)后(1年)的93.26±3.48分,差異有顯著性(P0.05)。 研究結(jié)論： Kneelax3關(guān)節(jié)測(cè)量?jī)x可用于量化評(píng)價(jià)膝關(guān)節(jié)ACL斷裂患者的膝關(guān)節(jié)前向穩(wěn)定性,ACL斷裂的膝關(guān)節(jié)前向穩(wěn)定性比健膝差。Kneelax3膝關(guān)節(jié)測(cè)量可作為一種輔助手段用于膝關(guān)節(jié)前交叉韌帶斷裂的診斷和療效評(píng)價(jià),提出其診斷ACL斷裂的參考值為132N應(yīng)力時(shí),患膝脛骨前移度8.91mm,索引1.63mm；雙側(cè)脛骨前移度差值2.52mm,索引差值0.68mm。關(guān)節(jié)鏡下ACL重建手術(shù)能減少患膝脛骨前移度,提高患膝的穩(wěn)定性,提高Lysholm膝關(guān)節(jié)功能評(píng)分,提高患者的生活質(zhì)量。隨著時(shí)間推移,術(shù)后1年內(nèi)膝關(guān)節(jié)的穩(wěn)定性有一定的下降趨勢(shì),Lysholm膝關(guān)節(jié)功能評(píng)分逐漸提高。
[Abstract]:Objective: the purpose of this study was to observe the anterior tibial movement and knee function before and after (Anterior Cruciate Ligament ACL) reconstruction of the anterior cruciate ligament (ACL) of the knee joint. Objective: to explore the significance of quantitative tibial anterior displacement in evaluating ACL fracture and knee joint stability after reconstruction. Through the collection of data, the diagnostic reference value of tibial anterior displacement for diagnosis of ACL fracture was put forward, and the changes of knee joint stability and joint function after ACL reconstruction were evaluated. Methods: fifty-eight patients who underwent arthroscopic anterior cruciate ligament reconstruction in the Department of four Orthopedics, the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine, were selected in this study. 55 patients were followed up for more than one year and no related complications were found. There were 31 males and 24 females with a mean age of 30.8 years (19 / 46). Cause of injury: 46 cases of sports injury, 5 cases of traffic accident and 4 cases of injury. There were 30 cases of simple ACL rupture, 21 cases of ACL rupture with meniscus injury, and 4 cases of ACL rupture with medial collateral ligament injury. The anterior cruciate ligament was reconstructed by arthroscopic reconstruction of anterior cruciate ligament by combined spinal and epidural anesthesia. The grafts were autogenous rouge tendon (semitendinosus tendon, semimembranous tendon) or allogeneic tendon. All patients were operated on by the same group of doctors. A consistent rehabilitation plan was adopted after operation. Kneelax3 joint measuring instrument was used in all cases before operation (, MONITORED REHABSYSTEMSB., Netherlands). v. Model: KNEELAX3) measured the anterior displacement of both knees and returned to hospital every 3 months within 1 year after operation. The stability of knee joint reconstruction of cruciate ligament after operation was evaluated with Kneelax3 joint measuring instrument and the score of knee joint function of Lysholm was used in each follow-up, and the knee joint stability of cruciate ligament reconstruction after operation was evaluated by Lysholm knee function score. At the same time, statistical comparative analysis was made. Results: flexion of knee joint was 30. 5%. The average forward shift of the affected knees was (3.35 鹵1.90) mm, and the average forward shift value of the affected knees was (0.64 鹵0.13) mm.66N, and the average forward movement of the affected knees was (4.73 鹵1.70) mm,. The results of the preoperative test showed that the average forward shift of the affected knees was (3.35 鹵1.90) mm, and (4.73 鹵1.70) mm, respectively. The average forward shift value of both knees was (0.88 鹵0.12) mm.88N, the average forward shift of the affected knees was (6.36 鹵1.21) mm, the average forward shift difference of both knees was (1.57 鹵0.22) mm.132N, and the average forward shift of the affected knees was (8.63 鹵2.32) mm,. The average forward difference of both knees was (2.51 鹵0.24) mm.. At 132N tension, 95% of patients suffered from knee tibial anterior displacement of 8.91mm, 95% of bilateral tibial anteversion difference of 2.52mm to 95% of knee index 1.63mm, 95% of bilateral index difference of 0.68mm. The anterior movement of knee joint after operation was lower than that before operation, the difference was statistically significant (P0.05). Within 1 year after ACL reconstruction, the anterior tibial displacement of the knee joint increased to a certain extent, suggesting that the stability of the knee joint decreased with the passage of time. Lysholm score increased from 63.58 鹵3.61 before operation to 93.26 鹵3.48 after operation (P0.05). Conclusion: the Kneelax3 joint measuring instrument can be used to quantitatively evaluate the anterior stability of knee joint in patients with ACL fracture of knee joint. The knee anterior stability of ACL fracture is worse than that of healthy knee. Kneelax 3 knee measurement can be used as an auxiliary method to diagnose and evaluate the curative effect of anterior cruciate ligament fracture of knee joint. When the reference value for diagnosing ACL fracture is 132N stress, the measurement of Kneelax 3 knee joint can be used to diagnose the fracture of anterior cruciate ligament. The anterior displacement of knee tibia was 8.91mm, and the index was 1.63mm. The difference of bilateral tibial forward displacement is 2.52mm, and the index difference is 0.68mm. Arthroscopic ACL reconstruction can reduce the anterior displacement of the knee, improve the stability of the knee, improve the Lysholm knee function score, and improve the quality of life of the patients. With the passage of time, the stability of knee joint decreased within 1 year after operation, and the Lysholm knee function score increased gradually.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R687.4
本文編號(hào)：2470386
[Abstract]:Objective: the purpose of this study was to observe the anterior tibial movement and knee function before and after (Anterior Cruciate Ligament ACL) reconstruction of the anterior cruciate ligament (ACL) of the knee joint. Objective: to explore the significance of quantitative tibial anterior displacement in evaluating ACL fracture and knee joint stability after reconstruction. Through the collection of data, the diagnostic reference value of tibial anterior displacement for diagnosis of ACL fracture was put forward, and the changes of knee joint stability and joint function after ACL reconstruction were evaluated. Methods: fifty-eight patients who underwent arthroscopic anterior cruciate ligament reconstruction in the Department of four Orthopedics, the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine, were selected in this study. 55 patients were followed up for more than one year and no related complications were found. There were 31 males and 24 females with a mean age of 30.8 years (19 / 46). Cause of injury: 46 cases of sports injury, 5 cases of traffic accident and 4 cases of injury. There were 30 cases of simple ACL rupture, 21 cases of ACL rupture with meniscus injury, and 4 cases of ACL rupture with medial collateral ligament injury. The anterior cruciate ligament was reconstructed by arthroscopic reconstruction of anterior cruciate ligament by combined spinal and epidural anesthesia. The grafts were autogenous rouge tendon (semitendinosus tendon, semimembranous tendon) or allogeneic tendon. All patients were operated on by the same group of doctors. A consistent rehabilitation plan was adopted after operation. Kneelax3 joint measuring instrument was used in all cases before operation (, MONITORED REHABSYSTEMSB., Netherlands). v. Model: KNEELAX3) measured the anterior displacement of both knees and returned to hospital every 3 months within 1 year after operation. The stability of knee joint reconstruction of cruciate ligament after operation was evaluated with Kneelax3 joint measuring instrument and the score of knee joint function of Lysholm was used in each follow-up, and the knee joint stability of cruciate ligament reconstruction after operation was evaluated by Lysholm knee function score. At the same time, statistical comparative analysis was made. Results: flexion of knee joint was 30. 5%. The average forward shift of the affected knees was (3.35 鹵1.90) mm, and the average forward shift value of the affected knees was (0.64 鹵0.13) mm.66N, and the average forward movement of the affected knees was (4.73 鹵1.70) mm,. The results of the preoperative test showed that the average forward shift of the affected knees was (3.35 鹵1.90) mm, and (4.73 鹵1.70) mm, respectively. The average forward shift value of both knees was (0.88 鹵0.12) mm.88N, the average forward shift of the affected knees was (6.36 鹵1.21) mm, the average forward shift difference of both knees was (1.57 鹵0.22) mm.132N, and the average forward shift of the affected knees was (8.63 鹵2.32) mm,. The average forward difference of both knees was (2.51 鹵0.24) mm.. At 132N tension, 95% of patients suffered from knee tibial anterior displacement of 8.91mm, 95% of bilateral tibial anteversion difference of 2.52mm to 95% of knee index 1.63mm, 95% of bilateral index difference of 0.68mm. The anterior movement of knee joint after operation was lower than that before operation, the difference was statistically significant (P0.05). Within 1 year after ACL reconstruction, the anterior tibial displacement of the knee joint increased to a certain extent, suggesting that the stability of the knee joint decreased with the passage of time. Lysholm score increased from 63.58 鹵3.61 before operation to 93.26 鹵3.48 after operation (P0.05). Conclusion: the Kneelax3 joint measuring instrument can be used to quantitatively evaluate the anterior stability of knee joint in patients with ACL fracture of knee joint. The knee anterior stability of ACL fracture is worse than that of healthy knee. Kneelax 3 knee measurement can be used as an auxiliary method to diagnose and evaluate the curative effect of anterior cruciate ligament fracture of knee joint. When the reference value for diagnosing ACL fracture is 132N stress, the measurement of Kneelax 3 knee joint can be used to diagnose the fracture of anterior cruciate ligament. The anterior displacement of knee tibia was 8.91mm, and the index was 1.63mm. The difference of bilateral tibial forward displacement is 2.52mm, and the index difference is 0.68mm. Arthroscopic ACL reconstruction can reduce the anterior displacement of the knee, improve the stability of the knee, improve the Lysholm knee function score, and improve the quality of life of the patients. With the passage of time, the stability of knee joint decreased within 1 year after operation, and the Lysholm knee function score increased gradually.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R687.4
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