本文關(guān)鍵詞： 關(guān)節(jié)鏡 前交叉韌帶 單束重建 解剖重建 臨床療效　出處：《河北北方學(xué)院》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：前瞻性對(duì)比關(guān)節(jié)鏡下前交叉韌帶(Anterior Cruciate ligament,ACL)股骨止點(diǎn)的解剖重建和傳統(tǒng)重建兩種不同定位方法的術(shù)后近期臨床療效。選取自2013年3月到2014年6月解放軍第252醫(yī)院骨關(guān)節(jié)外科收治的ACL斷裂患者,根據(jù)制定的選擇條件和排除條件進(jìn)行選擇,符合條件的患者共62例,其中男性患者50例,女性患者12例,年齡19~51歲,平均(30.90±9.18)歲,對(duì)所有患者進(jìn)行術(shù)前Lysholm膝關(guān)節(jié)評(píng)分。根據(jù)擬實(shí)施關(guān)節(jié)鏡下ACL重建手術(shù)股骨隧道定位點(diǎn)的不同,術(shù)前隨機(jī)抽取將全部患者分為解剖重建組和對(duì)照組。其中解剖重建組32例,在術(shù)中股骨止點(diǎn)定位方式上采用單束解剖重建,即建立的股骨隧道定位點(diǎn)為髁間窩過(guò)頂點(diǎn)與“裸區(qū)”(我們將外髁的內(nèi)側(cè)面沒(méi)有被軟骨覆蓋的區(qū)域稱為“裸區(qū)”)凹點(diǎn)切跡的連線中心點(diǎn),對(duì)照組30例則采用傳統(tǒng)的單束重建即通過(guò)脛骨隧道,在股骨外髁內(nèi)側(cè)壁相當(dāng)于鐘表面11點(diǎn)(右膝)或1點(diǎn)(左膝)的位置確定重建韌帶的股骨止點(diǎn)。兩組患者術(shù)后通過(guò)膝關(guān)節(jié)穩(wěn)定性、活動(dòng)度及Lysholm膝關(guān)節(jié)評(píng)分評(píng)估膝關(guān)節(jié)的功能,比較兩種股骨止點(diǎn)定位方法術(shù)后6~15個(gè)月膝關(guān)節(jié)的功能。結(jié)果顯示全部患者術(shù)后獲6~15個(gè)月,平均(9.50±2.63)個(gè)月的隨訪,最后隨訪時(shí),解剖重建組:全部患者膝關(guān)節(jié)屈伸活動(dòng)度正常,Lysholm膝關(guān)節(jié)評(píng)分從術(shù)前的17~73分,平均(50.18±15.60)分提高至隨訪結(jié)束時(shí)的82~100分,平均(95.83±4.98),術(shù)后評(píng)分優(yōu)于術(shù)前且差異具有顯著性意義(P0.05)。對(duì)照組:全部患者膝關(guān)節(jié)屈伸活動(dòng)度正常,Lysholm膝關(guān)節(jié)評(píng)分從術(shù)前的15~74分平均(49.93±18.16)分提高至隨訪結(jié)束時(shí)的74~100分,平均(88.00±8.84)分,術(shù)后評(píng)分優(yōu)于術(shù)前且差異具有顯著性意義(P0.05)。解剖重建組與對(duì)照組術(shù)前Lysholm評(píng)分沒(méi)有顯著性差異(P0.05),兩組術(shù)后隨訪結(jié)束時(shí)的Lysholm評(píng)分解剖重建組優(yōu)于對(duì)照組且差異具有顯著性意義(P0.05)。根據(jù)結(jié)果兩種手術(shù)方式術(shù)后都能使患者的膝關(guān)節(jié)功能得到基本的恢復(fù),均能取得較好的臨床療效。結(jié)果顯示關(guān)節(jié)鏡下ACL股骨止點(diǎn)的單束解剖重建與傳統(tǒng)的單束重建相比,術(shù)后近期臨床療效和膝關(guān)節(jié)功能恢復(fù)具有優(yōu)勢(shì)。但是由于本研究病例數(shù)較少,隨訪時(shí)間短,仍需增加樣本量,遠(yuǎn)期療效的差異也需要進(jìn)一步觀察。
[Abstract]:Anterior Cruciate ligament of anterior cruciate ligament was prospectively contrasted with arthroscopy. ACL). The short term clinical effect of two different localization methods: anatomical reconstruction and traditional reconstruction of femur. ACL from March 2013 to June 2014 in osteoarticular surgery of 252nd Hospital of PLA. A broken patient. According to the selection conditions and exclusion conditions, 62 patients were selected, including 50 male patients and 12 female patients aged 1951 years. The average age was 30. 90 鹵9. 18 years. All patients were evaluated with Lysholm knee joint score before operation. According to the location of femoral tunnel under arthroscopic ACL reconstruction. All the patients were randomly divided into anatomic reconstruction group and control group. 32 cases in anatomic reconstruction group were reconstructed by single bundle anatomical reconstruction. The established femoral tunnel location point is the line center of the notch of the intercondylar fossa and the "bare area" (we call the area not covered by cartilage on the medial side of the external condyle as the "bare area"). 30 cases in the control group were treated with traditional single-bundle reconstruction through tibial tunnel. The medial wall of the lateral femoral condyle was located at 11:00 (right knee) or 1 o'clock (left knee) on the surface of the bell to determine the femoral insertion of the reconstructed ligament. The stability of the knee joint was obtained after operation in both groups. The range of motion and Lysholm knee joint score were used to evaluate the function of knee joint, and to compare the function of knee joint between 6 and 15 months after operation by two methods of femoral insertion location. The results showed that all the patients received 6 ~ 15 months after operation. The average follow-up was 9.50 鹵2.63 months. At the last follow-up, in the anatomic reconstruction group, the Lysholm knee joint score of all the patients with normal knee flexion and extension activity was 1773 points before operation. The average score of 50.18 鹵15.60 was increased to 82-100 at the end of follow-up, with an average of 95.83 鹵4.98). The postoperative score was better than that before operation and the difference was significant (P 0.05). Control group: the knee flexion and extension of all the patients had normal range of motion. The Lysholm knee joint score increased from 159.93 鹵18.16 to 74-100 at the end of follow-up. The average score was 88.00 鹵8.84. The postoperative score was better than that before operation and the difference was significant (P 0.05). There was no significant difference in preoperative Lysholm score between the anatomical reconstruction group and the control group (P 0.05). The Lysholm score of the two groups at the end of follow-up was better than that of the control group (P 0.05). According to the results, the knee joint function of the patients was basically recovered after operation. The results showed that the single bundle anatomical reconstruction of the femoral insertion point of ACL under arthroscopy was better than that of the traditional single bundle reconstruction. The short-term clinical effect and the recovery of knee joint function have advantages, but because of the small number of cases and the short follow-up time, we still need to increase the sample size, and the difference of long-term curative effect also needs to be further observed.
【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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本文編號(hào)：1458410