本文選題：脛骨髁間嵴撕脫骨折　切入點(diǎn)：關(guān)節(jié)鏡下復(fù)位內(nèi)固定　出處：《延安大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過(guò)回顧性分析脛骨髁間嵴撕脫骨折關(guān)節(jié)鏡下空心拉力螺釘內(nèi)固定和傳統(tǒng)切開(kāi)復(fù)位內(nèi)固定的臨床療效,對(duì)比兩種手術(shù)治療脛骨髁間嵴撕脫骨折的優(yōu)缺點(diǎn),為臨床治療脛骨髁間嵴撕脫骨折手術(shù)方式的選擇提供更好的理論依據(jù)。方法:回顧性分析2012年1月~2015年1月延安大學(xué)附屬醫(yī)院骨科收住入院的脛骨髁間嵴撕脫骨折患者47例,關(guān)節(jié)鏡下空心拉力螺釘內(nèi)固定組(治療組)25例,傳統(tǒng)切開(kāi)復(fù)位內(nèi)固定組(對(duì)照組)22例,根據(jù)Meyers和Mckeekver分型,分別記錄每個(gè)患者手術(shù)時(shí)間、術(shù)中出血量、住院時(shí)間;兩組術(shù)前、術(shù)后2周、術(shù)后3月膝關(guān)節(jié)屈伸活動(dòng)度;兩組術(shù)前、術(shù)后2周、術(shù)后3月Lysholm膝關(guān)節(jié)評(píng)分;治療組和對(duì)照組術(shù)后并發(fā)癥比較,進(jìn)行統(tǒng)計(jì)分析,評(píng)價(jià)兩種手術(shù)治療的臨床療效。結(jié)果:經(jīng)過(guò)對(duì)比分析,治療組與對(duì)照組患者在一般資料方面相比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);治療組手術(shù)時(shí)間為(56.12±10.68min),對(duì)照組手術(shù)時(shí)間(75.45±12.43min),兩組經(jīng)統(tǒng)計(jì)分析,P0.05,差異有統(tǒng)計(jì)學(xué)意義。治療組術(shù)中出血量(81.96±10.42ml),對(duì)照組術(shù)中出血量(134.65±17.58ml),兩組相比較,差異有統(tǒng)計(jì)學(xué)意義,P0.05;治療組住院時(shí)間(10.42±4.26d),對(duì)照組住院時(shí)間(14.73±5.81d),兩組比較,差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05。兩組患者術(shù)前、術(shù)后2周、術(shù)后3月膝關(guān)節(jié)活動(dòng)度比較:治療組術(shù)前膝關(guān)節(jié)活動(dòng)度(1.43±2.78),對(duì)照組術(shù)前膝關(guān)節(jié)活動(dòng)度(34.81±2.64),兩組經(jīng)統(tǒng)計(jì)學(xué)分析,差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05;治療組術(shù)后2周膝關(guān)節(jié)活動(dòng)度(87.74±4.65),對(duì)照組術(shù)后2周膝關(guān)節(jié)活動(dòng)度(85.42±5.26),兩組統(tǒng)計(jì)學(xué)比較,差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05;治療組術(shù)后3月膝關(guān)節(jié)活動(dòng)度(127.36±10.34),對(duì)照組術(shù)后3月膝關(guān)節(jié)活動(dòng)度(114.82±9.81),兩組統(tǒng)計(jì)學(xué)比較,差異有統(tǒng)計(jì)學(xué)意義,P0.05。治療組術(shù)前、術(shù)后3月相比較,差異有統(tǒng)計(jì)學(xué)意義,P0.05;對(duì)照組術(shù)前、術(shù)后3月相比較,差異有統(tǒng)計(jì)學(xué)意義,P0.05。術(shù)前、術(shù)后2周、術(shù)后3月膝關(guān)節(jié)Lysholm評(píng)分結(jié)果顯示:①治療組術(shù)前膝關(guān)節(jié)Lysholm(40.25±13.65),經(jīng)治療術(shù)后可達(dá)(84.71±12.43),隨訪術(shù)后3月為(92.68±6.73),術(shù)前、術(shù)后2周、術(shù)后3月相比較,差異有統(tǒng)計(jì)學(xué)意義,P0.05;對(duì)照組術(shù)前膝關(guān)節(jié)Lysholm(38.95±14.68),經(jīng)治療術(shù)后2周可達(dá)(80.69±14.52),隨訪術(shù)后3月(85.64±4.75),術(shù)前、術(shù)后2周、術(shù)后3月相比較,差異有統(tǒng)計(jì)學(xué)意義,P0.05。②術(shù)前膝關(guān)節(jié)Lysholm治療組和對(duì)照組相比較,差異無(wú)明顯統(tǒng)計(jì)學(xué)意義,P0.05;術(shù)后2周膝關(guān)節(jié)Lysholm治療組和對(duì)照組相比較,差異無(wú)明顯統(tǒng)計(jì)學(xué)意義,P0.05;術(shù)后3月兩組膝關(guān)節(jié)Lysholm評(píng)分比較差異有統(tǒng)計(jì)學(xué)意義,P0.05。治療組和對(duì)照組術(shù)后并發(fā)癥比較:兩組患者均無(wú)術(shù)后感染、內(nèi)固定失敗,治療組出現(xiàn)術(shù)后疼痛1例,術(shù)后關(guān)節(jié)僵硬1例,總并發(fā)癥2例,占總數(shù)的8.0%;對(duì)照組出現(xiàn)術(shù)后疼痛4例,術(shù)后關(guān)節(jié)僵硬3例,總并發(fā)癥7例,占總數(shù)的31.82%,兩組經(jīng)X2檢驗(yàn),p0.05,即兩組并發(fā)癥發(fā)生率存在顯著差異。結(jié)論:①對(duì)于脛骨髁間嵴撕脫骨折患者,關(guān)節(jié)鏡下空心拉力螺釘內(nèi)固定和傳統(tǒng)切開(kāi)復(fù)位內(nèi)固定,都能獲得較好的臨床療效。②從患者術(shù)中出血量、手術(shù)時(shí)間、術(shù)后膝關(guān)節(jié)Lysholm評(píng)分、術(shù)后膝關(guān)節(jié)功能活動(dòng)度、術(shù)后膝關(guān)節(jié)并發(fā)癥等方面比較,治療組明顯優(yōu)于對(duì)照組。③脛骨髁間嵴撕脫骨折關(guān)節(jié)鏡下空心拉力螺釘內(nèi)固定治療,手術(shù)時(shí)間較短,切口小、創(chuàng)傷小、內(nèi)固定牢固可靠,術(shù)后膝關(guān)節(jié)可以早期進(jìn)行康復(fù)訓(xùn)練,減少術(shù)后膝關(guān)節(jié)僵硬、局部組織粘連,臨床療效滿意。④雖然本組病例在進(jìn)行兩種手術(shù)方法的組間比較分析時(shí),也作統(tǒng)計(jì)學(xué)處理,不過(guò)仍屬小樣本研究,在反映結(jié)果的準(zhǔn)確性及全面性上存在一定局限,但仍可為臨床處理脛骨髁間嵴骨折提供參考。
[Abstract]:Objective: through the retrospective analysis of the tibial intercondylar eminence fracture under arthroscopic cannulated screws internal fixation and the clinical effect of open reduction and internal fixation, comparing the two kinds of surgical treatment of tibial intercondylar eminence fracture and the advantages and disadvantages, for the clinical treatment of avulsion fracture of tibial intercondylar eminence and provide a theoretical basis for better operation mode choice. Methods: a retrospective analysis of January 2012 January ~2015 were admitted to the Department of orthopedics of Affiliated Hospital of Yan'an University of avulsion fracture of tibial intercondylar eminence in 47 cases, cannulated screws internal fixation under arthroscopy group (treatment group) 25 cases, conventional cut open reduction and internal fixation group (control group) 22 cases, according to the Meyers and Mckeekver type each of the patients were recorded, the operation time, bleeding volume, operation time; two groups before surgery, 2 weeks after operation, postoperative knee joint flexion and extension in March; two groups before surgery, 2 weeks after operation, postoperative March Lysholm knee score; treatment Comparison group and postoperative complications in the control group, statistical analysis, evaluation of clinical curative effect of the treatment of two types of surgery. Results: by comparison, the treatment group and the control group of patients in the general data comparison showed no significant difference (P0.05); the treatment group operation time was (56.12 + 10.68min), control group (operation time 75.45 + 12.43min), the two groups by statistical analysis, P0.05, the difference was statistically significant. The treatment group blood loss (81.96 + 10.42ml), the control group blood loss (134.65 + 17.58ml), compared the two groups, the difference was statistically significant, P0.05; the treatment group hospitalization time (10.42 + 4.26d). The control group hospitalization time (14.73 + 5.81d), the two groups, the difference was not statistically significant, P0.05. two groups of patients before and 2 weeks after operation, postoperative knee joint activity in March: in the treatment group before surgery of knee joint (1.43 + 2.78), the control group before surgery of knee joint (34.81 + 2.64), 涓ょ粍緇忕粺璁″鍒嗘瀽,宸紓鏃犵粺璁″鎰忎箟,P0.05;娌葷枟緇勬湳鍚，

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