發(fā)布時間：2018-03-08 10:15

  本文選題：踝關(guān)節(jié)外側(cè)副韌帶　切入點：腓骨長肌肌腱　出處：《四川醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:觀察取自體部分腓骨長肌肌腱重建踝關(guān)節(jié)外側(cè)副韌帶及改良Brostr?m術(shù)兩種手術(shù)方式治療踝關(guān)節(jié)外側(cè)副韌帶陳舊性損傷的臨床療效,初步探討取自體部分腓骨長肌肌腱重建踝關(guān)節(jié)外側(cè)副韌帶的可行性及有效性。方法:研究我院2012年8月~2013年5月,38例踝關(guān)節(jié)外側(cè)副韌帶陳舊性損傷患者,年齡18~43歲,平均30歲,男24例,女14例,病程均在4個月以上,均有踝關(guān)節(jié)疼痛,打軟腿,多次扭傷病史。其中22例采用取自體部分腓骨長肌肌腱重建踝關(guān)節(jié)外側(cè)副韌帶(A組),16例采用改良Brostr?m手術(shù)(B組),觀察術(shù)前術(shù)后AOFAS(美國足踝外科協(xié)會的踝與后足評分系統(tǒng))評分,觀察術(shù)前術(shù)后距骨傾斜角(talar tilt,TT)及距骨前移距離(anterior talar translation,ATT)的改變。并比較兩組患者手術(shù)時間及并發(fā)癥情況。結(jié)果:1、手術(shù)時間及一般資料B組(改良Brostr?m組)患者的平均手術(shù)時間為66.7±18.0min,A組(重建組)患者的平均手術(shù)時間為70.6±14.0min,兩組病人手術(shù)時間比較(P=0.752及t=0.457,P0.05),兩組病人術(shù)前距骨傾斜角(TT)比較(P=0.655及t=0.451,P0.05)、距骨前移距離(ATT)比較(P=0.978及t=0.028,P0.05)及AOFAS評分(分)比較(P=0.249及t=1.171,P0.05),兩組病人在手術(shù)時間、術(shù)前TT值、ATT值及AOFAS評分的差異無統(tǒng)計學(xué)意義。所有患者治療后均未出現(xiàn)傷口并發(fā)癥、踝關(guān)節(jié)繼發(fā)骨折、錨釘脫出等并發(fā)癥,A組未出現(xiàn)腓骨長肌肌腱斷裂、腓神經(jīng)損傷等并發(fā)癥。2、AOFAS評分平均隨訪時間為(20±5.7)月和(22.6±4.1)月,AOFAS評分,B組(改良Brostr?m組)術(shù)前為(59.38±2.247)分,術(shù)后末次隨訪為(86.50±2.160)分;A組(重建組)術(shù)前為(58.36±2.904)分,術(shù)后末次隨訪為(91.50±2.241)分。兩組病人術(shù)后AOFAS評分比較(P=0.000,P0.01),有統(tǒng)計學(xué)意義,A組優(yōu)于B組。治療前后AOFAS評分提高的分值部分,A組(33.14±2.100)分,B組(26.88±2.729)分,兩組比較(P=0.000,P0.01),有統(tǒng)計學(xué)意義,A組優(yōu)于B組。兩組病人術(shù)前術(shù)后AOFAS評分比較均為(P=0.000,P0.01),有統(tǒng)計學(xué)意義,治療有效。3、距骨傾斜角及距骨前移距離B組(改良Brostr?m組)距骨傾斜角(TT)由術(shù)前16.0°±1.34°改善為術(shù)后的末次隨訪時的6.44°±1.209°,距骨前移距離(ATT)由術(shù)前7.44±1.153mm改善為末次隨訪時5.63±1.147mm,A組(重建組)TT由術(shù)前16.23°±1.688°改善為末次隨訪6.27°±1.077°,ATT由術(shù)前7.45±1.01mm改善為末次隨訪時5.5±1.185mm。兩組病人術(shù)后TT值比較(P=0.188及t=1.342,P0.05)、ATT值比較(P=0.736及t=0.340,P0.05),兩組病人術(shù)后TT、ATT值差異無統(tǒng)計學(xué)意義,兩組病人在術(shù)后穩(wěn)定性方面無明顯差異。A組病人術(shù)前TT、ATT值與術(shù)后TT、ATT值比較均為(P=0.000,P0.01),B組術(shù)前TT、ATT值與術(shù)后TT、ATT值比較均為(P=0.000,P0.01),有統(tǒng)計學(xué)意義,術(shù)后TT、ATT值均明顯優(yōu)于術(shù)前。結(jié)論:1、采用取自體部分腓骨長肌肌腱重建踝關(guān)節(jié)外側(cè)副韌帶及改良Brostr?m術(shù)兩種手術(shù)方法均可明顯改善踝關(guān)節(jié)外側(cè)副韌帶陳舊性損傷病人術(shù)后功能及穩(wěn)定性。2、采用改良Brostr?m手術(shù)與取自體部分腓骨長肌肌腱重建踝關(guān)節(jié)外側(cè)副韌帶手術(shù)在患者術(shù)后關(guān)節(jié)穩(wěn)定性方面無明顯差異。3、采用取自體部分腓骨長肌肌腱重建踝關(guān)節(jié)外側(cè)副韌帶較改良Brostr?m術(shù)在病人術(shù)后功能恢復(fù)方面有一定的優(yōu)勢。
[Abstract]:Objective: To observe the effect of autologous peroneus longus tendon reconstruction of the lateral ligament of ankle joint and modified Brostr? Two surgical methods of m in the treatment of lateral ankle ligament injury in old clinical efficacy, to explore the feasibility and effectiveness of autologous partial peroneus longus tendon reconstruction of ankle lateral collateral ligament. Methods: the study our hospital in August 2012 ~2013 year in May, 38 cases of ankle lateral ligament injury in old patients, aged 18~43 years old, average 30 years old, male 24 cases, female 14 cases, the course was more than 4 months, with ankle pain, play soft legs, repeatedly twisting injury history. There were 22 cases of autologous part of fibula long muscle tendon reconstruction of the lateral ligament of ankle joint (A group), 16 cases with modified Brostr? M surgery (B group), to observe the postoperative AOFAS (AOFAS ankle and hindfoot score system) score, observe the postoperative talar tilt (talar tilt TT) And the translation of talus (anterior talar translation, ATT) change. And compare the two groups of patients with operation time and complications. Results: 1, the operation time and the general information group B (modified Brostr? M group) the average operation time of the patients was 66.7 + 18.0min, group A (reconstruction group) average operation time of patients 70.6 + 14.0min, two groups were compared operative time (P=0.752 and t=0.457, P0.05), two groups of patients before the talar tilt (TT) comparison (P=0.655 and t=0.451, P0.05), translation of talus (ATT) comparison (P=0.978 and t=0.028, P0.05) and AOFAS score (points) compared (P=0.249 and t=1.171, P0.05), the two groups of patients at the time of surgery, preoperative TT value, there were no significant differences in ATT values and AOFAS scores. All patients had no wound complications, secondary ankle fracture, anchor prolapse and other complications in A group, there was no fracture of long peroneal muscle tendon, peroneal nerve injury 騫跺彂鐥，

本文編號：1583473