本文選題：膝關(guān)節(jié)　切入點(diǎn)：多發(fā)韌帶損傷　出處：《吉林大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 通過對膝關(guān)節(jié)多發(fā)韌帶損傷患者不同階段的治療，探討多發(fā)韌帶損傷后同期重建治療與分期重建治療的臨床療效對比。 方法： 選取自2009年6月至2014年3月間，于本院骨科治療的67例多發(fā)韌帶損傷患者進(jìn)行隨訪，男性患者42例，女性患者25例，年齡18-54歲，平均年齡37歲。交通事故28例，高處跌落16例，高空墜物14例，滑雪等扭傷9例,均為閉合傷。傷后手術(shù)時(shí)間2～20天，平均7天。Schenk分型（KDII~KDV）：KDII型（ACL+PCL）37例、KDIIIM型（ACL+PCL+MCL）14例、KDIIIL型（ACL+PCL+LCL）11例、KDIV型（ACL+PCL+MCL+LCL）5例，間或伴有半月板損傷�；颊呋枷リP(guān)節(jié)前、后抽屜實(shí)驗(yàn)均為陽性，Lachman實(shí)驗(yàn)陽性，IKDC評分D。手術(shù)方案：分期治療：一期重建后交叉韌帶，修復(fù)內(nèi)、外側(cè)副韌帶或及損傷的半月板，二期重建前交叉韌帶；同期治療：同期重建前、后交叉韌帶或及修復(fù)內(nèi)、外側(cè)副韌帶，損傷的半月板；并早期開始功能康復(fù)鍛煉。記錄患者術(shù)前、術(shù)后Lysholm評分、IKDC評分，評估手術(shù)療效。 結(jié)果： 術(shù)后患者恢復(fù)良好，切口均Ⅰ期愈合，少數(shù)患者存在腫脹、疼痛等并發(fā)癥，，患者隨訪6~24個(gè)月。同期治療：手術(shù)術(shù)后3個(gè)月復(fù)查，后抽屜試驗(yàn)陰性；內(nèi)、外側(cè)研磨試驗(yàn)陰性；內(nèi)外側(cè)方應(yīng)力試驗(yàn)陰性；3例Luchman試驗(yàn)弱陽性；分期治療：一期手術(shù)術(shù)后3個(gè)月復(fù)查，后抽屜試驗(yàn)陰性；內(nèi)、外側(cè)研磨試驗(yàn)陰性；內(nèi)外側(cè)方應(yīng)力試驗(yàn)陰性；前抽屜試、Luchman試驗(yàn)陽性。二期手術(shù)術(shù)后三個(gè)月復(fù)查，前抽屜試及后抽屜試驗(yàn)陰性；Luchman試驗(yàn)陰性。將記錄數(shù)據(jù)行統(tǒng)計(jì)學(xué)分析，術(shù)后復(fù)查數(shù)據(jù)對比術(shù)前Lysholm功能評分有明顯改善，分期重建與同期重建Lysholm評分對比有統(tǒng)計(jì)學(xué)差異。 結(jié)論： 1.膝關(guān)節(jié)多發(fā)韌帶損傷鏡下分期重建及同期重建均效果良好。 2.膝關(guān)節(jié)多發(fā)韌帶損傷分期重建臨床療效優(yōu)秀率要高于同期重建。 3.關(guān)節(jié)鏡下韌帶重建安全可行、創(chuàng)傷小、副作用少。
[Abstract]:Objective:. Through the treatment of multiple ligament injury of knee joint at different stages, the clinical effect of reconstruction after multiple ligament injury was compared with that of stage reconstruction. Methods:. From June 2009 to March 2014, 67 patients with multiple ligament injury treated in our hospital were followed up. There were 42 male patients and 25 female patients, aged 18-54 years, with an average age of 37 years. There were 16 cases of high fall, 14 cases of falling objects and 9 cases of sprain, all of which were closed injuries. The operative time after injury was 220 days, with an average of 7 days. Schenk's classification included KDIIIM / KDII / PCL)37, KDIIIM / KDII / ACL PCL MCL)14 / KDIIIL / ACL PCL LCL)11 / KDIV PCL MCL LCL)5, respectively. The anterior and posterior drawer tests were all positive Lachman test positive and IKDC score D.Surgical scheme: stage treatment: reconstruction of posterior cruciate ligament, repair of medial and lateral collateral ligament or injured meniscus. Second stage reconstruction of anterior cruciate ligament; simultaneous treatment: before and after reconstruction of posterior cruciate ligament and repair of medial and lateral collateral ligaments and injured meniscus; and early functional rehabilitation exercise. The Lysholm score of patients before and after operation was recorded. To evaluate the curative effect of the operation. Results:. The patients recovered well, the incisions healed in the first stage, and a few patients had complications such as swelling and pain. The patients were followed up for 624 months. At the same time, 3 months after operation, the posterior drawer test was negative, the medial and lateral lapping tests were negative. Luchman test was weakly positive in 3 cases with stress test on both sides of the inner and outer side, and was treated by stages: 3 months after primary operation, the posterior drawer test was negative, the inner and outer side lapping test was negative, the inner and outer side stress test was negative, and the internal and external side stress test was negative. The anterior drawer test was positive for Luchman test. Three months after secondary operation, the former drawer test and posterior drawer test negative Luchman test were negative. The recorded data were statistically analyzed, and the postoperative reexamination data were significantly improved compared with the preoperative Lysholm score. There was statistical difference between Lysholm score of stage reconstruction and that of reconstruction at the same time. Conclusion:. 1. Arthroscopic reconstruction and simultaneous reconstruction of multiple ligament injury of knee joint were effective. 2. The rate of clinical effect of multiple ligament injury reconstruction by stages was higher than that of simultaneous reconstruction. 3. Arthroscopic ligament reconstruction is safe and feasible, with less trauma and less side effects.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.4

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本文編號：1618805