本文選題：踝關(guān)節(jié)　切入點(diǎn)：關(guān)節(jié)鏡　出處：《石河子大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:對(duì)不同原因所致踝關(guān)節(jié)腫痛接受關(guān)節(jié)鏡治療后的臨床療效進(jìn)行評(píng)價(jià)。方法:回顧性分析于2010到2015年間在石河子大學(xué)第一附屬醫(yī)院接受關(guān)節(jié)鏡檢查并進(jìn)行微創(chuàng)手術(shù)的30例有踝關(guān)節(jié)腫痛患者的臨床資料。其中男性15例,女性15例,年齡16-76歲(平均48歲);單純左踝損傷為10例,單純右踝損傷為19例,雙側(cè)踝關(guān)節(jié)損傷為1例;16例疼痛部位為前外側(cè)痛,5例疼痛部位為前內(nèi)側(cè)痛,5例疼痛部位為前側(cè)痛,4例疼痛部位為后側(cè)痛。病因:8例骨性關(guān)節(jié)炎,8例滑膜炎(包含急性和慢性),7例創(chuàng)傷性關(guān)節(jié)炎,3例骨性關(guān)節(jié)炎合并滑膜炎,1例類風(fēng)濕性關(guān)節(jié)炎合并創(chuàng)傷性關(guān)節(jié)炎,1例痛風(fēng)性關(guān)節(jié)炎合并滑膜炎,1例類風(fēng)濕性關(guān)節(jié)炎,1例痛風(fēng)性關(guān)節(jié)炎。排除踝關(guān)節(jié)關(guān)節(jié)間隙完全消失;手術(shù)部位軟組織感染;有出血的傾向;高弓足、足內(nèi)翻等嚴(yán)重畸形的患者。病程1個(gè)月-21年,平均48個(gè)月。所有患者均常規(guī)行踝關(guān)節(jié)正側(cè)位X線和踝關(guān)節(jié)MRI,12例患者出現(xiàn)增生骨贅和游離體,6例有陳舊性撕脫骨折。MRI示18例患者有踝關(guān)節(jié)有少量積液,15例患者有軟組織嵌夾,踝關(guān)節(jié)前側(cè)和前外側(cè)最常發(fā)生腫脹。關(guān)節(jié)鏡下需對(duì)患者進(jìn)行以下操作,包含了單純滑膜清理術(shù)、增生骨贅切除術(shù)、游離體摘除術(shù);通過(guò)美國(guó)足踝外科協(xié)會(huì)(AOFAS)踝后足評(píng)分,Meislin criterie(邁斯林標(biāo)準(zhǔn))以及可視化疼痛評(píng)分(VAS)對(duì)每個(gè)病人術(shù)前、術(shù)后3個(gè)月時(shí)以及術(shù)后6個(gè)月時(shí)的踝關(guān)節(jié)功能狀態(tài)進(jìn)行評(píng)估。使用SPSS 22.0統(tǒng)計(jì)學(xué)軟件對(duì)本次收集數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)處理,對(duì)患者術(shù)前、術(shù)后3個(gè)月、術(shù)后6個(gè)月時(shí)的AOFAS評(píng)分采用配對(duì)t檢驗(yàn)進(jìn)行統(tǒng)計(jì)學(xué)分析,p0.05為差異有統(tǒng)計(jì)學(xué)意義;對(duì)患者術(shù)前、術(shù)后3個(gè)月、術(shù)后6個(gè)月時(shí)的隨訪結(jié)果VASFA評(píng)分采用秩和檢驗(yàn)比較,p0.05表示差異有統(tǒng)計(jì)學(xué)意義;對(duì)患者術(shù)后3個(gè)月、術(shù)后6個(gè)月的Meislin criterie(邁斯林標(biāo)準(zhǔn))進(jìn)行總優(yōu)良率的計(jì)算。結(jié)果:在術(shù)后3個(gè)月及6個(gè)月的隨訪中,AOFAS評(píng)分由術(shù)前的61.73±5.70增加至術(shù)后3個(gè)月84.90±1.97、6個(gè)月89.53±4.66,術(shù)前術(shù)后比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);Meislin criterie(邁斯林標(biāo)準(zhǔn))評(píng)估結(jié)果:術(shù)后3個(gè)月時(shí)分?jǐn)?shù)為優(yōu)良的有9例患者(占30%的比例);術(shù)后6個(gè)月時(shí)分?jǐn)?shù)為優(yōu)良的有26例患者(占86.7%的比例)。隨訪過(guò)程中VAS評(píng)分也得到了改善。結(jié)論:關(guān)節(jié)鏡對(duì)各種原因所致的踝關(guān)節(jié)腫痛確有較好的臨床療效,值得推廣應(yīng)用。
[Abstract]:Objective: to evaluate the clinical effect of arthroscopic treatment for ankle swelling and pain caused by different causes. Methods: from 2010 to 2015, the arthroscopic examination was performed in the first affiliated Hospital of Shihezi University. Clinical data of 30 patients with ankle swelling and pain, including 15 males, 15 women, aged 16-76 years (mean 48 years old), had 10 left ankle injuries and 19 right ankle injuries. Bilateral ankle joint injury: 1 case: 16 cases pain site: anterolateral pain site 5 cases anterior and medial pain site 5 cases anterior side pain 4 cases anterior side pain 4 cases posterior side pain. Etiology of 8 cases of osteoarthritis and 8 cases of synovitis (including 5 cases of anterior medial pain 5 cases of pain site of anterior side pain of 4 cases of pain site of pain site of 4 cases of pain site of posterior side pain. Acute and chronic arthritis 7 cases of traumatic arthritis 3 cases of osteoarthritis with synovitis 1 case of rheumatoid arthritis with traumatic arthritis 1 case of gouty arthritis with synovitis 1 case of gouty arthritis. Ganglitis. Eliminating the complete disappearance of ankle joint space; Surgical site soft tissue infection; tendency to bleed; patients with severe deformities such as high arch foot, foot varus, etc. The course of disease ranged from 1 month to 21 years. Mean 48 months. All patients were routinely treated with X-ray and MRI of ankle joint, 12 cases with osteophyte hyperplasia and 6 cases with old avulsion fracture. MRI showed that 18 cases had ankle joint with a small amount of effusion and 15 cases had soft tissue clamp. Anterior and anterolateral ankle swelling is most common. Arthroscopic procedures include simple synovial debridement, excision of osteophytes and excision of free body. Meislin criteriee (Meislin criteria) and visual pain score (VASS) were used for each patient before operation. The functional status of ankle was evaluated 3 months after operation and 6 months after operation. The collected data were statistically processed with SPSS 22.0 statistical software. The AOFAS score at 6 months after operation was statistically analyzed by paired t test, and there was significant difference between the two groups before and 3 months after operation. The VASFA score at 6 months after operation was compared with the rank sum test, and the difference was statistically significant at 3 months after operation. The total excellent and good rate of Meislin was calculated at 6 months after operation. Results: the scores of Meislin were increased from 61.73 鹵5.70 before operation to 84.90 鹵1.97 and 89.53 鹵4.66 at 3 months and 6 months after operation, respectively. There was a significant difference before and after operation. Results of Meislin criteria: 9 patients (30%%) had good scores at 3 months after operation, 26 patients (86.7%%) had good scores at 6 months after operation. Conclusion: arthroscopy has a good clinical effect on ankle swelling and pain caused by various causes. It is worth popularizing and applying.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4

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