本文選題：膝關(guān)節(jié)韌帶損傷　切入點(diǎn)：早期　出處：《大連醫(yī)科大學(xué)》2015年碩士論文

【摘要】：研究背景和目的:膝關(guān)節(jié)韌帶損傷屬于常見損傷,處理不及時(shí),易導(dǎo)致膝關(guān)節(jié)明顯松弛,從而引發(fā)膝關(guān)節(jié)功能障礙。而多數(shù)患者因患肢體征表現(xiàn)不明顯錯(cuò)過急診最佳治療期。所以本研究旨在探討膝關(guān)節(jié)韌帶損傷所致關(guān)節(jié)僵硬是否能通過早期功能鍛煉而起到有效的臨床治療療效。方法:收集2013年七月至2015年二月于大連醫(yī)科大學(xué)附屬第一醫(yī)院門診收治的35例膝關(guān)節(jié)韌帶損傷所致關(guān)節(jié)僵硬患者,其中男性15例,女性20例,年齡12歲至45歲,就診時(shí)間均大于傷后兩周,均為單膝閉合性損傷,損傷韌帶未完全斷裂,無其他部位骨折�？傆�(jì)左膝15例,右膝20例,其中內(nèi)側(cè)副韌帶損傷12例,后交叉韌帶損傷4例,前交叉韌帶損傷3例,內(nèi)側(cè)副韌帶合并后交叉韌帶損傷8例,內(nèi)側(cè)副韌帶合并前交叉韌帶損傷8例。所有患者以系統(tǒng)康復(fù)功能鍛煉保守治療為主。通過對比治療前后膝關(guān)節(jié)活動(dòng)度,下肢肌力評定,采用IKDC膝關(guān)節(jié)功能主觀評價(jià)表,Lysholm評分來評估治療效果。采用t檢驗(yàn)對計(jì)數(shù)資料進(jìn)行比較,將P0.05具有統(tǒng)計(jì)學(xué)意義的因素納入回歸模型中進(jìn)行分析;檢驗(yàn)水準(zhǔn)α=0.05,當(dāng)P0.05認(rèn)為有統(tǒng)計(jì)學(xué)意義,所有數(shù)據(jù)分析均通過SPSS17.0完成。結(jié)果:本組35例患者均獲得隨訪治療,隨訪治療時(shí)間均為一年,隨訪時(shí)35例較治療前有明顯改善,可滿足日常生活,查體見:治療后患者膝關(guān)節(jié)活動(dòng)范圍良好;患肢主動(dòng)伸直2°(±2°)至屈曲130°(±10°),基本與健側(cè)相同;所有患肢前抽屜試驗(yàn)及后抽屜試驗(yàn)均為(-)或(+-);Lachman實(shí)驗(yàn)屈膝10°-15°時(shí)抽屜試驗(yàn)均為(-)或(+-);膝關(guān)節(jié)0°位和30°位側(cè)方應(yīng)力試驗(yàn)均為(-)或(+-);軸移實(shí)驗(yàn)3人為(+)性,其余均為(-),雙膝90°時(shí)被動(dòng)內(nèi)旋和外旋,兩側(cè)對比無明顯差異。膝關(guān)節(jié)力線正常;關(guān)節(jié)穩(wěn)定性良好。通過對股四頭肌的抗阻力檢測,股四頭肌抗阻力測定為4級,部分患者股四頭肌的抗阻力檢測可達(dá)5級。MRI隨訪見韌帶損傷部位均存在自愈現(xiàn)象。膝關(guān)節(jié)IKDC膝關(guān)節(jié)功能主觀評價(jià)表:35例患者治療前評分情況如下,其中有3人評分為D級,28人為C級,4人為B級。治療后一年隨訪,其中3人評分為C級,30人評分為B級,2人評分為A級.治療前后膝關(guān)節(jié)功能活動(dòng)度有明顯改善;膝關(guān)節(jié)Lysholm評分:治療前27.09±9.76分,治療后末次隨訪84.51±8.51分。治療前后隨訪比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),即治療有效。結(jié)果:膝關(guān)節(jié)韌帶損傷所致關(guān)節(jié)僵硬早期通過系統(tǒng)的功能鍛煉可及時(shí)有效地保護(hù)膝關(guān)節(jié),使膝關(guān)節(jié)達(dá)到正常功能,該方法損傷小,恢復(fù)快,臨床效果好。尤其是適合膝關(guān)節(jié)韌帶部分損傷的患者。
[Abstract]:Background and objective: ligament injury of knee joint is a common injury. This study was designed to investigate whether joint stiffness caused by ligamentous injury of the knee joint can be achieved by early functional exercise. Methods: from July 2013 to February 2015, 35 cases of knee joint stiffness caused by ligament injury were collected from the first affiliated Hospital of Dalian Medical University. There were 15 males and 20 females, aged from 12 to 45 years old. The time of seeing a doctor was longer than that of two weeks after injury. All of them were closed injury of one knee, incomplete rupture of the injured ligament and no fracture of other parts. There were 15 cases of left knee and 20 cases of right knee. There were 12 cases of medial collateral ligament injury, 4 cases of posterior cruciate ligament injury, 3 cases of anterior cruciate ligament injury, 8 cases of medial collateral ligament combined with posterior cruciate ligament injury. There were 8 cases of medial collateral ligament associated with anterior cruciate ligament injury. The IKDC knee joint function subjective evaluation table was used to evaluate the therapeutic effect. T test was used to compare the count data, and P0.05 factors with statistical significance were analyzed in the regression model. Results: all the 35 patients were followed up for one year, and 35 cases were improved after treatment. After treatment, the range of knee joint motion was good, the active extension of the affected limb was 2 擄(鹵2 擄) to flexion 130 擄(鹵10 擄), which was basically the same as that of the normal side. All the anterior drawer tests and posterior drawer tests of the affected limbs were either -) or (-) or (-) or (-) or (-) or (-) when the knee flexion was 10 擄-15 擄; the lateral stress tests of the knee joints at 0 擄and 30 擄were either -) or (-) or (-) or (-); The rest of the patients were in the same position. The passive internal rotation and external rotation at 90 擄were not significantly different between the two sides. The strength line of the knee joint was normal, and the joint stability was good. The anti-resistance of quadriceps femoris muscle was determined to be grade 4 by detecting the resistance of quadriceps femoris muscle. The anti-resistance test of quadriceps femoris muscle in some patients can be up to grade 5. Follow-up showed that there was self-healing in the site of ligament injury. The subjective evaluation table of knee joint function of IKDC: 35 patients before treatment were as follows. One year after the treatment, 30 patients with grade C and 30 patients with grade C were graded as grade B and 2 patients with grade A. the functional range of knee joint improved significantly before and after treatment. Lysholm score of knee joint: 27.09 鹵9.76 before treatment, The last follow-up after treatment was 84.51 鹵8.51 points. There was significant difference between the two groups before and after treatment, that is, the treatment was effective. Results: the knee joint stiffness caused by ligamentous injury of knee joint could be protected in time and effectively by systematic functional exercise. This method has the advantages of little injury, quick recovery and good clinical effect, especially for the patients with partial ligament injury of the knee joint.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R684

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本文編號：1660498