本文選題：月骨 + 游離肌腱��； 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:月骨無菌性壞死又稱Kienbock病,好發(fā)于青壯年優(yōu)勢腕,病因至今不明,可分為內(nèi)因和外因,是多種因素共同作用導(dǎo)致的結(jié)果,隨著現(xiàn)代影像學(xué)技術(shù)的發(fā)展,臨床診斷較為明確,但治療方案多樣化。根據(jù)臨床分期,月骨無菌性壞死早期可行保守治療,而大量文獻(xiàn)資料報(bào)道,多數(shù)晚期病人均需通過手術(shù)治療,且手術(shù)方案繁多,主要分為生物學(xué)手術(shù)、生物力學(xué)手術(shù)、月骨單純摘除和月骨替代術(shù)、近排腕骨切除術(shù)及橈腕關(guān)節(jié)融合術(shù)。目前較為常用的治療晚期月骨無菌性壞死的術(shù)式是月骨摘除游離肌腱填塞術(shù),常選擇掌長肌腱腱球作為月骨替代物,但對(duì)于填塞后能否確保腕關(guān)節(jié)穩(wěn)定性及功能恢復(fù),腕部解剖關(guān)系的改變是否會(huì)造成新的腕部創(chuàng)傷,至今顯有報(bào)道,因此我們考慮能否通過分析比較在治療晚期月骨無菌性壞死的過程中采取或未采取游離肌腱填塞的患者臨床資料隨訪,探討肌腱填塞后對(duì)腕關(guān)節(jié)穩(wěn)定性及功能的影響。對(duì)比兩種治療晚期月骨無菌性壞死的術(shù)式,為臨床工作中肌腱切除的必要性及切除后肌腱填塞的效果提供一定的參考依據(jù),為月骨無菌性壞死的治療提供更好的選擇。方法:研究對(duì)象:根據(jù)研究的需要制定出病例選擇標(biāo)準(zhǔn):①根據(jù)患者病史、體格檢查、X線及CT三維成像技術(shù),確診為晚期月骨無菌性壞死的患者②按照臨床常用的Lichtman分期,病情屬Ⅲ、Ⅳ期患者③無中樞系統(tǒng)疾病或其他腕關(guān)節(jié)損傷性疾�、軣o代謝性疾病、無患側(cè)腕關(guān)節(jié)炎癥、腕部骨折及脫位病史、手術(shù)史的患者⑤無影響手術(shù)治療的全身性疾病。我們將選擇回顧河北醫(yī)科大學(xué)第三醫(yī)院自2005-2014過去9年內(nèi)所收治的月骨無菌性壞死患者共55例,其中早期患者10例(Ⅰ期、Ⅱ期),不作為此次研究對(duì)象。將符合上述篩選標(biāo)準(zhǔn)的晚期月骨無菌性壞死患者45例,共計(jì)45側(cè),所有檢查患者中右手為優(yōu)勢手40例,左手5例。分為對(duì)照組:行單純月骨摘除術(shù)20例(20側(cè))。研究組:行月骨摘除掌長肌腱填塞術(shù)25例(25側(cè)),平均隨訪時(shí)間為術(shù)后6個(gè)月~9年,分別測定兩組患者Cooney評(píng)分,術(shù)前及術(shù)后改良腕高率、改良腕高指數(shù),并利用上肢功能障礙評(píng)定量表(PRWE)評(píng)定患者術(shù)后生活質(zhì)量,所測得的數(shù)據(jù)采用SPSS21.0統(tǒng)計(jì)學(xué)軟件進(jìn)行分析。計(jì)量資料用χ—±S表示,組間比較采用t檢驗(yàn)及秩和檢驗(yàn)。結(jié)果:1一般結(jié)果兩組患者共45例(45側(cè)),通過門診隨訪,其中行傳統(tǒng)單純月骨摘除術(shù)20例(20側(cè)),行月骨摘除游離掌長肌腱填塞術(shù)25例(25側(cè)),患者住院時(shí)間平均15天,手術(shù)切口均未出現(xiàn)感染、血腫、皮緣壞死、瘢痕粘連等并發(fā)癥,平均拆線時(shí)間12天,均達(dá)到一期愈合,術(shù)后隨訪無一例患者出現(xiàn)腕關(guān)節(jié)功能障礙,正中神經(jīng)卡壓,畸形及疼痛加重等并發(fā)癥,所有獲得隨訪患者臨床癥狀均有不同程度的改善,腕關(guān)節(jié)屈伸活動(dòng)范圍及患肢握力值較術(shù)前明顯增大,腕部正中神經(jīng)Tinel征(-)。2療效評(píng)價(jià)、改良腕高率及改良腕高比值的測定2.1療效評(píng)價(jià)按照Cooney腕關(guān)節(jié)評(píng)分法,傳統(tǒng)單純月骨摘除術(shù)組:優(yōu)12例,良4例,可3例,差1例,優(yōu)良率80%。月骨摘除游離掌長肌腱填塞組:優(yōu)20例,良3例,可2例,差0例,優(yōu)良率92%,兩組患者手術(shù)療效優(yōu)良率比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2.2改良腕高率及改良腕高指數(shù)的測定本次研究中采用Nattran提出的改良腕高率及改良腕高指數(shù)作為術(shù)后腕骨排列是否紊亂的測定標(biāo)準(zhǔn),分別測定兩組患者術(shù)前、術(shù)后改良腕高率及改良腕高指數(shù)。術(shù)前兩組患者改良腕高率測定結(jié)果比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)前兩組患者改良腕高指數(shù)測定結(jié)果比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后兩組患者改良腕高率測定結(jié)果比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后兩組患者改良腕高指數(shù)測定結(jié)果比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3患者PRWE評(píng)分測定根據(jù)Mac Dermid提出的PRWE(Patient-Rated Wrist Evaluation)腕關(guān)節(jié)功能評(píng)分,術(shù)后隨訪兩組患者PRWE評(píng)分比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1對(duì)于晚期月骨無菌性壞死病人行月骨摘除游離掌長肌腱填塞術(shù)是一種有效的手術(shù)方法。2腕月骨摘除后游離掌長肌腱填塞術(shù)療效確切,手術(shù)操作簡便,創(chuàng)傷小,患者恢復(fù)時(shí)間短,花費(fèi)少,可做為晚期月骨壞死病人首選術(shù)式。3填塞肌腱對(duì)腕骨穩(wěn)定性有一定的支撐作用,可防止腕骨排列的紊亂。
[Abstract]:Objective: the aseptic necrosis of the moon bone, called Kienbock's disease, is well distributed in the dominant wrist of the young and middle-aged. The cause of the disease is not clear so far. It can be divided into internal and external causes. It is the result of a variety of factors. With the development of modern imaging technology, the clinical diagnosis is more clear, but the treatment scheme is diversified. According to clinical stages, the early osteonecrosis of the bone is possible. Conservative treatment, and a large number of literature reports, most advanced patients need surgical treatment, and there are various surgical procedures, mainly divided into biological surgery, biomechanical surgery, bone removal and bone replacement, near row carpal and radial wrist arthrodesis. The most commonly used treatment of advanced osteonecrosis of the moon bone is currently used. There is a report on whether the change of the wrist anatomical relationship will cause a new wrist trauma, but we consider whether or not it is possible to treat the late month bone by analysis and comparison. In the process of bacterial necrosis, the clinical data of patients with or without free tendon tamponade were followed up to explore the effects of tendon tamponade on the stability and function of the wrist. Two methods for the treatment of advanced osteonecrosis of the moon were compared to provide a certain reference for the necessity of tendon excision and the effect of the tendon tamponade in the clinical work. To provide a better choice for the treatment of aseptic necrosis of the bone. Methods: according to the needs of the study, the case selection criteria were established: (1) patients with advanced aseptic necrosis of the bone were diagnosed according to the patient's history, physical examination, X - ray and CT three-dimensional imaging techniques, according to the commonly used Lichtman staging. There is no metabolic disease, no metabolic disease, no lateral wrist inflammation, wrist fracture and dislocation, and no surgical history of patients with systemic disease. We will choose to review the Third Hospital of Hebei Medical University since 2005-2014 for the past 9 years. There were 55 cases of bacterial necrosis. 10 of the early patients (stage I, stage II) were not the subject of this study. 45 patients with advanced osteonecrosis of the month bone, which were in line with the above screening criteria, total 45 sides, 40 cases of the right hand and 5 left hand in all patients, were divided into the control group: 20 cases (20 sides) were performed simple months of bone extirpation. The study group: A Study Group: 25 cases (25 sides) of long term tendon tamponade were removed. The average follow-up time was 6 months ~9 years after the operation. The Cooney score was measured in two groups of patients. The rate of wrist height was improved before and after the operation, the wrist high index was improved, and the quality of life after the operation was evaluated by the upper limb dysfunction rating scale (PRWE). The measured data were measured by SPSS21.0 statistics software. The measurement data were expressed with chi square S, and the t test and rank sum test were used in the group. Results: 45 cases (45 sides) were compared with 45 cases (45 sides). 20 cases (20 sides) were performed traditional simple monthly bone extirpation and 25 cases (25 sides) were removed with free metacarpal long tendon. The average hospitalization time was 15 days, and all the surgical incisions were in the patients. There was no infection, hematoma, necrosis of skin margin, scar adhesion and other complications. The average time of breaking the line was 12 days. All patients were followed up with one stage healing. None of the patients were followed up with wrist joint dysfunction, median nerve compression, malformation and aggravation of pain. All patients were followed up with different degrees of improvement in clinical symptoms and flexion and extension of wrist joint. The dynamic range and the value of the grip strength of the affected limb were significantly higher than that before the operation. The evaluation of the effect of the median nerve Tinel sign (-).2 of the wrist, the improved wrist high rate and the improved wrist high ratio were evaluated according to the Cooney wrist joint scoring method and the traditional simple month bone extirpation group: excellent 12 cases, good 4 cases, 3 cases, 1 poor cases, and excellent rate of 80%. month bone removal free palmar long muscle tendon tamponade Group: excellent 20 cases, good 3 cases, 2 cases, poor 0 cases, good rate 92%, two groups of patients have no significant difference in operation effect (P0.05).2.2 improved wrist high rate and improved wrist high index measurement in this study using Nattran proposed improved wrist high rate and improved wrist high finger number as the postoperative carpal arrangement disorder determination criteria, The improved wrist high rate and improved wrist height index were not measured before operation in the two groups. There was no significant difference between the two groups before the operation (P0.05). There was no significant difference between the two groups before the operation of improved wrist height index (P0.05). The results of the improved wrist high rate in the two groups were different after the operation. There was statistical significance (P0.05). The results of improved wrist height index in two groups were statistically significant (P0.05) the PRWE score of.3 patients was measured according to the PRWE (Patient-Rated Wrist Evaluation) wrist joint function score based on Mac Dermid, and there was a significant difference in PRWE score between the two groups of patients after the operation (P0.05). Conclusion: 1 For patients with advanced osteonecrosis of the bone, free palmar long tendon tamponade is an effective operative method for the patients with osteonecrosis of the bone. The free palmar long tendon tamponade after.2 wrist extirpation is effective. The operation is simple, the trauma is small, the recovery time is short, and the cost is less. It is the first choice of the surgical.3 tamponade to the wrist in the late month of the osteonecrosis patients. Bone stability has a certain supporting function to prevent the disorder of carpal arrangement.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王焱;李公;潘恒;何矯;;帶血管蒂橈骨瓣移位術(shù)治療月骨缺血性壞死[J];中國當(dāng)代醫(yī)藥;2013年29期

2 唐詩添;黃富國;王軍;康斌;唐華;;頭狀骨移位治療月骨無菌性壞死[J];華西醫(yī)學(xué);2009年04期

3 欽斌;黃永火;黃偉;呂發(fā)金;甘強(qiáng);王仁崇;;國人正常月骨的CT測量及其臨床意義[J];重慶醫(yī)科大學(xué)學(xué)報(bào);2009年01期

4 潘志軍;趙云珍;;腕月骨無菌性壞死診治研究進(jìn)展[J];浙江醫(yī)學(xué);2008年10期

5 張峰;臧洪敏;;骨間前動(dòng)脈背側(cè)支橈骨瓣移植術(shù)治療月骨壞死療效觀察[J];山東醫(yī)藥;2008年21期

6 宮旭,路來金;月骨無菌性壞死的治療進(jìn)展[J];國外醫(yī)學(xué)(骨科學(xué)分冊);2005年05期

7 王曉南,陳克俊;月骨無菌性壞死的臨床治療進(jìn)展[J];實(shí)用手外科雜志;2004年01期

8 宮旭,路來金,王克利;舟骨環(huán)形征在腕月骨無菌性壞死X線片分期中的臨床意義[J];中華手外科雜志;2004年01期

9 孟釗,邵新中,周君琳,張桂生,陳燕;四種自體植入物作月骨替代物的對(duì)比實(shí)驗(yàn)研究[J];中華手外科雜志;2003年04期

10 陳雪榮,周平,孫文東,車斌;頭狀骨移位治療月骨無菌性壞死[J];骨與關(guān)節(jié)損傷雜志;2003年05期

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