本文選題：髕骨脫位 + 髕骨不穩(wěn)��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：研究背景:隨著我國經(jīng)濟(jì)的發(fā)展,人口逐步增長(zhǎng),髕骨脫位及髕骨周圍組織損傷所造成的髕骨不穩(wěn)定的患者也逐漸增多。膝關(guān)節(jié)外傷�？蓪�(dǎo)致髕股內(nèi)側(cè)支持帶損傷,引起膝關(guān)節(jié)前部疼痛,嚴(yán)重時(shí)可引起患肢膝關(guān)節(jié)穩(wěn)定性下降,甚至造成患者患肢活動(dòng)障礙。若該損傷未能得到及有效時(shí)的治療,則膝關(guān)節(jié)髕股關(guān)節(jié)面不穩(wěn)將導(dǎo)致關(guān)節(jié)面軟骨磨損加速,遠(yuǎn)期發(fā)生膝關(guān)節(jié)骨性關(guān)節(jié)炎的風(fēng)險(xiǎn)較高。而就髕骨脫位而言,該病的易感因素作用與疾病的發(fā)生及發(fā)展有著較為密切的聯(lián)系。隨著醫(yī)學(xué)科學(xué)的發(fā)展和進(jìn)步,近年來越來越多的易感因素被納入到髕骨脫位易感性的評(píng)價(jià)體系中來,并且已經(jīng)取得了一定的研究結(jié)果,特別是在影像學(xué)相關(guān)的對(duì)于易感因素的診斷方面。但是對(duì)于髕骨脫位易感因素綜合作用及諸多易感因素的關(guān)系的相關(guān)研究較少,且并無一科學(xué)有效并得到廣泛認(rèn)可的評(píng)價(jià)體系來評(píng)價(jià)髕骨脫位的患病風(fēng)險(xiǎn)。目的:探討影響髕骨脫位發(fā)生的眾多易感因素的作用強(qiáng)弱、易感因素之間的相互作用規(guī)律以及由急性初次髕骨脫位轉(zhuǎn)變?yōu)閺?fù)發(fā)性髕骨脫位的主要易感因素及其作用強(qiáng)弱。方法:回顧性分析我院2010年1月至2016年10月就診于我院并以“髕骨脫位”為主要診斷收入我科的患者122例,將其分為急性初次脫位組(初發(fā)組):共42例,和復(fù)發(fā)型脫位組(復(fù)發(fā)組):共80例。收集患者的患肢膝關(guān)節(jié)正側(cè)位平片、膝關(guān)節(jié)mr平掃以及ct平掃影像學(xué)資料。其中患者年齡16.3±5.4,性別:男:70例,女:52例。分別對(duì)初發(fā)組和復(fù)發(fā)組的患者進(jìn)行測(cè)量。收集其年齡、性別、髕骨形態(tài)分型、髕骨高度、髕骨傾斜、滑車形態(tài)分型、滑車溝深度、滑車外側(cè)傾斜角、tt-tg距離以及q角等資料,并對(duì)所收集的資料進(jìn)行統(tǒng)計(jì)學(xué)分析。分析所收集的易感因素中各因素所占比例,并比較初發(fā)組與復(fù)發(fā)組中各個(gè)易感因素之間是否具有統(tǒng)計(jì)學(xué)差異。除此之外,選取初發(fā)組與復(fù)發(fā)組中具有顯著差異的易感因素用于評(píng)分系統(tǒng)的制作,用于評(píng)價(jià)髕骨脫位由初次脫位轉(zhuǎn)變?yōu)閺?fù)發(fā)脫位的風(fēng)險(xiǎn)。結(jié)果:初發(fā)組年齡為17±3.3歲,復(fù)發(fā)組年齡為15±5.2歲,具有顯著差異(p0.05)。初發(fā)組insall-salvati值為1.30±0.16,復(fù)發(fā)組為1.37±0.13,具有顯著差異(p0.05)。初發(fā)組髕骨傾斜角:17°±4.8,復(fù)發(fā)組髕骨傾斜角為:20°±6.8,具有顯著差異(p0.05)。初發(fā)組滑車溝深度:2.2±0.15mm,復(fù)發(fā)組滑車溝深度:2.1±0.23mm,具有統(tǒng)計(jì)學(xué)差異(p0.05)。初發(fā)組滑車外側(cè)傾斜角:12.2°±0.05,復(fù)發(fā)組滑車外側(cè)傾斜角:12.5°±0.08,兩者經(jīng)統(tǒng)計(jì)學(xué)分析無明顯差異。初發(fā)組tt-tg距離12±7.4mm,復(fù)發(fā)組tt-tg距離16±8.8mm,兩組間具有顯著差異(p0.05)。初發(fā)組:q角:22°±2.2,復(fù)發(fā)組:q角:23°±1.5,不具有顯著差異。初發(fā)組:男性28人,女性14人,復(fù)發(fā)組:男性42人,女性38人。不具顯著差異。初發(fā)組:輕度滑車發(fā)育不良18人,重度滑車發(fā)育不良:24人,復(fù)發(fā)組:輕度滑車發(fā)育不良12人,重度滑車發(fā)育不良68人。具有顯著差異。初發(fā)組:WibergⅠ型18人,WibergⅡ型10人,WibergⅢ型14人,復(fù)發(fā)組WibergⅠ型30人,WibergⅡ型28人,WibergⅢ型22人,不具有顯著差異。總體樣本中各易感因素比例:高位髕骨占90.16%(110),髕骨傾斜占70.49%(86),滑車發(fā)育不良95.83%(115),脛骨結(jié)節(jié)外移75.41%(92),股骨前傾過大68.85%(84),年齡小于16歲:59.01%(72),男性57.38%(70),女性42.62%(52),WibergⅠ型:39.34%(48),WibergⅡ型31.15%(38),WibergⅢ型29.51%(36)。選取年齡、髕骨高度、髕骨傾斜、滑車發(fā)育情況以及脛骨結(jié)節(jié)位置這5項(xiàng)易感因素制作評(píng)分系統(tǒng)。以復(fù)發(fā)組80名患者的得分分析易感因素,其中0分2人,1分5人,2分11人,3分人36,4分21人,5分7人。結(jié)論:1.在眾多髕骨脫位易感因素中滑車發(fā)育不良對(duì)于髕骨脫位的發(fā)生的作用最為重要。2.年齡、髕骨高度、髕骨傾斜、滑車發(fā)育情況以及脛骨結(jié)節(jié)位置這5項(xiàng)易感因素在初次髕骨脫位轉(zhuǎn)變?yōu)閺?fù)發(fā)型髕骨脫位的過程中有重要作用。3.復(fù)發(fā)脫位風(fēng)險(xiǎn)評(píng)分系統(tǒng)能有效評(píng)價(jià)患者復(fù)發(fā)脫位的風(fēng)險(xiǎn)。
[Abstract]:Background: with the development of China's economy and the gradual increase of population, patellar instability caused by dislocation of patella and the injury of the surrounding patellar tissue is increasing. The knee joint trauma often leads to the injury of the medial patellar retinaculum, causing pain in the front of the knee joint, which can cause the stability of the knee joint to decrease and even cause the suffering of the knee joint. If the injury is not available and effective, the instability of the patellar joint surface of the knee joint will lead to the acceleration of the articular cartilage wear, and the risk of the long-term knee osteoarthritis is higher. As for the patellar dislocation, the susceptibility factor of the disease is closely related to the occurrence and development of the disease. With the development and progress of medical science, more and more susceptible factors have been brought into the evaluation system of patellar dislocation susceptibility in recent years, and some research results have been obtained, especially in the diagnosis of susceptibility factors related to imaging. There is less research on the relationship of factors, and there is no scientific and effective evaluation system to evaluate the risk of patellar dislocation. Objective: To explore the effect of many susceptible factors that affect patellar dislocation, the interaction between the susceptible factors and the change from the acute first patellar dislocation to recurrence. Methods: a retrospective analysis of 122 patients in our hospital from January 2010 to October 2016 with "patellar dislocation" as the main diagnostic income of our department was divided into 42 cases of acute initial dislocation group (primary group): a total of 80 cases (relapse group): a total of 80 cases. Mr plain scan of the knee joint of the affected limb, flat scan of knee joint and CT plain scan imaging data. The age of the patients was 16.3 + 5.4, sex: male: 70 cases and 52 cases. The age, sex, patellar morphology, patellar height, patellar tilting, trochlear shape, trochlear depth, and trochlear were collected. The data collected by the oblique angle, the TT-TG distance and the Q angle were statistically analyzed. The proportion of the factors in the susceptible factors collected was analyzed, and the statistical difference between the primary and recurrent groups was compared. Sensory factors were used to make a scoring system for evaluating the risk of patellar dislocation from initial dislocation to recurrent dislocation. Results: the age of the first group was 17 + 3.3 years, the age of the recurrent group was 15 + 5.2 years, with a significant difference (P0.05). The initial group insall-salvati was 1.30 + 0.16, the relapse group was 1.37 + 0.13, with a significant difference (P0.05). Patellar patella in the primary group. The angle of bone inclination was 17 + 4.8. The patellar tilting angle of the recurrent group was 20 + 6.8 (P0.05). The depth of the trochlear groove in the primary group was 2.2 + 0.15mm, and the depth of the trochlear trench in the recurrent group was 2.1 + 0.23mm, with statistical difference (P0.05). The lateral inclination of the trochlear in the primary group was 12.2? 0.05, and the lateral inclination of the trochlear in the recurrent group was 12.5? 0.08. The statistical credits were counted. The TT-TG distance of the primary group was 12 + 7.4mm, and the TT-TG distance in the recurrent group was 16 + 8.8mm, and the two groups had significant differences (P0.05). The initial group was Q angle: 22 + 2.2. The recurrent group was Q angle: 23 / 1.5, no significant difference. The primary group was 42 men, 14 women and 38. No significant difference. The primary group: mild trochlear hair There were 18 poor children and 24 severe trochlear dysplasia: 12 patients with mild trochlear dysplasia and 68 severe trochlear dysplasia. There were 18 Wiberg type I, 10 Wiberg type II, 14 Wiberg type III, Wiberg type I in relapse group, Wiberg type I 28, and 22 Wiberg III, with no significant difference. The proportion of various susceptibility factors: 90.16% (110) of high patellar bone, 70.49% (86) of patellar tilting, 95.83% (115) of trochlear dysplasia, 75.41% (92) of tibial tubercle, 68.85% (84) of femur, younger than 16 years of age: 59.01% (72), Wiberg type I, Wiberg type I, Wiberg type III type. Taking age, patellar height, patellar tilt, trochlear development and tibial nodule position, the scoring system was made to make a scoring system. The scores of 80 patients in the recurrent group were analyzed easily, including 0 points, 2, 1, 5, 2, 11, 3 36,4 21, 5 7. Conclusion: 1. in numerous patellar dislocation factors, 1. slide car dysplasia in many patellar dislocation factors. The most important.2. age, the height of the patella, the patellar tilt, the development of the trochlear and the position of the tibial tubercle, the 5 susceptible factors of patellar dislocation have an important role in the transformation of the initial patellar dislocation into a recurrent patellar dislocation. The risk of recurrent dislocation of.3. can be effectively evaluated by the risk score of recurrent dislocation of the patellar dislocation.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R681.8

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本文編號(hào)：1917859