本文選題：內(nèi)側(cè)半月板損傷 + 內(nèi)側(cè)間室　； 參考：《中南大學學報(醫(yī)學版)》2017年09期

【摘要】：目的:探討在膝關(guān)節(jié)鏡手術(shù)中,運用內(nèi)側(cè)副韌帶(medial collateral ligament,MCL)拉花松解技術(shù)處理合并膝關(guān)節(jié)內(nèi)側(cè)間室緊張的內(nèi)側(cè)半月板后角(posterior horn of medial meniscus,PHMM)撕裂時的安全性和有效性。方法:2013年1月至2014年12月對32例合并膝關(guān)節(jié)內(nèi)側(cè)間室緊張的PHMM撕裂患者,均使用MCL拉花松解技術(shù)。用18號靜脈穿刺針于MCL脛骨止點附近進行松解,同時取膝關(guān)節(jié)外翻位處理PHMM撕裂。術(shù)后第1天、4周、12周分別行外翻應力試驗及雙膝外翻應力位X線片評估MCL愈合情況。術(shù)后1,3,6個月隨訪,之后每半年隨訪1次,每次采用疼痛視覺評分(Visual Analogue Scales,VAS),Lysholm,Tegner和國際膝關(guān)節(jié)文獻委員會(International Knee Documentation Committee,IKDC)評分評價患側(cè)膝關(guān)節(jié)功能。結(jié)果:32例患者均得到隨訪,隨訪時間24~36(平均28)個月。無1例MCL撕裂、股骨骨折、關(guān)節(jié)軟骨損傷及神經(jīng)血管損傷等并發(fā)癥。雙膝外翻應力位X線片內(nèi)側(cè)關(guān)節(jié)間隙測量:術(shù)后第1天健側(cè)為(4.3±1.3)mm,患側(cè)為(6.6±1.6)mm,二者比較差異有統(tǒng)計學意義(P0.05);術(shù)后4周健側(cè)為(4.2±1.5)mm,患側(cè)為(5.5±1.2)mm,二者比較差異有統(tǒng)計學意義(P0.05);術(shù)后12周健側(cè)為(4.3±1.4)mm,患側(cè)為(4.8±1.5)mm,二者比較差異無統(tǒng)計學意義(P0.05)。VAS術(shù)前4.5±1.5,最終隨訪為1.7±1.0,二者比較差異有統(tǒng)計學意義(t=16.561,P0.05);Lysholm評分術(shù)前為52.3±5.8,最終隨訪為93.2±6.3,二者比較差異有統(tǒng)計學意義(t=-41.353,P0.05);Tegner評分術(shù)前為4.1±1.1,最終隨訪為5.5±0.6,二者比較差異有統(tǒng)計學意義(t= 18.792,P0.05);IKDC主觀評分術(shù)前為54.5±6.2,最終隨訪為93.8±4.5,二者比較差異有統(tǒng)計學意義(t= 38.253,P0.05)。結(jié)論:MCL拉花松解是一種安全、有效的處理合并膝關(guān)節(jié)內(nèi)側(cè)間室緊張的PHMM撕裂的手術(shù)方法。
[Abstract]:Objective: to investigate the safety and efficacy of medial collateral ligamentum ligamentus medial collateral ligament (medial collateral ligamentus) decompression technique in the treatment of posterior meniscus posterior meniscusPHMMMMM with medial interventricular tension in knee arthroscopy. Methods: from January 2013 to December 2014, 32 cases of PHMM tears complicated with medial ventricular tension of knee joint were treated with MCL technique. The venous puncture needle No. 18 was used to release the tibia near the tibia of MCL, and the knee joint valgus was taken to deal with PHMM tear. The healing of MCL was evaluated by valgus stress test and X ray film of double knee valgus stress position at 4 weeks and 12 weeks after operation. Visual Analogue scales and Lysholm Tegner and International knee documentation Committee (Ike) were used to evaluate the knee function of the affected side. Results all 32 cases were followed up for 24 ~ 36 (mean 28) months. There were no complications such as MCL laceration, femoral fracture, articular cartilage injury and neurovascular injury. Measurement of the medial joint space in the bilateral knee valgus stress position: on the 1st day after operation, the normal side was 4.3 鹵1.3 mm, the affected side was 6.6 鹵1.6 mm, the difference was statistically significant (P 0.05), the healthy side was 4.2 鹵1.5 mm and the affected side was 5.5 鹵1.2 mm at 4 weeks after operation, the difference was statistically significant (P 0.05). 12 weeks after operation, the healthy side was 4.3 鹵1.4 mm and the affected side 4.8 鹵1.5 mm. There was no significant difference between the two groups before operation (4.5 鹵1.5) and final follow-up (1.7 鹵1.0). The difference between the two groups was statistically significant (P < 0.01). The Lysholm score was 52.3 鹵5.8 before operation and 93.2 鹵6.3 at final follow-up. Tegner score was 4.1 鹵1.1 before operation and 5.5 鹵0.6 at final follow-up. There was significant difference between the two groups. The subjective score of IKDC was 54.5 鹵6.2 before operation and 93.8 鹵4.5 at final follow-up. There was significant difference between the two groups. Conclusion it is safe and effective to treat PHMM tears associated with medial ventricular tension of knee joint.
【作者單位】： 中南大學湘雅二醫(yī)院骨科;
【基金】：湖南省財政廳科研項目(2015137)~~
【分類號】：R687.4
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本文編號：1992677