本文選題：尺骨 + 短縮截骨術(shù)��； 參考：《華北理工大學(xué)》2015年碩士論文

【摘要】：目的探討尺骨遠(yuǎn)端橫形截骨、梯形截骨及干骺端斜形截骨三種不同短縮截骨方法在治療尺骨撞擊綜合征方面的臨床療效。方法分析華北理工大學(xué)附屬骨科醫(yī)院在2010年1月至2014年1月采用三種不同短縮截骨方法治療的尺骨撞擊綜合征患者共44例,將患者分為3組,其中尺骨遠(yuǎn)端橫形截骨組(A組)13例,尺骨遠(yuǎn)端梯形截骨組(B組)15例,尺骨遠(yuǎn)端干骺端斜形截骨組(C組)16例。于圍手術(shù)期分別記錄三組患者的切口長(zhǎng)度、手術(shù)所需時(shí)間及術(shù)中出血量;比較三組患者術(shù)前、術(shù)后尺骨變異情況、Mayo評(píng)分變化情況、截骨斷端愈合時(shí)間及VAS評(píng)分變化情況,用于評(píng)估三種不同尺骨短縮截骨方法對(duì)尺骨撞擊綜合征患者的癥狀改善程度及手術(shù)療效。結(jié)果1術(shù)前A、B、C三組病人在性別、病程、側(cè)別、年齡、尺骨變異情況、臨床癥狀與體征方面均未見(jiàn)顯著性差異(P0.05),具有可比性。2A、B、C三組病人術(shù)后腕關(guān)節(jié)疼痛程度、功能狀態(tài)、活動(dòng)范圍、握力評(píng)分均高于術(shù)前,Mayo總評(píng)分由術(shù)前的30(25,35.25)上升為術(shù)后的90(85,93.75),患者術(shù)后癥狀緩解,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。3 A、B、C三組病人術(shù)后尺骨陽(yáng)性變異率明顯低于術(shù)前,由術(shù)前的93.81%降至術(shù)后的6.81%,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后尺骨變異值明顯低于術(shù)前,由術(shù)前平均(0.35±0.21)cm變?yōu)樾g(shù)后平均(-0.30±0.13)cm,尺骨陽(yáng)性變異情況得到明顯改善,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。4 A、B、C三組病人在切口長(zhǎng)度、手術(shù)所需時(shí)間、截骨斷端愈合時(shí)間上相比較,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。C組在手術(shù)切口長(zhǎng)度、手術(shù)時(shí)間、截骨斷端愈合時(shí)間上均優(yōu)于A與B兩組。A、B、C三組病人均在上肢止血帶下操作,術(shù)中出血量上未見(jiàn)顯著性差異(P0.05)。5 A、B、C三組病人術(shù)后3個(gè)月VAS評(píng)分低于術(shù)前,術(shù)后6個(gè)月VAS評(píng)分低于術(shù)后3個(gè)月,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05),患者尺側(cè)腕痛癥狀緩解。術(shù)前、術(shù)后3個(gè)月、術(shù)后6個(gè)月VAS評(píng)分相比較,C組低于A與B組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),C組在遠(yuǎn)期腕痛的緩解方面優(yōu)于A、B兩組。結(jié)論三種不同短縮截骨方法用于治療尺骨撞擊綜合征均可獲得滿(mǎn)意療效。通過(guò)對(duì)比,尺骨遠(yuǎn)端干骺端截骨法在切口長(zhǎng)度、手術(shù)所需時(shí)間、截骨斷端愈合時(shí)間及遠(yuǎn)期腕痛的緩解方面均優(yōu)于其它兩種短縮截骨方法,不僅手術(shù)切口短,操作簡(jiǎn)單,截骨斷端愈合快,還可以在術(shù)中查看并修補(bǔ)損傷的三角纖維軟骨盤(pán),減輕因三角纖維軟骨損傷而引起的疼痛,是一種比較理想的治療尺骨撞擊綜合征的方法。
[Abstract]:Objective to investigate the clinical effect of three different short osteotomy methods: transverse osteotomy trapezoid osteotomy and metaphyseal oblique osteotomy in the treatment of ulnar impingement syndrome. Methods from January 2010 to January 2014, 44 patients with ulnar impingement syndrome treated with three different short osteotomy methods were analyzed and divided into 3 groups. There were 13 cases in distal ulnar transverse osteotomy group (A group), 15 cases in distal ulnar trapezoid osteotomy group (B group) and 16 cases in distal ulnar metaphyseal oblique osteotomy group (C group). The length of incision, the time required for operation and the amount of blood lost during the operation were recorded during the perioperative period, and the changes of the Mayo score, the healing time of the osteotomy end and the VAS score were compared between the three groups before and after operation. To evaluate the degree of symptom improvement and surgical efficacy of three different ulnar shortening osteotomy methods in patients with ulnar impingement syndrome. Results 1there was no significant difference in sex, course of disease, side type, age, ulna variation, clinical symptoms and signs among the three groups of patients before operation (P0.05). The range of activity and the total score of grip strength were higher than those of the preoperative Mayo score from 30 (25 / 35.25) to 90 (85 / 93.75). The postoperative symptoms were relieved, and the difference was statistically significant (P0.05). The positive variation rate of ulna in the three groups was significantly lower than that before operation. From 93.81% before operation to 6.81% after operation, the difference was statistically significant (P0.05). The variation of ulna was significantly lower than that before operation, from (0.35 鹵0.21) cm before operation to (-0.30 鹵0.13) cm after operation. The positive variation of ulna was significantly improved. The difference was statistically significant (P0.05). There was significant difference in the healing time of the cut end between the two groups (P0.05). The operative incision length, operation time and healing time of the osteotomy end in group C were better than those in group A and group B all operated under the tourniquet of upper limb. There was no significant difference in the amount of intraoperative bleeding (P0.05). The VAS score in the three groups was lower than that in the preoperative group 3 months after operation, and the VAS score in 6 months after operation was lower than that in the postoperative 3 months. The difference was statistically significant (P0.05), and the symptoms of ulnar carpal pain were relieved. The VAS score of group C was lower than that of group A and group B before operation, 3 months after operation and 6 months after operation, and the difference was statistically significant (P0.05) the relief of long-term wrist pain in group C was better than that in group A and B (P0.05). Conclusion three different short osteotomy methods can be used to treat ulnar impingement syndrome. By comparison, the distal ulnar metaphyseal osteotomy was superior to the other two methods in incision length, operation time, healing time and long-term relief of wrist pain, which was not only short incision, but also simple to operate. It is an ideal method to treat ulnar impingement syndrome because of the quick healing of the broken end of the osteotomy and the repair of the injured triangular fibrochondral disc during the operation to alleviate the pain caused by the injury of the triangular fibrous cartilage.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R687.3

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本文編號(hào)：2084489