【摘要】：目的:此次研究旨在探討膝關(guān)節(jié)的多發(fā)韌帶的損傷經(jīng)關(guān)節(jié)鏡分期修復(fù)與重建的技術(shù)方法與臨床效果。方法:收集從2014年1月至2016年12月于忻州市人民醫(yī)院分期行關(guān)節(jié)鏡診療的膝關(guān)節(jié)多發(fā)韌帶損傷患者38例,此中男患者為20例,女患者為18例,年齡區(qū)間為19~68歲,平均年齡36歲;入選患者均為單膝傷,此中右膝22例,左膝16例。其中ACL、PCL、MCL和LCL 4條韌帶均損傷4例,ACL、PCL和MCL損傷15例,ACL、PCL和LCL損傷11例,僅ACL、PCL損傷8例,其中并發(fā)軟骨損傷患者8例,半月板損傷患者14例。對本組所有患者均采用先關(guān)節(jié)鏡下重建后十字韌帶(PCL),同時(shí)修復(fù)斷裂的內(nèi)側(cè)副韌帶(MCL)或外側(cè)副韌帶(LCL),膝關(guān)節(jié)鍛煉3月功能得到恢復(fù)后,再重建或修復(fù)前十字韌帶(ACL)及損傷的軟骨和半月板,術(shù)后均指導(dǎo)進(jìn)行系統(tǒng)化的康復(fù)訓(xùn)練。根據(jù)患者術(shù)前、術(shù)后膝關(guān)節(jié)主動(dòng)活動(dòng)度計(jì)量、Lysholm標(biāo)準(zhǔn)評分、IKDC評分進(jìn)行療效評價(jià)。結(jié)果:對本組38例膝關(guān)節(jié)多發(fā)韌帶損傷患者分別進(jìn)行術(shù)后隨訪6~24個(gè)月,平均13.6個(gè)月,21例(55.3%)患者膝關(guān)節(jié)功能恢復(fù)接近至傷前程度;17例(44.7%)患者功能有顯著改善,無需輔助器材即可自力行走。患者術(shù)后膝關(guān)節(jié)疼痛、腫脹、屈伸活動(dòng)受限等癥狀改善,復(fù)查X線片示關(guān)節(jié)力線及對合均良好,所有患者均未發(fā)生感染。膝關(guān)節(jié)的抽屜試驗(yàn)和內(nèi)外翻試驗(yàn)以及Lachman試驗(yàn)、軸移試驗(yàn)等檢測均為陰性。術(shù)后Lysholm膝關(guān)節(jié)功能評分、膝關(guān)節(jié)IKDC評分、關(guān)節(jié)活動(dòng)范圍均有顯著提高。術(shù)前Lysholm膝關(guān)節(jié)功能評分(35.4±3.6)分,最后一次隨訪Lysholm膝關(guān)節(jié)功能評分(88.7±7.4)分。術(shù)前膝關(guān)節(jié)IKDC評分(23.4±4.2)分,最后一次隨訪膝關(guān)節(jié)IKDC評分(79.7±5.2)分。術(shù)前膝關(guān)節(jié)活動(dòng)范圍(62.4±4.3)°,最后一次隨訪膝關(guān)節(jié)活動(dòng)范圍(119.28±5.3)°術(shù)后評分與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:關(guān)節(jié)鏡下分期修復(fù)和重建膝關(guān)節(jié)的后十字韌帶及前十字韌帶等其他膝關(guān)節(jié)構(gòu)造對于多發(fā)韌帶損傷的治療效果確切,是一種破壞性小,并發(fā)癥少,療程短,安全有效的治療方法。
[Abstract]:Objective: to investigate the technique and clinical effect of arthroscopic repair and reconstruction of multiple ligament injury of knee joint. Methods: from January 2014 to December 2016, 38 patients with multiple ligament injuries of knee joint were treated by arthroscopy in Xinzhou people's Hospital. 20 cases were male and 18 cases were female. The age range was 1968 years, with an average age of 36 years. All the patients were single knee injury, including 22 cases of right knee and 16 cases of left knee. The four ligaments of LCL and LCL were all injured in 4 cases. There were 15 cases with MCL and 15 cases with LCL injury. Only 8 cases were injured by LCL, including 8 cases complicated with cartilage injury and 14 cases with meniscus injury. All the patients underwent arthroscopic reconstruction of posterior cruciate ligament (PCL),) and repair of the broken medial collateral ligament (MCL) or lateral collateral ligament (LCL),) for 3 months. (ACL) and injured cartilage and meniscus were reconstructed or repaired. The curative effect was evaluated according to the Lysholm standard score and IKDC score before and after operation. Results: 38 patients with multiple ligament injury of knee joint were followed up for 6 ~ 24 months, the average of 13.6 months was 13.6 months, 21 cases (55.3%) had knee joint function recovery close to the degree of injury, 17 cases (44.7%) had significant improvement in the function of knee joint. You can walk on your own without auxiliary equipment. The symptoms of knee joint pain, swelling, limited flexion and extension were improved after operation. X-ray examination showed that the joint force line and involution were good, and no infection occurred in all the patients. Drawer test, varus test, Lachman test and axial shift test were all negative. Postoperative Lysholm knee function score, knee joint IKDC score, joint motion range were significantly improved. Preoperative Lysholm knee function score was (35.4 鹵3.6) and Lysholm knee function score was (88.7 鹵7.4) points at the last follow-up. The preoperative IKDC score was (23.4 鹵4.2) and the last follow-up was (79.7 鹵5.2). The preoperative range of knee motion was (62.4 鹵4.3) 擄, and the postoperative score of the last follow-up was (119.28 鹵5.3) 擄, which was significantly different from that before operation (P0.05). Conclusion: arthroscopic repair and reconstruction of the posterior cruciate ligament and anterior cruciate ligament are effective in the treatment of multiple ligament injuries. A safe and effective treatment.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.4

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