發(fā)布時(shí)間：2018-10-31 10:47

【摘要】：目的:關(guān)節(jié)鏡下經(jīng)骨道及經(jīng)軟組織道兩種鋼絲內(nèi)固定方法治療脛骨髁間棘骨折的臨床研究。方法:對(duì)2012年8月-2015年12月在濟(jì)陽(yáng)縣中醫(yī)院骨科收治的50例符合脛骨髁間棘骨折診斷標(biāo)準(zhǔn)的住院患者分別行膝關(guān)節(jié)鏡下經(jīng)骨道和經(jīng)軟組織道鋼絲兩種內(nèi)固定方法,并進(jìn)行總結(jié)。其中女性18例,男性32例,年齡9歲到45歲,左膝關(guān)節(jié)22例,右膝關(guān)節(jié)28例,脛骨近端骨骺未閉合10例。其中經(jīng)骨道固定組20例,經(jīng)軟組織道固定組30例,其中骨骺未閉合者均采用經(jīng)軟組織道固定。術(shù)前及術(shù)后均采用Lysholm膝關(guān)節(jié)評(píng)分法進(jìn)行評(píng)分,并分別行膝關(guān)節(jié)正側(cè)位X片以明確骨折分型判斷骨折的復(fù)位及愈合等情況,根據(jù)Lysholm評(píng)分及影像學(xué)資料評(píng)價(jià)經(jīng)骨道及經(jīng)軟組織道兩種內(nèi)固定療法的臨床療效。結(jié)果:1.本研究50例脛骨髁間棘骨折患者均在骨科門(mén)診復(fù)查時(shí)進(jìn)行隨訪調(diào)查,隨訪時(shí)間約6-12個(gè)月不等,平均約為9個(gè)月左右。在手術(shù)后3個(gè)月時(shí)復(fù)查患膝關(guān)節(jié)正側(cè)位X線片,其報(bào)告均顯示骨折線模糊,骨痂通過(guò)骨折線。在手術(shù)后6個(gè)月時(shí)復(fù)查膝關(guān)節(jié)正側(cè)位X線片報(bào)告均顯示骨折完全愈合,無(wú)畸形愈合,未見(jiàn)明顯骨折線,無(wú)髁間窩撞擊征象。術(shù)后6個(gè)月時(shí)患者門(mén)診復(fù)查,對(duì)其進(jìn)行膝關(guān)節(jié)穩(wěn)定性檢測(cè),前抽屜實(shí)驗(yàn),Lachman實(shí)驗(yàn)為陰性,兩組無(wú)顯著差異(P0.05)。2.兩組在兩組手術(shù)時(shí)間,止血帶時(shí)間,住院時(shí)間方面,兩組在手術(shù)時(shí)間,止血帶應(yīng)用時(shí)間,住院時(shí)間均無(wú)差異(P0.05)。3.兩組術(shù)前Lysholm評(píng)分無(wú)顯著差異,兩組術(shù)后與術(shù)前相比具有統(tǒng)計(jì)學(xué)意義(P0.05),而術(shù)后兩組Lysholm評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4.兩組骨折患者相關(guān)指標(biāo)比較,治療后,經(jīng)骨道組優(yōu)14例,良4例,可2例;軟組織道組20例,良6例,可4例,兩組優(yōu)良率比較差異未見(jiàn)統(tǒng)計(jì)學(xué)意義(P0.05)。5.術(shù)后并發(fā)癥的比較患者術(shù)后并發(fā)癥的觀察:50位患者術(shù)后門(mén)診復(fù)查時(shí),手術(shù)切口愈合情況皆為Ⅰ/甲,術(shù)后患者分別于1個(gè)月、3個(gè)月、6個(gè)月、9個(gè)月、12個(gè)月多次來(lái)門(mén)診復(fù)查均未見(jiàn)深靜脈血栓、關(guān)節(jié)內(nèi)感染、關(guān)節(jié)僵直、創(chuàng)傷性關(guān)節(jié)炎等并發(fā)癥。結(jié)論:關(guān)節(jié)鏡下經(jīng)骨道及經(jīng)軟組織道兩種內(nèi)固定方法治療脛骨髁間棘棘骨折的兩組手術(shù)效果比較無(wú)統(tǒng)計(jì)學(xué)意義,術(shù)后膝關(guān)節(jié)穩(wěn)定性好,活動(dòng)度良,患者感覺(jué)滿意。兩種手術(shù)方法對(duì)脛骨髁間棘骨折有良好的治療作用。經(jīng)軟組織道固定方法尤其適用于骨骺未閉合的患者。
[Abstract]:Objective: to study the treatment of tibial intercondylar spine fracture by two kinds of wire internal fixation under arthroscopy. Methods: from August 2012 to December 2015, 50 inpatients who met the diagnostic criteria of tibial intercondylar spine fracture in Department of Orthopaedics, Jiyang traditional Chinese Medicine Hospital, were treated with internal fixation under knee arthroscopy and wire through soft tissue canal, respectively. And sum up. Among them, 18 cases were female, 32 cases were male, the age was 9 to 45 years old, 22 cases were left knee joint, 28 cases were right knee joint, 10 cases were unclosed proximal tibia epiphysis. There were 20 cases in the transosseous canal fixation group and 30 cases in the soft tissue canal fixation group. Lysholm knee scoring method was used before and after operation, and the anterior and lateral X ray films of knee joint were performed to determine the reduction and healing of the fracture. Lysholm score and imaging data were used to evaluate the clinical effect of transosseous and soft tissue canal fixation. The result is 1: 1. In this study, 50 cases of tibial intercondylar spine fracture were followed-up in orthopaedic outpatient clinic. The follow-up time ranged from 6 to 12 months, with an average of about 9 months. At 3 months after operation, the X-ray films of anterior and lateral position of knee joint were reexamined. The results showed that the fracture line was blurred and the callus passed through the fracture line. At 6 months after operation, X-ray examination showed complete union of the knee joint, no malunion, no obvious fracture line and no sign of impingement of intercondylar fossa. 6 months after the outpatient review, the knee stability test, anterior drawer test, Lachman test was negative, there was no significant difference between the two groups (P0.05). The operation time, tourniquet time, hospitalization time of the two groups in the two groups, the two groups in the operation time, tourniquet application time, hospitalization time were not different (P0.05). There was no significant difference in Lysholm scores between the two groups before operation (P0.05), but there was no significant difference in Lysholm scores between the two groups after operation (P0.05). After treatment, 14 cases were excellent, 4 cases were good, 2 cases were fair, 20 cases were good, 6 cases were good and 4 cases were fair in soft tissue canal group, there was no significant difference in excellent and good rate between the two groups (P0.05). Comparison of postoperative complications observation of postoperative complications: I / A was found in all of the 50 patients with postoperative outpatient reexamination, and the postoperative patients were 1 month, 3 months, 6 months, 9 months, respectively, and all of them were cured in 1 month, 3 months, 6 months and 9 months, respectively. There were no complications such as deep venous thrombosis, intraarticular infection, joint stiffness, traumatic arthritis and so on. Conclusion: there is no significant difference between the two groups in the treatment of tibial intercondylar spine fracture by arthroscopic internal fixation of bone canal and soft tissue canal. The postoperative knee joint is stable, the movement is good, and the patients feel satisfied. The two surgical methods have a good effect on the treatment of tibial intercondylar spine fracture. Soft tissue canal fixation is especially suitable for patients with unclosed epiphysis.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 代振動(dòng);袁宏偉;路闖;王燦亞;田俊華;賈會(huì)光;;關(guān)節(jié)鏡下克氏針固定治療脛骨髁間前棘骨折[J];實(shí)用骨科雜志;2012年08期

2 高玉鐳;孫磊;張銳;張磊;田敏;;關(guān)節(jié)鏡監(jiān)視下治療青少年脛骨髁間隆突撕脫性骨折[J];中國(guó)矯形外科雜志;2012年10期

3 曹飛;李建;俞斌;周陳斌;劉建新;;關(guān)節(jié)鏡下“Y”形隧道法縫線固定治療成人脛骨髁間隆突骨折[J];吉林醫(yī)學(xué);2012年02期

4 魏慧明;唐春艷;戴彬;;脛骨髁間隆突骨折關(guān)節(jié)鏡下內(nèi)固定的臨床觀察[J];中國(guó)實(shí)用醫(yī)藥;2011年17期

5 宋登新;劉成文;張明貴;何小文;吳子征;傅燕飛;趙毅;;關(guān)節(jié)鏡下治療不同時(shí)期脛骨髁間棘骨折[J];臨床骨科雜志;2011年02期

6 周紅星;李欽宗;張保健;蘭宇斌;潘登;;關(guān)節(jié)鏡輔助下治療脛骨髁間嵴骨折[J];中國(guó)內(nèi)鏡雜志;2011年04期

7 國(guó)華;張向民;胡宏偉;侯存強(qiáng);;關(guān)節(jié)鏡下編織聚酯線多點(diǎn)固定治療髁間隆突骨折30例臨床觀察[J];中國(guó)矯形外科雜志;2010年13期

8 趙輝;張衛(wèi)國(guó);張鵬;徐昕;黃曉華;王小武;;關(guān)節(jié)鏡下“8字”縫線法治療成人前交叉韌帶下止點(diǎn)撕脫骨折24例[J];創(chuàng)傷外科雜志;2009年03期

9 馬海濤;畢大衛(wèi);陳億民;姚小聰;翟利鋒;劉道君;;關(guān)節(jié)鏡下帶線錨釘治療脛骨髁間嵴骨折[J];中國(guó)骨傷;2008年03期

10 宋延禮;;抽出鋼絲法內(nèi)固定治療脛骨髁間隆突撕脫骨折[J];現(xiàn)代醫(yī)藥衛(wèi)生;2007年08期

，

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