【摘要】：目的探討內(nèi)側(cè)副韌帶股骨止點(diǎn)上移術(shù)與重建術(shù)治療陳舊性膝內(nèi)側(cè)結(jié)構(gòu)松弛的臨床療效,為臨床治療陳舊性膝內(nèi)側(cè)結(jié)構(gòu)松弛提供參考。方法以華北理工大學(xué)附屬骨科醫(yī)院(唐山市第二醫(yī)院)于2010年1月至2015年1月收治的64例陳舊性膝關(guān)節(jié)內(nèi)側(cè)結(jié)構(gòu)松弛患者為研究對象,根據(jù)不同的手術(shù)方式分為上移組(31例)和重建組(33例)。上移組采用內(nèi)側(cè)副韌帶股骨止點(diǎn)上移術(shù)進(jìn)行治療,重建組采用自體肌腱內(nèi)側(cè)副韌帶重建術(shù)進(jìn)行治療。于術(shù)前及術(shù)后18個(gè)月分別采用國際膝關(guān)節(jié)文獻(xiàn)委員會膝關(guān)節(jié)評估表(IKDC)、Lysholm評分、Tegner評分等評測兩組患者膝關(guān)節(jié)功能,拍攝患側(cè)膝關(guān)節(jié)外翻應(yīng)力位X線測量內(nèi)側(cè)間隙開口大小及關(guān)節(jié)間隙夾角(JS)評價(jià)兩組患者膝關(guān)節(jié)穩(wěn)定性;于術(shù)后18個(gè)月采用《膝內(nèi)側(cè)副韌帶臨床效果評定表》評測兩組患者的臨床總體療效。結(jié)果兩組患者病例數(shù)、年齡、性別、病程、手術(shù)側(cè)別等一般資料比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后兩組患者切口均為Ⅰ期愈合,無下肢深靜脈血栓形成等術(shù)后并發(fā)癥發(fā)生。64例患者均獲得隨訪,上移組隨訪時(shí)間為19~24月,平均(21.05±1.55)個(gè)月,重建組隨訪時(shí)間為18~23月,平均(20.95±1.47)個(gè)月。隨訪的所有患者中,均無僵硬、強(qiáng)直、再次損傷及感染等情況發(fā)生。術(shù)前兩組患者IKDC評分、Lysholm評分、Tegner評分、VAS評分、膝關(guān)節(jié)內(nèi)側(cè)間隙開口及JS比較,差異不具有統(tǒng)計(jì)學(xué)意義,具有可比性(P0.05)。與術(shù)前比較,術(shù)后18個(gè)月,兩組患者IKDC評分、Lysholm評分、Tegner評分、VAS評分、膝關(guān)節(jié)內(nèi)側(cè)關(guān)節(jié)間隙開口及JS顯著改善(P0.05)。術(shù)后18個(gè)月,與上移組比較,重建組IKDC評分、Lysholm評分、Tegner評分、臨床總體療效優(yōu)良率升高;膝關(guān)節(jié)內(nèi)側(cè)關(guān)節(jié)間隙開口及JS減小(P0.05);膝關(guān)節(jié)VAS評分無明顯變化(P0.05)。結(jié)論1內(nèi)側(cè)副韌帶股骨止點(diǎn)上移術(shù)與重建術(shù)均能有效治療陳舊性膝關(guān)節(jié)內(nèi)側(cè)結(jié)構(gòu)松弛;2內(nèi)側(cè)副韌帶重建術(shù)在改善膝關(guān)節(jié)功能、提高膝關(guān)節(jié)穩(wěn)定性及臨床總體療效方面優(yōu)于股骨止點(diǎn)上移術(shù),而在改善膝關(guān)節(jié)內(nèi)側(cè)疼痛方面兩種手術(shù)無明顯差異。
[Abstract]:Objective to investigate the clinical effect of medial collateral ligament (MCL) insertion and reconstruction in the treatment of old medial knee structural relaxation, and to provide reference for clinical treatment of old medial knee structural relaxation. Methods from January 2010 to January 2015, 64 patients with old medial structural relaxation of knee joint were treated in the affiliated Orthopaedic Hospital of North China University of Technology (Tangshan second Hospital). According to different operation methods, the patients were divided into upper displacement group (31 cases) and reconstruction group (33 cases). The upper group was treated by the femoral insertion of medial collateral ligament and the reconstruction group was treated by reconstruction of the medial collateral ligament of autogenous tendon. The knee joint function of the two groups was evaluated by (IKDC), Lysholm score and Tegner score before operation and 18 months after operation. Knee joint stability was evaluated by measuring the size of medial space and joint space angle (JS). At 18 months after operation, the clinical efficacy of medial collateral ligament of knee was evaluated by evaluating the clinical effect of the two groups. Results there was no significant difference between the two groups in the number of cases, age, sex, course of disease, surgical side and other general data (P0.05). There was no postoperative complications such as deep vein thrombosis of lower extremity in both groups. The follow-up time of upper shift group was 19 ~ 24 months (mean (21.05 鹵1.55) months). The follow-up time of the reconstruction group was from 18 to 23 months (mean (20.95 鹵1.47) months). No stiffness, ankylosis, reinjury or infection occurred in all patients followed up. Preoperative IKDC score, Lysholm score, Tegner score, VAS score, the medial space of knee joint opening and JS comparison, the difference was not statistically significant, comparable (P0.05). Compared with preoperative 18 months, IKDC score, Lysholm score, Tegner score, VAS score, medial articular space of knee joint and JS were significantly improved in both groups (P0.05). At 18 months after operation, the IKDC score, Lysholm score, Tegner score, total curative effect of the reconstruction group increased, and the opening of medial articular space and JS decreased in the reconstruction group (P0.05). There was no significant change in VAS score of knee joint (P0.05). Conclusion (1) the medial collateral ligament can be effectively used for the treatment of old medial relaxation of knee joint. 2the reconstruction of medial collateral ligament was superior to that of femoral upshift in improving the function of knee joint, improving the stability of knee joint and the overall clinical curative effect, but there was no significant difference between the two operations in improving medial knee pain.
【學(xué)位授予單位】：華北理工大學(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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