膝關(guān)節(jié)多發(fā)韌帶損傷一期關(guān)節(jié)鏡手術(shù)治療的中遠(yuǎn)期隨訪研究
發(fā)布時(shí)間：2018-11-17 09:40
【摘要】：研究目的:回顧性研究關(guān)節(jié)鏡治療膝關(guān)節(jié)多發(fā)韌帶損傷的臨床療效。并探討影響手術(shù)療效的因素。研究資料與方法:回顧2006年1月至2015年10月山東大學(xué)齊魯醫(yī)院收治確診為膝關(guān)節(jié)多發(fā)韌帶損傷且應(yīng)用關(guān)節(jié)鏡治療的52例患者的臨床資料,成功隨訪23例,隨訪成功率為44.2%。其中男16例,女7例,年齡18至58歲,平均35歲。受傷至手術(shù)時(shí)間為4天至15個(gè)月,平均75天。所有患者行一期手術(shù)治療。12例行早期手術(shù)治療,11例行延期手術(shù)治療。其中前交叉韌帶(anterior cruciate liga-ment,ACL)重建 + 內(nèi)側(cè)副韌帶(medial collateral ligament,MCL)修補(bǔ) 6 例,ACL重建+后交叉韌帶(posteri-or cruciate ligament,PCL)重建+MCL 修補(bǔ) 3 例,ACL 重建+PCL 重建 8 例,ACL 重建+外側(cè)副韌帶(lateral collateral ligam-ent,LCL)修補(bǔ)2例,ACL重建+LCL重建2例,ACL重建+MCL重建1例,ACL重建+PCL重建+LCL重建1例。記錄患者術(shù)后膝關(guān)節(jié)的恢復(fù)情況以及術(shù)后相關(guān)并發(fā)癥的發(fā)生情況,并于術(shù)前及末次隨訪時(shí)應(yīng)用國(guó)際膝關(guān)節(jié)文獻(xiàn)委員會(huì)(International Knee Documentation Committee,IKDC)評(píng)分,Tegner 評(píng)分,Lysholm 評(píng)分評(píng)估膝關(guān)節(jié)的功能狀況。根據(jù)手術(shù)時(shí)機(jī)、性別、年齡、損傷的韌帶數(shù)、隨訪時(shí)間等因素分組,并分別統(tǒng)計(jì)分析各組間的優(yōu)良率。研究結(jié)果:23例患者隨訪13至122個(gè)月,平均54.6個(gè)月。1例患者出現(xiàn)膝關(guān)節(jié)活動(dòng)受限(活動(dòng)度90°),14例患者出現(xiàn)偶發(fā)膝關(guān)節(jié)疼痛(氣候變化,久站等情況下出現(xiàn)膝關(guān)節(jié)疼痛),發(fā)生率為60.9%;3例患者在重勞動(dòng)后可出現(xiàn)膝關(guān)節(jié)輕微腫脹,發(fā)生率為13.0%;8例患者在運(yùn)動(dòng)或重勞動(dòng)時(shí)偶現(xiàn)"打軟腿"的情況,發(fā)生率為34.8%。所有隨訪患者均未出現(xiàn)移植物斷裂、關(guān)節(jié)感染、頑固性疼痛等嚴(yán)重并發(fā)癥。部分患者末次隨訪時(shí)行磁共振成像(Magnetic Resonance Imaging,MRI)示:重建韌帶形態(tài)良好,走形正常,關(guān)節(jié)腔內(nèi)無明顯異常信號(hào)�；颊咝g(shù)前IKDC評(píng)分為(31.5±10.5)分,末次隨訪時(shí)為(79.6±11.0)分,差異有統(tǒng)計(jì)學(xué)意義(t=16.836 p0.01);術(shù)前Lysholm評(píng)分為(37.9±11.9)分,末次隨訪時(shí)為(89.6±8.3)分,差異有統(tǒng)計(jì)學(xué)意義(t=16.089 p0.01);術(shù)前Tegner評(píng)分為(0.9±0.7)分,末次隨訪時(shí)為(4.0±0.8)分,差異有統(tǒng)計(jì)學(xué)意義(t=15.486 p0.01)。根據(jù)IKDC評(píng)分劃分術(shù)后療效等級(jí),總體優(yōu)良率為69.6%。手術(shù)時(shí)機(jī)、性別、隨訪時(shí)間、是否存在合并傷的組間優(yōu)良率無統(tǒng)計(jì)學(xué)差異。損傷韌帶數(shù)目為2條的患者的術(shù)后優(yōu)良率為91.7%,損傷數(shù)目大于2條的患者的術(shù)后優(yōu)良率為45.5%,差異有統(tǒng)計(jì)學(xué)意義;大于50歲的患者術(shù)后優(yōu)良率為0%,與其余兩組的優(yōu)良率具有顯著差異,差異具有統(tǒng)計(jì)學(xué)意義。根據(jù)Lysholm評(píng)分,總體優(yōu)良率為82.6%,各組間的優(yōu)良率無統(tǒng)計(jì)學(xué)差異。研究結(jié)論:1、一期關(guān)節(jié)鏡下修復(fù)與重建膝關(guān)節(jié)多發(fā)韌帶損傷可有效改善膝關(guān)節(jié)功能,顯著提高膝關(guān)節(jié)穩(wěn)定性,是治療膝關(guān)節(jié)多發(fā)韌帶損傷的有效治療方法。2、早期手術(shù)治療與延期手術(shù)治療均可獲得滿意的手術(shù)療效,兩者在術(shù)后膝關(guān)節(jié)功能評(píng)價(jià)方面并無差異,臨床工作中應(yīng)根據(jù)膝關(guān)節(jié)韌帶受損情況,關(guān)節(jié)腫脹程度等實(shí)際情況選擇手術(shù)時(shí)機(jī),早期或延期行一期手術(shù)治療。3、患者的性別、術(shù)后隨訪時(shí)間以及術(shù)前是否存在合并傷對(duì)手術(shù)后的優(yōu)良率并無顯著影響;而患者的年齡以及合并PCL損傷可影響術(shù)后的療效,對(duì)于年輕的、無PCL的患者,手術(shù)后的優(yōu)良率可顯著提高。
[Abstract]:Objective: To study the clinical effect of arthroscopy in the treatment of multiple ligament injury of knee joint. and the factors that influence the operation of the operation are discussed. The data and methods of the study were as follows: From January 2006 to October 2015, the clinical data of 52 patients with the diagnosis of multiple ligament injury and the application of arthroscopy in Qilu Hospital of Shandong University were reviewed. The successful follow-up of 23 cases was followed up with a follow-up success rate of 42.2%. Of these, 16 males and 7 females, aged 18 to 58, were 35 years of age. The duration of the injury was 4 days to 15 months, with an average of 75 days. All patients underwent a first-stage surgical treatment. 12 cases of early-stage operation and 11 cases of delayed operation. In this study, 6 cases of anterior cruciate ligament (ACL) reconstruction, 6 cases of medial-medial collateral ligament (MCL), 3 cases of ACL reconstruction + posterior cruciate ligament (PCL) reconstruction + MCL repair, 8 cases of ACL reconstruction + PCL, 2 cases of ACL reconstruction + lateral collateralligan-ent (LCL) were repaired. ACL reconstruction + LCL reconstruction 2 cases, ACL reconstruction + MCL reconstruction 1 case, ACL reconstruction + PCL reconstruction + LCL reconstruction 1 case. The recovery of the knee and the occurrence of postoperative complications were recorded and the functional status of the knee was assessed by the International Knee Documentation Committee (IKDC) score, the Tegner score, and the Lysholm score at the pre-and end-time follow-up. According to the time of operation, the number of ligaments, the number of ligaments, the follow-up time and other factors, the rate of good and good was statistically analyzed. Results: 23 patients were followed up for 13 to 122 months, with an average of 54. 6 months. One patient experienced limited knee joint activity (range of motion 90 擄) and 14 patients with occasional knee pain (knee pain in the case of climate change, long standing, etc.), with an incidence of 60. 9%; The incidence of slight swelling of the knee was 13. 0% in 3 cases, and the incidence rate was 34.8% in 8 cases. There were no serious complications such as graft fracture, joint infection, and intractable pain in all follow-up patients. Magnetic resonance imaging (MRI) was performed at the last follow-up of a part of the patient. The reconstruction of the ligament was good, the shape of the ligament was normal, and there was no obvious abnormal signal in the joint cavity. The pre-operative IKDC score was (31.5 to 10.5), and at the end of the last follow-up (79.6 to 11.0), the difference was of statistical significance (t = 16. 836 p0.01); the preoperative Lysholm score was (37.9 to 11. 9), and at the end of the follow-up (89.6 to 8.3), the difference was statistically significant (t = 16.089 p0.01); The pre-operative Tegner score was (0.9 to 0.7), and at the end of the last follow-up (4.0 to 0.8), the difference was statistically significant (t = 15.486 p0.01). The overall good and good rate was 66.9%, according to IKDC score. There was no statistical difference between the time of operation, sex, follow-up time, and whether there was a group of combined injuries. The excellent rate of good and good rate was 95.7%, the rate of good and good was 45.5%, the difference was statistically significant, and the rate of excellent and good was 0% after the 50-year-old patients, and the excellent and good rate was significantly different from the other two groups. The difference was of statistical significance. The excellent and good rate was 82.6% according to the Lysholm score, and there was no statistical difference between the groups. Conclusion: 1. The repair and reconstruction of the multiple ligament of the knee joint under the first-stage arthroscope can improve the function of the knee joint, improve the stability of the knee joint, and is an effective treatment method for the treatment of the multiple-ligament injury of the knee joint. Both the early operative treatment and the delayed operation treatment can achieve satisfactory operation effect, both of which have no difference in the function evaluation of the knee joint after operation, and the operation timing should be selected according to the actual conditions such as the damage of the ligament of the knee joint, the degree of the swelling of the joint and the like in the clinical work, 3. The patient's sex, the post-operative follow-up time and the pre-operation have no significant effect on the good and good rate after operation; the age of the patient and the combined PCL injury can affect the curative effect after operation, and for the young, non-PCL-free patients, The rate of good and good after operation can be improved significantly.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4
本文編號(hào)：2337328
[Abstract]:Objective: To study the clinical effect of arthroscopy in the treatment of multiple ligament injury of knee joint. and the factors that influence the operation of the operation are discussed. The data and methods of the study were as follows: From January 2006 to October 2015, the clinical data of 52 patients with the diagnosis of multiple ligament injury and the application of arthroscopy in Qilu Hospital of Shandong University were reviewed. The successful follow-up of 23 cases was followed up with a follow-up success rate of 42.2%. Of these, 16 males and 7 females, aged 18 to 58, were 35 years of age. The duration of the injury was 4 days to 15 months, with an average of 75 days. All patients underwent a first-stage surgical treatment. 12 cases of early-stage operation and 11 cases of delayed operation. In this study, 6 cases of anterior cruciate ligament (ACL) reconstruction, 6 cases of medial-medial collateral ligament (MCL), 3 cases of ACL reconstruction + posterior cruciate ligament (PCL) reconstruction + MCL repair, 8 cases of ACL reconstruction + PCL, 2 cases of ACL reconstruction + lateral collateralligan-ent (LCL) were repaired. ACL reconstruction + LCL reconstruction 2 cases, ACL reconstruction + MCL reconstruction 1 case, ACL reconstruction + PCL reconstruction + LCL reconstruction 1 case. The recovery of the knee and the occurrence of postoperative complications were recorded and the functional status of the knee was assessed by the International Knee Documentation Committee (IKDC) score, the Tegner score, and the Lysholm score at the pre-and end-time follow-up. According to the time of operation, the number of ligaments, the number of ligaments, the follow-up time and other factors, the rate of good and good was statistically analyzed. Results: 23 patients were followed up for 13 to 122 months, with an average of 54. 6 months. One patient experienced limited knee joint activity (range of motion 90 擄) and 14 patients with occasional knee pain (knee pain in the case of climate change, long standing, etc.), with an incidence of 60. 9%; The incidence of slight swelling of the knee was 13. 0% in 3 cases, and the incidence rate was 34.8% in 8 cases. There were no serious complications such as graft fracture, joint infection, and intractable pain in all follow-up patients. Magnetic resonance imaging (MRI) was performed at the last follow-up of a part of the patient. The reconstruction of the ligament was good, the shape of the ligament was normal, and there was no obvious abnormal signal in the joint cavity. The pre-operative IKDC score was (31.5 to 10.5), and at the end of the last follow-up (79.6 to 11.0), the difference was of statistical significance (t = 16. 836 p0.01); the preoperative Lysholm score was (37.9 to 11. 9), and at the end of the follow-up (89.6 to 8.3), the difference was statistically significant (t = 16.089 p0.01); The pre-operative Tegner score was (0.9 to 0.7), and at the end of the last follow-up (4.0 to 0.8), the difference was statistically significant (t = 15.486 p0.01). The overall good and good rate was 66.9%, according to IKDC score. There was no statistical difference between the time of operation, sex, follow-up time, and whether there was a group of combined injuries. The excellent rate of good and good rate was 95.7%, the rate of good and good was 45.5%, the difference was statistically significant, and the rate of excellent and good was 0% after the 50-year-old patients, and the excellent and good rate was significantly different from the other two groups. The difference was of statistical significance. The excellent and good rate was 82.6% according to the Lysholm score, and there was no statistical difference between the groups. Conclusion: 1. The repair and reconstruction of the multiple ligament of the knee joint under the first-stage arthroscope can improve the function of the knee joint, improve the stability of the knee joint, and is an effective treatment method for the treatment of the multiple-ligament injury of the knee joint. Both the early operative treatment and the delayed operation treatment can achieve satisfactory operation effect, both of which have no difference in the function evaluation of the knee joint after operation, and the operation timing should be selected according to the actual conditions such as the damage of the ligament of the knee joint, the degree of the swelling of the joint and the like in the clinical work, 3. The patient's sex, the post-operative follow-up time and the pre-operation have no significant effect on the good and good rate after operation; the age of the patient and the combined PCL injury can affect the curative effect after operation, and for the young, non-PCL-free patients, The rate of good and good after operation can be improved significantly.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4
【參考文獻(xiàn)】
相關(guān)期刊論文 前6條
1 鞠曉東;王健全;敖英芳;梅宇;張辛;王佳寧;趙峰;;關(guān)節(jié)鏡下單骨道雙束和單骨道單束重建前交叉韌帶療效的初步對(duì)比研究[J];中國(guó)運(yùn)動(dòng)醫(yī)學(xué)雜志;2013年07期
2 李業(yè)成;張巍;吳勇;王洪俊;康龍;胡綿虎;陳根元;朱寶林;;LARS與自體骨-髕腱-骨重建膝關(guān)節(jié)前交叉韌帶急性損傷的療效比較[J];中國(guó)修復(fù)重建外科雜志;2012年09期
3 皇甫小橋;趙金忠;何耀華;楊星光;王鋒;朱越;劉聞欣;;膝關(guān)節(jié)多發(fā)韌帶損傷的修復(fù)與重建[J];中華骨科雜志;2011年02期
4 郝建學(xué);高石軍;劉鎖利;萬建設(shè);;前交叉韌帶重建與移植物的選擇[J];中國(guó)組織工程研究與臨床康復(fù);2010年16期
5 楊渝平;敖英芳;王健;閆輝;田得祥;王健全;余家闊;胡躍林;崔國(guó)慶;于長(zhǎng)隆;;急性前交叉韌帶斷裂合并內(nèi)側(cè)副韌帶、半月板損傷的臨床研究[J];中國(guó)運(yùn)動(dòng)醫(yī)學(xué)雜志;2007年05期
6 陳疾忤;后交叉韌帶損傷研究進(jìn)展[J];中國(guó)運(yùn)動(dòng)醫(yī)學(xué)雜志;2001年04期
，本文編號(hào)：2337328
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/2337328.html
最近更新
教材專著
