【摘要】：一.目的本文通過應用膝關節(jié)鏡下前交叉韌帶(anterior cruciate ligament,ACL)解剖重建治療61例急性期與慢性期前交叉韌帶損傷的患者,對比分析急性期與慢性期膝關節(jié)鏡下前交叉韌帶重建術后療效差異是否存在統(tǒng)計學意義,意圖給骨科臨床醫(yī)生手術時機選擇提供參考。二.資料與方法資料:本文選取了吉林大學附屬中日聯(lián)誼醫(yī)院骨科患者中單純ACL損傷于2014年10月—2015年12月期間、年齡在18歲-55歲之間的由同年資教授完成的61例手術患者。這些患者以損傷時間與手術時間間隔2周為界限,分為損傷急性期與慢性期。急性期23例,年齡18-53歲,平均30.82±9.41歲,其中男18例、女5例;左側膝關節(jié)13例,右側膝關節(jié)10例,雙側膝關節(jié)0例。受傷原因:5例摔傷,14例運動性損傷,4例扭傷。慢性期38例,年齡18-55歲,平均31.02±11.51歲,其中男26例,女12例;左側膝關節(jié)17例,右側膝關節(jié)22例,雙側膝關節(jié)0例。受傷原因:11例無明顯誘因,10例摔傷,3例運動性損傷,14例扭傷。方法:本文對患者進行術后1、3、12個月的隨訪,檢查患者前抽屜試驗、Lachman試驗、軸移試驗(Pivot shift)、術后12個月復查膝關節(jié)MRI影像學表現(xiàn)、膝關節(jié)活動度(ROM)、IKDC評分及Lysholm評分行術后組間比較。使用SPSS 21.0統(tǒng)計軟件進行數(shù)據(jù)分析,包括一般數(shù)據(jù)描述(均數(shù)±標準差)和t檢驗。以P0.05作為檢驗標準。三.結果兩組患者術后隨訪時間最短12個月,最長26個月,平均隨訪時間17.6個月。膝關節(jié)鏡下解剖重建急性期與慢性期前交叉韌帶損傷臨床療效均滿意。術后1個月膝關節(jié)活動度急性期組均值為102.95±7.22,慢性期組均值為97.36±6.74,經(jīng)t檢驗P0.05,有統(tǒng)計學意義。術后3個月膝關節(jié)活動度急性期組均值為125.47±3.82,慢性期組均值為124.65±4.57,經(jīng)t檢驗P0.05,無統(tǒng)計學意義。術后隨訪12個月時Lysholm評分急性期重建組均值為85.13±6.71、慢性期重建組均值為78.50±8.21,經(jīng)t檢驗P0.05,具有統(tǒng)計學意義。術后隨訪12個月時IKDC評分急性期重建組均值為85.82±5.72、慢性期重建組均值為81.70±4.52,經(jīng)t檢驗P0.05,具有統(tǒng)計學意義。四.結論膝關節(jié)鏡下解剖重建治療ACL損傷利于患肢早期功能鍛煉,最大恢復患肢膝關節(jié)功能有明顯優(yōu)勢。急性期重建治療在術后早期恢復膝關節(jié)活動度及膝關節(jié)功能較慢性期有優(yōu)勢�；颊咝g后遠期膝關節(jié)功能恢復程度急性期韌帶重建組優(yōu)于慢性期。
[Abstract]:I. Objective to treat 61 patients with acute and chronic anterior cruciate ligament injury by arthroscopic anterior cruciate ligament (anterior cruciate ligament,ACL) anatomical reconstruction. To compare and analyze the difference between acute and chronic arthroscopic anterior cruciate ligament reconstruction (ACL) reconstruction in order to provide reference for orthopedic clinicians. II. Materials and methods: 61 patients with simple ACL injury between October 2014 and December 2015 were selected from orthopaedic department of Sino-Japanese Friendship Hospital affiliated to Jilin University, aged between 18 and 55 years. These patients were divided into acute and chronic injury by 2 weeks interval between injury time and operation time. 23 cases (aged 18-53 years, mean 30.82 鹵9.41 years) in acute stage, including 18 males and 5 females, 13 cases of left knee joint, 10 cases of right knee joint and 0 cases of bilateral knee joint. The causes of injury were: 5 cases fell, 14 cases sports injury, 4 cases sprain. There were 38 cases of chronic stage, aged 18-55 years (mean 31.02 鹵11.51 years), including 26 males and 12 females, 17 cases of left knee joint, 22 cases of right knee joint and 0 cases of bilateral knee joint. The causes of injury were: 11 cases without obvious inducement, 10 cases with fall, 3 cases with sports injury and 14 cases with sprain. Methods: the patients were followed up for 1 and 12 months after operation. The anterior drawer test, Lachman test, axial shift test and (Pivot shift), were performed 12 months after operation to review the imaging findings of knee joint MRI and the range of knee motion (ROM),. IKDC score and Lysholm score were compared after operation. SPSS 21. 0 statistical software was used for data analysis, including general data description (mean 鹵standard deviation) and t test. Take P0.05 as the test standard. Three Results the follow-up time was 12 months and 26 months, with an average follow-up time of 17.6 months. Arthroscopic anatomical reconstruction of acute and chronic anterior cruciate ligament injury was satisfactory. One month after operation, the mean value of knee motion was 102.95 鹵7.22 in acute stage group and 97.36 鹵6.74 in chronic stage group. There was statistical significance by t test (P0.05). 3 months after operation, the mean value of knee motion was 125.47 鹵3.82 in the acute stage group and 124.65 鹵4.57 in the chronic stage group. There was no significant difference between the two groups by t test (P0.05). The mean value of Lysholm score was 85.13 鹵6.71 in acute stage and 78.50 鹵8.21 in chronic stage after 12 months follow-up. There was statistical significance by t test (P0.05). The mean value of IKDC score was 85.82 鹵5.72 in acute reconstruction group and 81.70 鹵4.52 in chronic stage reconstruction group after 12 months follow-up. There was statistical significance by t test (P0.05). four Conclusion the anatomical reconstruction under knee arthroscopy is beneficial to the early functional exercise of the affected limb, and the maximum recovery of the knee joint function of the affected limb has obvious advantages. Acute stage reconstruction has advantages over chronic stage in early recovery of knee motion and knee function. The long-term recovery of knee joint function in patients with acute ligament reconstruction was superior to that in chronic stage.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.4

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