【摘要】：背景:膝關(guān)節(jié)韌帶是保證膝關(guān)節(jié)正常運(yùn)動(dòng)功能的重要穩(wěn)定結(jié)構(gòu),隨著膝關(guān)節(jié)多韌帶損傷的發(fā)病率的逐年升高,其已成為近些年討論及研究的熱點(diǎn)。較早的認(rèn)識(shí)與治療對(duì)該疾病的康復(fù)及預(yù)后有著至關(guān)重要的作用。隨著現(xiàn)代膝關(guān)節(jié)鏡技術(shù)的發(fā)展,膝關(guān)節(jié)內(nèi)韌帶斷裂修復(fù)與重建的傳統(tǒng)開(kāi)放手術(shù)逐漸被關(guān)節(jié)鏡手術(shù)取代,但仍對(duì)手術(shù)時(shí)期選擇上存在分歧,目前較為明顯的兩觀點(diǎn)為一期重建與修復(fù)或分期重建與修復(fù),至于哪種時(shí)期的選擇更有利于該病的治療,今后仍需較大的臨床試驗(yàn)與回顧研究進(jìn)行總結(jié)。目的:探討膝關(guān)節(jié)多韌帶損傷的臨床特點(diǎn)及關(guān)節(jié)鏡下一期重建與修復(fù)的臨床療效分析。方法:收集我科自2012年2月至2014年12月收治的膝關(guān)節(jié)多韌帶損傷患者42例,其中男性患者29例,女性患者13例,平均年齡為33.5歲;損傷類型分別為:ACL+MCL損傷19例,ACL+PCL損傷12例,PCL+MCL損傷3例,ACL+PCL+MCL損傷13例,ACL+PCL+MCL+LCL損傷5例,其中同時(shí)合并外側(cè)半月板損傷14例,合并內(nèi)側(cè)半月板損傷10例。42例患者均在關(guān)節(jié)鏡下行一期韌帶重建或修復(fù),術(shù)后給予系統(tǒng)的康復(fù)鍛煉,分別于術(shù)前、術(shù)后對(duì)患膝進(jìn)行Lysholm評(píng)分、IKDC評(píng)分及主動(dòng)關(guān)節(jié)活動(dòng)度計(jì)量,收集術(shù)前、術(shù)后記錄數(shù)據(jù),比較治療療效。結(jié)果:42例無(wú)一失訪,隨訪時(shí)間為6-36個(gè)月,平均隨訪12.6個(gè)月,42例患者均在3周內(nèi)進(jìn)行手術(shù)。隨訪見(jiàn)42例患者屈伸膝均無(wú)明顯受限,無(wú)關(guān)節(jié)感染等并發(fā)癥發(fā)生,查體見(jiàn):42例患者患膝前、后抽屜試驗(yàn)(-),lachman試驗(yàn)(-),外旋撥號(hào)試驗(yàn)(-),0°及30°位內(nèi)外翻應(yīng)力試驗(yàn)(-)。術(shù)后復(fù)查X線及MRI檢查見(jiàn)內(nèi)固定物位置良好,無(wú)松動(dòng)、移位,重建骨道無(wú)擴(kuò)大及不愈合,重建韌帶無(wú)斷裂,復(fù)查時(shí)詳細(xì)記錄各項(xiàng)數(shù)據(jù)后得出:膝關(guān)節(jié)IKDC評(píng)分:術(shù)前(22.3±4.5)分,末次隨訪時(shí)(78.4±5.4)分;lysholm評(píng)分術(shù)前(32.4±4.5)分,末次隨訪時(shí)(89.4±9.6)分;患膝關(guān)節(jié)活動(dòng)度術(shù)前(63.5±6.2)°,末次隨訪時(shí)(118.6±4.7)°,手術(shù)前與末次隨訪時(shí)比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:對(duì)膝關(guān)節(jié)多韌帶損傷患者而言,早期關(guān)節(jié)鏡下一期重建ACL、PCL或聯(lián)合修復(fù)內(nèi)外側(cè)副韌帶可有效恢復(fù)膝關(guān)節(jié)穩(wěn)定性與功能,是治療膝關(guān)節(jié)多發(fā)韌帶損傷的有效方法。
[Abstract]:Background: knee ligament is an important and stable structure to ensure the normal motor function of knee joint. With the increasing incidence of multiple ligament injury of knee joint, it has become a hot topic of discussion and research in recent years. Early recognition and treatment are crucial to the recovery and prognosis of the disease. With the development of modern knee arthroscopy, the traditional open surgery for the repair and reconstruction of the internal ligament of the knee joint is gradually replaced by arthroscopic surgery, but there are still differences on the choice of the operative period. At present, the two obvious viewpoints are one-stage reconstruction and repair or phased reconstruction and repair. As to which stage is more favorable to the treatment of the disease, there is still a need for a large clinical trial and retrospective study to sum up in the future. Objective: to investigate the clinical features of multiple ligament injury of knee joint and the clinical effect of one stage reconstruction and repair under arthroscopy. Methods: from February 2012 to December 2014, 42 patients with multiple ligament injury of knee joint were collected, including 29 male patients and 13 female patients, with an average age of 33.5 years. The types of injury were: ACL MCL injury in 19 cases, ACL PCL injury in 12 cases, PCL MCL injury in 3 cases, ACL PCL MCL injury in 13 cases and, ACL PCL MCL LCL injury in 5 cases, in which 14 cases were accompanied with lateral meniscus injury. There were 10 cases with medial meniscus injury. 42 patients underwent primary ligament reconstruction or repair under arthroscopy. Systemic rehabilitation exercises were performed before and after operation. Lysholm score, IKDC score and active joint activity were measured before and after operation. Collect the data before and after operation and compare the curative effect. Results: 42 cases were followed up for 6 to 36 months, with an average follow-up of 12.6 months. 42 patients underwent surgery within 3 weeks. 42 cases of knee flexion and extension were not significantly limited, and no complications such as joint infection occurred. The results showed that 42 patients had anterior and posterior drawer test (-), lachman test), external rotation dialing test (-). Internal and external stress test at 0 擄and 30 擄(-). After operation, X-ray and MRI examination showed that the internal fixator was in good position, no loosening, displacement, no enlargement and nonunion of the reconstructed bone canal, no rupture of the reconstructed ligament, The IKDC score of knee joint was (22.3 鹵4.5) points before operation and (78.4 鹵5.4) points at the last follow-up. The lysholm score was (32.4 鹵4.5) before operation and (89.4 鹵9.6) at the last follow-up. The range of knee motion was (63.5 鹵6.2) 擄before operation and (118.6 鹵4.7) 擄at the last follow-up. The difference was statistically significant before operation and at the last follow-up (P0.05). Conclusion: early arthroscopic reconstruction of ACL,PCL or combined repair of internal and external collateral ligaments can effectively restore the stability and function of knee joint and is an effective method for the treatment of multiple ligament injury of knee joint.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.4

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本文編號(hào)：2416434