關(guān)節(jié)鏡輔助下同種異體半月板移植術(shù)后臨床功能評(píng)價(jià)及1-8年隨訪研究
發(fā)布時(shí)間：2019-02-14 06:53
【摘要】：背景近30年來,隨著內(nèi)鏡技術(shù)的不斷進(jìn)步以及對(duì)半月板血液供應(yīng),解剖,生物力學(xué)的研究不斷深入,半月板損傷的診斷、治療及術(shù)后的功能康復(fù)有了長足的發(fā)展。半月板損傷的治療一般分為保守治療及手術(shù)干預(yù),適合保守治療的病例較少且效果較差,常見的手術(shù)治療方式有切除、部分切除、縫合等方法。但半月板切除后會(huì)繼發(fā)并發(fā)癥,早在1948年,Fairbank等人已經(jīng)證實(shí)有部分骨關(guān)節(jié)炎(OA)的發(fā)生是由既往半月板切除后引起。目前,對(duì)于半月板全部切除患者的治療焦點(diǎn)仍然是如何選擇恰當(dāng)?shù)闹委煼椒◤亩苊饣驕p緩關(guān)節(jié)退變的發(fā)生。所以半月板損傷后治療的難點(diǎn)主要是如何最大可能達(dá)到半月板的原始生理功能,恢復(fù)膝關(guān)節(jié)正常的活動(dòng)功能,減輕疼痛癥狀,避免并發(fā)癥的發(fā)生。為了盡可能降低半月板切除后所帶來的一系列并發(fā)癥,恢復(fù)膝關(guān)節(jié)正常生物力學(xué)環(huán)境,避免繼發(fā)引起的關(guān)節(jié)磨損,延緩關(guān)節(jié)退變,中外學(xué)者進(jìn)行了大量的臨床及基礎(chǔ)研究。認(rèn)為只有半月板重建可以最大程度上恢復(fù)半月板切除后引起的膝關(guān)節(jié)功能障礙。目前研究的半月板重建材料主要包括自體組織結(jié)構(gòu)重建、半月板假體設(shè)計(jì)植入、組織工程化研究和同種異體半月板。自體組織重建包括髕韌帶,肌腱,軟骨膜,但重建后的臨床效果不佳,主要原因是這些組織形式和結(jié)構(gòu)和半月板不同,與原半月板在匹配度上相差太大。而且取自體組織對(duì)供區(qū)也是一次傷害。組織工程半月板發(fā)展較快,主要由組織支架材料、細(xì)胞及生長因子構(gòu)成,有良好的發(fā)展前景,尚處于實(shí)驗(yàn)研究階段。目前臨床應(yīng)用較多,患者相對(duì)容易接受,臨床效果較好的半月板重建方法只有同種異體半月板移植。自上世紀(jì)后期,學(xué)者們對(duì)于異體半月板的儲(chǔ)存、消毒、匹配及半月板移植的手術(shù)技術(shù)做了大量的研究。目前,MAT取得了滿意的短期效果,但中長期臨床效果,尤其在軟骨保護(hù),預(yù)防或減緩OA的發(fā)生,異體半月板在體內(nèi)的形態(tài)學(xué)及組織學(xué)變化,移植后對(duì)膝關(guān)節(jié)功能中長期的影響等尚無規(guī)范的、嚴(yán)謹(jǐn)?shù)脑冏C醫(yī)學(xué)證據(jù)。本研究立足于我院既往MAT患者進(jìn)行1-8年臨床功能評(píng)價(jià)及隨訪研究。對(duì)MAT治療半月板切除提供一定的理論支持和臨床實(shí)踐經(jīng)驗(yàn)。目的通過對(duì)既往半月板移植的病例進(jìn)行臨床功能評(píng)價(jià)及術(shù)后1-8年隨訪研究,提高對(duì)半月板移植的評(píng)估及手術(shù)效果的評(píng)價(jià)。方法隨訪自2006年12月至2013年12月在我院進(jìn)行MAT的74例MAT進(jìn)行電話隨訪,隨訪成功例數(shù)為56例。隨訪成功率為75.7%。其中男性30例(53.6%),女性26例(46.4%)。年齡16?50歲,平均為(32.11土9.15)歲,外側(cè)移植20例,內(nèi)側(cè)移植33例,內(nèi)外同期移植3例。通過使用IKDC膝關(guān)節(jié)功能評(píng)分、Lysholm評(píng)分、Tegner運(yùn)動(dòng)評(píng)分以及視覺模擬評(píng)分(VAS)評(píng)估疼痛,進(jìn)行隨訪結(jié)果的評(píng)價(jià)。影像學(xué)評(píng)估包括對(duì)標(biāo)準(zhǔn)前后位X線片上的關(guān)節(jié)間隙以及磁共振成像(MRI)上的評(píng)價(jià)。結(jié)果IKDC評(píng)分從術(shù)前的54.43提高到隨訪時(shí)的81.16(P0.05),Lysholm評(píng)分從69.03提高到89.39(P0.05),Tegner評(píng)分從術(shù)前的3.91提高到7.41(P0.05)。。VAS評(píng)分從5.32顯著下降到2.36(P0.05)。影像學(xué)包括X平片及MRI評(píng)估發(fā)現(xiàn)個(gè)例隨訪出現(xiàn)輕微的關(guān)節(jié)間隙變窄。移植半月板在MRI上表現(xiàn)出外凸征是MAT術(shù)后一個(gè)常見的結(jié)果。結(jié)論這項(xiàng)研究表明,平均70個(gè)月的MAT可以顯著提高膝關(guān)節(jié)的活動(dòng)功能,改善疼痛,我們從MRI上觀察到了半月板外凸以及皺縮現(xiàn)象,但是外凸的增加與MAT術(shù)后時(shí)間的長短及膝關(guān)節(jié)功能評(píng)分似乎并沒有關(guān)系。
[Abstract]:In the last 30 years, with the progress of endoscopic technique and the study of the supply, anatomy and biomechanics of the meniscal blood, the diagnosis, treatment and functional rehabilitation of the meniscus injury have made great progress. The treatment of meniscal injury is generally divided into conservative treatment and surgical intervention. However, after the meniscal resection, complications were secondary and, as early as in 1948, Fairbank et al. have confirmed that some osteoarthritis (OA) occurred after a prior meniscectomy. At present, the focus on the treatment of the total meniscal resection of the patient is still the choice of appropriate treatment methods to avoid or slow the occurrence of a degenerative joint. Therefore, the difficulty of the treatment after meniscus injury is mainly how to maximize the original physiological function of the meniscus, restore the normal function of the knee joint, relieve the pain symptoms, and avoid the occurrence of the complications. In order to reduce the series of complications following the meniscectomy as much as possible, the normal biomechanical environment of the knee joint is restored, the joint wear caused by the secondary injury is avoided, the joint is delayed, and a great deal of clinical and basic research has been conducted by the Chinese and foreign scholars. It is considered that only the meniscal reconstruction can restore the knee joint dysfunction due to the meniscal resection to a maximum extent. The currently studied meniscal reconstruction material mainly includes the reconstruction of the autograft structure, the design of the meniscal prosthesis, the tissue engineering study and the allogenic meniscus. The re-establishment of the autograft includes the patellar tendon, the tendon and the cartilage membrane, but the clinical effect after the reconstruction is not good, the main reason is that the form and structure of the tissue and the meniscus are different, and the difference between the original meniscus and the original meniscus is too large. and the body tissue is also a one-time injury to the supply area. The development of meniscus of tissue engineering is rapid, mainly composed of tissue scaffold material, cell and growth factor, has good development prospect, and is still in the experimental research stage. At present, the clinical application is more, the patient is relatively easy to accept, and the meniscal reconstruction method with better clinical effect is only the allogenic meniscal transplantation. Since the late last century, scholars have done a lot of research on the storage, disinfection, matching and meniscal transplantation of the meniscus. At present, the MAT has a satisfactory short-term effect, but medium and long-term clinical effect, especially in the protection of cartilage, the occurrence of OA, the morphology and the histological change of the meniscus in the body, the long-and long-term effects of the transplantation on the function of the knee joint, etc., are not regulated, a rigorous evidence of medical evidence. This study is based on the clinical function evaluation and follow-up study of the previous MAT patients in our hospital for 1-8 years. To provide some theoretical support and clinical practice experience for MAT treatment of meniscectomy. Objective To evaluate the clinical function and the follow-up of 1-8 years after operation, and to improve the evaluation of the meniscal transplantation and the evaluation of the effect of the operation. Methods 74 patients with MAT were followed up in our hospital from December 2006 to December 2013. The number of successful follow-up was 56 cases. The success rate of follow-up was 75.7%. Among them, 30 were male (53.6%) and 26 (44.6%). The age was 16-50 years, the average was (32. 11, 9.15), the lateral graft was 20 cases, the inner graft was 33 cases, and the internal and external simultaneous transplantation was 3 cases. The results of the follow-up were evaluated by using the IKDC knee function score, the Lysholm score, the Tegner motion score, and the visual analog score (VAS) to assess the pain. Imaging assessments included evaluation of the joint space on the pre-and post-standard X-ray patch and on magnetic resonance imaging (MRI). Results The IIKDC score was increased from 54. 43 before the operation to 81.16 at the follow-up (P0.05). The Lysholm score was increased from 69. 03 to 89. 39 (P0.05), and the Tegner score was increased from 3.91 to 7.41 (P0.05). The VAS score decreased from 5.32 to 2.36 (P0.05). Imaging consisted of an X-plane and an MRI assessment that revealed a slight narrowing of the joint gap in the follow-up. The transplantation of the meniscus on MRI showed a common result after the MAT operation. Conclusion This study shows that the average of 70 months of MAT can significantly improve the activity of the knee joint and improve the pain. We have observed the meniscus of the meniscus and the shrinkage of the meniscus on the MRI, but the increase of the male and the length of the time after the MAT and the score of the function of the knee joint seem to have no relation.
【學(xué)位授予單位】：第四軍醫(yī)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
本文編號(hào)：2421931
[Abstract]:In the last 30 years, with the progress of endoscopic technique and the study of the supply, anatomy and biomechanics of the meniscal blood, the diagnosis, treatment and functional rehabilitation of the meniscus injury have made great progress. The treatment of meniscal injury is generally divided into conservative treatment and surgical intervention. However, after the meniscal resection, complications were secondary and, as early as in 1948, Fairbank et al. have confirmed that some osteoarthritis (OA) occurred after a prior meniscectomy. At present, the focus on the treatment of the total meniscal resection of the patient is still the choice of appropriate treatment methods to avoid or slow the occurrence of a degenerative joint. Therefore, the difficulty of the treatment after meniscus injury is mainly how to maximize the original physiological function of the meniscus, restore the normal function of the knee joint, relieve the pain symptoms, and avoid the occurrence of the complications. In order to reduce the series of complications following the meniscectomy as much as possible, the normal biomechanical environment of the knee joint is restored, the joint wear caused by the secondary injury is avoided, the joint is delayed, and a great deal of clinical and basic research has been conducted by the Chinese and foreign scholars. It is considered that only the meniscal reconstruction can restore the knee joint dysfunction due to the meniscal resection to a maximum extent. The currently studied meniscal reconstruction material mainly includes the reconstruction of the autograft structure, the design of the meniscal prosthesis, the tissue engineering study and the allogenic meniscus. The re-establishment of the autograft includes the patellar tendon, the tendon and the cartilage membrane, but the clinical effect after the reconstruction is not good, the main reason is that the form and structure of the tissue and the meniscus are different, and the difference between the original meniscus and the original meniscus is too large. and the body tissue is also a one-time injury to the supply area. The development of meniscus of tissue engineering is rapid, mainly composed of tissue scaffold material, cell and growth factor, has good development prospect, and is still in the experimental research stage. At present, the clinical application is more, the patient is relatively easy to accept, and the meniscal reconstruction method with better clinical effect is only the allogenic meniscal transplantation. Since the late last century, scholars have done a lot of research on the storage, disinfection, matching and meniscal transplantation of the meniscus. At present, the MAT has a satisfactory short-term effect, but medium and long-term clinical effect, especially in the protection of cartilage, the occurrence of OA, the morphology and the histological change of the meniscus in the body, the long-and long-term effects of the transplantation on the function of the knee joint, etc., are not regulated, a rigorous evidence of medical evidence. This study is based on the clinical function evaluation and follow-up study of the previous MAT patients in our hospital for 1-8 years. To provide some theoretical support and clinical practice experience for MAT treatment of meniscectomy. Objective To evaluate the clinical function and the follow-up of 1-8 years after operation, and to improve the evaluation of the meniscal transplantation and the evaluation of the effect of the operation. Methods 74 patients with MAT were followed up in our hospital from December 2006 to December 2013. The number of successful follow-up was 56 cases. The success rate of follow-up was 75.7%. Among them, 30 were male (53.6%) and 26 (44.6%). The age was 16-50 years, the average was (32. 11, 9.15), the lateral graft was 20 cases, the inner graft was 33 cases, and the internal and external simultaneous transplantation was 3 cases. The results of the follow-up were evaluated by using the IKDC knee function score, the Lysholm score, the Tegner motion score, and the visual analog score (VAS) to assess the pain. Imaging assessments included evaluation of the joint space on the pre-and post-standard X-ray patch and on magnetic resonance imaging (MRI). Results The IIKDC score was increased from 54. 43 before the operation to 81.16 at the follow-up (P0.05). The Lysholm score was increased from 69. 03 to 89. 39 (P0.05), and the Tegner score was increased from 3.91 to 7.41 (P0.05). The VAS score decreased from 5.32 to 2.36 (P0.05). Imaging consisted of an X-plane and an MRI assessment that revealed a slight narrowing of the joint gap in the follow-up. The transplantation of the meniscus on MRI showed a common result after the MAT operation. Conclusion This study shows that the average of 70 months of MAT can significantly improve the activity of the knee joint and improve the pain. We have observed the meniscus of the meniscus and the shrinkage of the meniscus on the MRI, but the increase of the male and the length of the time after the MAT and the score of the function of the knee joint seem to have no relation.
【學(xué)位授予單位】：第四軍醫(yī)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
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 羅殿中;章亞東;侯樹勛;楊家斐;趙慶;張軼超;薛超;;半月板相關(guān)間接測量指標(biāo)的匹配性探討[J];軍醫(yī)進(jìn)修學(xué)院學(xué)報(bào);2011年08期
，本文編號(hào)：2421931
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