【摘要】：【目的】探討高軸移(high grade pivot shift HGPS)前交叉韌(anterior cruciate ligament ACL)損傷的危險(xiǎn)因素,為提高高軸移ACL損傷患者的療效提供依據(jù)和參考。【方法】回顧性取2014年04月至2015年10月解放軍401醫(yī)院骨科收治的前交叉韌帶損傷患者60例,隨機(jī)數(shù)字法分為普通組、輕度軸移組、高軸移組,每組20例。患者均行ACL重建術(shù)治療,術(shù)前完善相關(guān)檢查,收集3組患者基本資料(包括患者的性別、年齡、受傷到手術(shù)時(shí)間)、MRI影象資料(包括測量外側(cè)脛骨平臺(tái)后傾角(posterior-inferior tibial slope PITS)、內(nèi)側(cè)脛骨平臺(tái)后傾角及觀察前外側(cè)韌帶(anterolateral ligament ALL)異常狀況及術(shù)中外側(cè)半月板及內(nèi)側(cè)半月板損傷情況,對(duì)采集的數(shù)據(jù)應(yīng)用SPSS17.0軟件進(jìn)行處理并進(jìn)行單因素Logistic分析與多因素Logistic回歸分析,分析高軸移前交叉韌帶損傷的危險(xiǎn)因素�！窘Y(jié)果】高軸移組中外側(cè)脛骨平臺(tái)后傾角,與輕度軸移組與普通組有明顯差異(P0.05);輕度軸移組MRI測量外側(cè)脛骨平臺(tái)后傾角,與普通組有明顯差異(P0.05);單因素結(jié)果顯示:三個(gè)組中高軸移前交叉韌帶損傷發(fā)生率與性別、年齡、受傷到手術(shù)時(shí)間、內(nèi)側(cè)脛骨平臺(tái)后傾角、內(nèi)側(cè)半月板損傷無明顯相關(guān)性(P0.05);高軸移前交叉韌帶損傷發(fā)生率與外側(cè)脛骨平臺(tái)后傾角、前外側(cè)韌帶、外側(cè)半月板損傷有明顯相關(guān)性(P0.05),Logistic回歸分析顯示:高軸移前交叉韌帶損傷發(fā)生率與外側(cè)脛骨平臺(tái)后傾角、前外側(cè)韌帶損傷、外側(cè)半月板損傷有顯著相關(guān)性(P0.05)�！窘Y(jié)論】(1)高軸移前交叉韌帶損傷的危險(xiǎn)因素有外側(cè)脛骨平臺(tái)后傾角偏大、合并前外側(cè)韌帶損傷、合并半月板損傷;(2)根據(jù)危險(xiǎn)因素在治療高軸移前交叉韌帶的過程中除單純重建前交叉韌帶外,還應(yīng)糾正外側(cè)脛骨平臺(tái)后傾角,對(duì)損傷的半月板進(jìn)行縫合修復(fù),同時(shí)要對(duì)前外側(cè)韌帶進(jìn)行加強(qiáng)或重建,有利于提高治療效果,改善愈后,減少遠(yuǎn)期并發(fā)癥的發(fā)生。
[Abstract]:[objective] to investigate the risk factors of (anterior cruciate ligament ACL) damage in the anterior cross ligament of high axis shifted (high grade pivot shift HGPS). [methods] from April 2014 to October 2015, 60 patients with anterior cruciate ligament injury in the Department of Orthopaedics of Chinese PLA 401 Hospital were randomly divided into the normal group and the control group, and the patients were divided into two groups: the normal group (n = 60) and the control group (n = 60). Mild shift group, high axis shift group, 20 cases in each group. All the patients were treated with ACL reconstruction, the relevant examinations were improved before operation, and the basic data of three groups of patients (including gender, age, time from injury to operation) were collected. MRI imaging data (including measurement of lateral tibial plateau posterior obliquity (posterior-inferior tibial slope PITS), medial tibial plateau posterior inclination) and observation of anterior lateral ligament (anterolateral ligament ALL) abnormalities and medial lateral meniscus and medial meniscus injury. The collected data were processed by SPSS17.0 software and analyzed by univariate Logistic analysis and multi-factor Logistic regression analysis to analyze the risk factors of the injury of the anterior cruciate ligament with high axis shift. [results] the posterior inclination of the middle-lateral tibial plateau in the high-axis shift group was significantly higher than that in the control group (P < 0.05). There was a significant difference between the mild axis shift group and the ordinary group (P0.05). The posterior inclination of lateral tibial plateau measured by MRI in mild axisymmetric group was significantly different from that in normal group (P0.05). Univariate results showed that there was no significant correlation between the incidence of high axial displacement anterior cruciate ligament injury and gender, age, time from injury to operation, posterior inclination of medial tibial plateau and medial meniscus injury in the three groups (P0.05). The incidence of high axial displacement anterior cruciate ligament injury was significantly correlated with the posterior obliquity of lateral tibial plateau, anterior lateral ligament and lateral meniscus injury (P0.05). Logistic regression analysis showed that the incidence of high axial displacement of the anterior cruciate ligament was associated with the posterior inclination of the lateral tibial plateau and the injury of the anterior lateral ligament. There was significant correlation between lateral meniscus injury (P0.05). [conclusion] (1) the risk factors of high axial displacement anterior cruciate ligament injury are lateral tibial plateau posterior obliquity, anterior lateral ligament injury and meniscus injury; (2) according to the risk factors, the posterior inclination of the lateral tibial plateau should be corrected and the injured meniscus should be sutured and repaired in addition to reconstruction of the anterior cruciate ligament in the treatment of high axial displacement of the anterior cruciate ligament. At the same time, strengthening or reconstruction of the anterior lateral ligament is helpful to improve the therapeutic effect, improve the recovery and reduce the occurrence of long-term complications.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4

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