麥?zhǔn)险髟谂袛喙顷P(guān)節(jié)病患者關(guān)節(jié)鏡半月板切除術(shù)療效中的作用
發(fā)布時(shí)間：2019-05-18 17:00
【摘要】：背景與目的 目前使用關(guān)節(jié)鏡外科手術(shù)治療伴有骨關(guān)節(jié)病的半月板損傷存在爭(zhēng)議,主要由于其術(shù)后療效難以評(píng)估。近年來,關(guān)于關(guān)節(jié)鏡下半月板切除術(shù)在骨關(guān)節(jié)病患者中應(yīng)用的爭(zhēng)論主要聚焦于手術(shù)患者的病例選擇,支持關(guān)節(jié)鏡手術(shù)的學(xué)者認(rèn)為具有“有癥狀的半月板損傷”的患者需要手術(shù)干預(yù),對(duì)于這些骨關(guān)節(jié)病患者來說,切除不穩(wěn)定的損傷的半月板是有必要的。然而,如何精確定義“有癥狀的半月板損傷”是非常困難的,尤其是在患有骨關(guān)節(jié)病的患者中,因此,術(shù)前準(zhǔn)確診斷“有癥狀的半月板損傷”可能是解決此類問題的關(guān)鍵所在。 由于麥?zhǔn)险魇欠磻?yīng)膝關(guān)節(jié)半月板損傷的重要體征之一,尤其是不穩(wěn)定的半月板損傷,因此我們假設(shè)麥?zhǔn)险鞑粌H可以精確的在術(shù)前判斷是否為“有癥狀的半月板損傷”,同時(shí)也能以此來評(píng)估手術(shù)以后的療效。本研究通過對(duì)比骨關(guān)節(jié)病患者的麥?zhǔn)险髋c關(guān)節(jié)鏡檢查結(jié)果,分析麥?zhǔn)险鞯拿舾卸燃疤禺惗?以及觀察麥?zhǔn)险鳈z查結(jié)果與患者術(shù)后預(yù)后之間的關(guān)系,以此來判斷骨關(guān)節(jié)病的患者中,那些患者需要進(jìn)行關(guān)節(jié)鏡下半月板切除手術(shù)。 方法 回顧性分析本院2008年3月至2011年8月期間,149例由影像學(xué)診斷為“半月板損傷伴骨關(guān)節(jié)病”并經(jīng)過關(guān)節(jié)鏡手術(shù)治療的患者(平均年齡58.8歲),術(shù)后平均隨訪12個(gè)月。根據(jù)麥?zhǔn)险鹘Y(jié)果與關(guān)節(jié)鏡檢查是否存在半月板損傷符合程度計(jì)算麥?zhǔn)险鞯拿舾卸燃疤匾舛取８鶕?jù)其術(shù)前麥?zhǔn)险鹘Y(jié)果進(jìn)行分組,對(duì)比組間手術(shù)前后患者Lysholm評(píng)分及VAS評(píng)分改善程度。 結(jié)果 麥?zhǔn)险鞯拿舾卸燃疤禺惗确謩e為79.27%與67.16%,麥?zhǔn)险麝栃郧谊P(guān)節(jié)鏡檢查存在半月板損傷的患者Lysholm評(píng)分由術(shù)前平均43.25分改善為術(shù)后平均75.82分(P0.05), VAS評(píng)分則由術(shù)前平均7.91分改善至術(shù)后平均3.07分(P0.05),并與其他組間對(duì)照,差異存在統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論 在合并骨關(guān)節(jié)病的半月板損傷患者中,麥?zhǔn)险麝栃钥梢宰鳛轭A(yù)計(jì)術(shù)后療效滿意的依據(jù)。在膝關(guān)節(jié)骨關(guān)節(jié)病的治療中,麥?zhǔn)险麝栃?并于影像學(xué)資料相符的患者需要進(jìn)行手術(shù)治療。
[Abstract]:Background & objective at present, the use of arthroscopy in the treatment of meniscus injury with osteoarthropathy is controversial, mainly because it is difficult to evaluate the postoperative efficacy. In recent years, the debate about the application of arthroscopic meniscus resection in patients with osteoarthropathy has mainly focused on the choice of cases in patients undergoing surgery. Scholars who support arthroscopic surgery believe that patients with "symptomatic meniscus injury" need surgical intervention. For these patients with osteoarthropathy, it is necessary to remove unstable meniscus. However, it is very difficult to accurately define "symptomatic meniscus injury", especially in patients with osteoarthropathy. Therefore, accurate preoperative diagnosis of "symptomatic meniscus injury" may be the key to solve this problem. Because McCartney's sign is one of the important signs of meniscus injury of knee joint, especially unstable meniscus injury, we assume that McCartney's sign can not only accurately judge whether it is "symptomatic meniscus injury" before operation. At the same time, it can also be used to evaluate the curative effect after operation. In this study, the sensitivity and specificity of McDonalski sign were analyzed by comparing the results of McChrystal sign and arthroscopy in patients with osteoarthropathy, and the relationship between the results of McChrill sign and the prognosis of patients was observed. In order to judge the patients with osteoarthropathy, those patients need arthroscopic meniscus resection. Methods from March 2008 to August 2011, 149 patients (mean age 58.8 years) diagnosed as meniscus injury with osteoarthropathy and treated by arthroscopy were analyzed retrospectively. The average follow-up period was 12 months. The sensitivity and specificity of Macs sign were calculated according to the coincidence degree of meniscus injury between the results of McDonalski sign and arthroscopy. The Lysholm score and VAS score of the patients before and after operation were compared according to the results of McDonalski sign before and after operation. Results the sensitivity and specificity of McGrady's sign were 79.27% and 67.16%, respectively. The Lysholm score of patients with positive McDonalski sign and meniscus injury was improved from an average of 43.25 points before operation to an average of 75.82 points after operation (P 0.05). The VAS score improved from 7.91 points before operation to 3.07 points after operation (P 0.05), and there was significant difference between the two groups (P 0.05). Conclusion in patients with meniscus injury complicated with osteoarthropathy, the positive sign can be used as the basis for predicting the satisfactory curative effect after operation. In the treatment of osteoarthropathy of knee joint, patients with McGrady's sign positive and consistent with imaging data need surgical treatment.
【學(xué)位授予單位】：浙江大學(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)：2480178
[Abstract]:Background & objective at present, the use of arthroscopy in the treatment of meniscus injury with osteoarthropathy is controversial, mainly because it is difficult to evaluate the postoperative efficacy. In recent years, the debate about the application of arthroscopic meniscus resection in patients with osteoarthropathy has mainly focused on the choice of cases in patients undergoing surgery. Scholars who support arthroscopic surgery believe that patients with "symptomatic meniscus injury" need surgical intervention. For these patients with osteoarthropathy, it is necessary to remove unstable meniscus. However, it is very difficult to accurately define "symptomatic meniscus injury", especially in patients with osteoarthropathy. Therefore, accurate preoperative diagnosis of "symptomatic meniscus injury" may be the key to solve this problem. Because McCartney's sign is one of the important signs of meniscus injury of knee joint, especially unstable meniscus injury, we assume that McCartney's sign can not only accurately judge whether it is "symptomatic meniscus injury" before operation. At the same time, it can also be used to evaluate the curative effect after operation. In this study, the sensitivity and specificity of McDonalski sign were analyzed by comparing the results of McChrystal sign and arthroscopy in patients with osteoarthropathy, and the relationship between the results of McChrill sign and the prognosis of patients was observed. In order to judge the patients with osteoarthropathy, those patients need arthroscopic meniscus resection. Methods from March 2008 to August 2011, 149 patients (mean age 58.8 years) diagnosed as meniscus injury with osteoarthropathy and treated by arthroscopy were analyzed retrospectively. The average follow-up period was 12 months. The sensitivity and specificity of Macs sign were calculated according to the coincidence degree of meniscus injury between the results of McDonalski sign and arthroscopy. The Lysholm score and VAS score of the patients before and after operation were compared according to the results of McDonalski sign before and after operation. Results the sensitivity and specificity of McGrady's sign were 79.27% and 67.16%, respectively. The Lysholm score of patients with positive McDonalski sign and meniscus injury was improved from an average of 43.25 points before operation to an average of 75.82 points after operation (P 0.05). The VAS score improved from 7.91 points before operation to 3.07 points after operation (P 0.05), and there was significant difference between the two groups (P 0.05). Conclusion in patients with meniscus injury complicated with osteoarthropathy, the positive sign can be used as the basis for predicting the satisfactory curative effect after operation. In the treatment of osteoarthropathy of knee joint, patients with McGrady's sign positive and consistent with imaging data need surgical treatment.
【學(xué)位授予單位】：浙江大學(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3條
1 張洪濤;張繼文;姜波;胡守力;;關(guān)節(jié)鏡微骨折術(shù)治療膝骨關(guān)節(jié)炎合并軟骨損傷療效觀察[J];中華實(shí)用診斷與治療雜志;2011年03期
2 費(fèi)文勇;謝軍;章洪喜;施曉明;;膝骨性關(guān)節(jié)炎關(guān)節(jié)鏡下微骨折技術(shù)的臨床療效[J];臨床骨科雜志;2010年01期
3 阿提坎;居來提;;淺談膝骨關(guān)節(jié)病的冶療效果及進(jìn)展[J];求醫(yī)問藥(下半月);2013年06期
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