早期髌骨脱位对幼兔胫骨结节位置的影响

发布时间：2018-05-02 18:17

  本文选题：髌骨脱位 + 滑车发育　； 参考：《河北医科大学》2017年硕士论文

【摘要】：目的:髌骨脱位属于髌股关节疾病,也是髌骨不稳的一种,临床较多发,多见于青少年,女性多于男性。CT扫描技术对髌股关节疾病的诊断有着很高的价值。CT不仅能够显示髌骨和股骨的形态,还能辅助测量髌股关节疾病中的很多重要参数,用于评价髌股关节的对合关系是否正常。此次动物实验我们通过CT测量的正是幼兔膝关节的TT-TG(Tibial Tubercle-Trochlear Groove Distance,胫骨结节-股骨滑车间距)和胫骨结节外移比例,因为在人体当中这两个参数值对研究髌骨脱位有着十分重要的意义。本动物实验的目的是研究早期髌骨脱位对胫骨结节-股骨滑车间距离、胫骨结节位置的影响。方法:40只一个月龄大的新西兰白兔(共80膝,由河北医科大学动物中心提供)体重300-500g,分成2组(N=40/组)即:设立左膝对照组(a)和右膝髌骨脱位组(b)。a组行单纯假手术(单纯进行术前称重,麻醉,皮肤切开缝合),b组行髌骨脱位术(术前称重,均使用氯胺酮(20mg/kg)联合甲苯噻嗪(5mg/kg)于幼兔耳缘静脉处进行注射麻醉,麻醉后对兔子两后腿膝关节进行备皮准备(剪除兔毛),行标准常规消毒,无菌单平铺于术区表面,沿着幼兔膝关节正中行一长2cm左右的切口,逐层切开皮肤及皮下组织,并分离软组织,将关节囊暴露。动作轻柔避免损伤神经血管。分别沿髌骨内侧缘、外侧缘做一长约2cm切口,外推髌骨,测试髌骨外移度,造成髌骨向外侧脱位,用可吸收一号线(absorbablethread No.1)暂时缝合外侧关节囊,观察髌骨位置外移,活动膝关节发现髌骨不能在股骨滑车沟内正常运动,再用一号可吸收线(absorbable thread No.1)将外侧关节囊重叠缝合3~4针,逐层缝合皮下组织及皮肤,无菌辅料及绷带包扎伤口)。术后行丁诺菲肌肉注射(2/日)缓解疼痛,口服环丙沙星(10mg/kg)预防感染,为期3天。为避免关节粘连,手术3日之后再开始促使兔子双膝关节活动。手术进行之前以及手术后6个月对实验兔子的膝关节进行CT扫描检查,测量TT-TG(Tibial Tubercle-Trochlear Groove Distance,胫骨结节-股骨滑车间距)以及胫骨结节外移比值,对比研究两组兔子的TT-TG(Tibial TubercleTrochlear Groove Distance,胫骨结节-股骨滑车间距)以及胫骨结节外移比值的变化情况。结果:CT检查测量结果显示,术前对照组(a)和髌骨脱位组(b)的CT测量值之间没有统计学意义。行膝关节髌骨脱位术后6个月,经统计学分析结果可见:对照组(a)的TT-TG测量值为1.01mm±0.35,髌骨脱位组(b)则为2.98±0.66mm(P0.05);对照组(a)胫骨结节外移比值为0.46±0.08,髌骨脱位组胫骨结节外移比值为0.55±0.05(P0.05)。结论:早期髌骨脱位能够导致TT-TG的增大以及胫骨结节外置,同样也具有重要的临床意义,那就是我们应该更加关注青少年髌骨脱位,在其髌骨脱位的早期就加以干预,给予保守或手术治疗,尽早改善青少年髌骨脱位患者膝关节的髌股对合关系,阻止发育不良的进一步发展。
[Abstract]:Objective: patellar dislocation is a disease of patellofemoral joint and a kind of patellar instability. The diagnostic value of CT scanning in women is higher than that in men. Ct can not only show the shape of patella and femur, but also help to measure many important parameters of patellofemoral joint disease. Used to evaluate whether the involution of the patellofemoral joint is normal. In this animal experiment, we measured the TT-TG(Tibial Tubercle-Trochlear Groove distance (the distance between the tibial nodule and the femoral trochlea) and the proportion of the tibial nodule moving out of the knee joint of the young rabbit by CT. These two parameters are of great significance in the study of patellar dislocation. The purpose of this animal experiment was to study the effect of early patellar dislocation on the distance between the tibial tubercle and the trochlear and the location of the tibial tubercle. Methods A total of 40 one-month-old New Zealand white rabbits (80 knees in total) were studied. The body weight of 300-500g was given by Animal Center of Hebei Medical University, divided into two groups: control group with left knee (group A) and group B with dislocation of patella of right knee (group A) with simple sham-operation (weighing before operation and anaesthesia). The patella dislocation group (weighing 20 mg / kg before operation) and toluene thiazide (5 mg / kg) were injected into the auricular vein of young rabbits. After anesthesia, the rabbit's hind leg knee joint was prepared for skin preparation (cut off rabbit hair, disinfected by standard routine, sterile single tile on the surface of the operation area, along the middle of the knee joint of the young rabbit by a long 2cm incision, layer by layer incision of the skin and subcutaneous tissue, The soft tissue was separated and the joint capsule was exposed. Gentle movement to avoid damage to the nerve and blood vessels. A long 2cm incision was made along the medial and lateral edge of the patella, and the patella was extrapolated. The lateral dislocation of the patella was induced by measuring the degree of patellar displacement. The lateral articular sac was temporarily sutured with absorbable line 1 (absorbable line 1) to observe the location of the patella. The patella was found to be unable to move normally in the trochlear sulcus of the femur. The lateral articular capsule was sutured with three or four stitches with absorbable thread No. 1. The subcutaneous tissue and skin were sutured layer by layer, sterile excipients and bandages were used to bind the wound. After operation, buprofen intramuscular injection 2 / d was used to relieve pain and ciprofloxacin 10 mg / kg was given orally for 3 days to prevent infection. In order to avoid joint adhesion, the operation 3 days later began to promote bilateral knee movement in rabbits. The knee joints of experimental rabbits were examined with CT before and 6 months after operation to measure the TT-TG(Tibial Tubercle-Trochlear Groove distance, the distance between the tibial nodule and the trochlear, and the ratio of tibial nodule displacement. The changes of TT-TG(Tibial TubercleTrochlear Groove distance (tibial tuberculus-femoral trochlear distance) and the ratio of tibial nodule displacement were compared between the two groups. Results there was no significant difference in CT measurements between the preoperative control group and the patellar dislocation group. Six months after patellar dislocation of the knee joint, the results of statistical analysis showed that the TT-TG value of the control group was 0.35 卤0.35, and that of the patellar dislocation group was 2.98 卤0.66mmP0.05, while that of the control group was 0.46 卤0.08, and that of the patellar dislocation group was 0.55 卤0.05P0.05. Conclusion: early patellar dislocation can lead to the enlargement of TT-TG and the external insertion of tibial tubercle. It is also of great clinical significance that we should pay more attention to juvenile patellar dislocation and intervene at the early stage of patellar dislocation. Conservative or surgical treatment was given to improve patellofemoral involution of knee joint of juvenile patellar dislocation patients as early as possible to prevent the further development of dysplasia.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R684

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