量化胫骨前移度评估前交叉韧带重建术后膝关节稳定性的研究
发布时间：2019-05-06 18:12
【摘要】：研究目的： 本研究旨在观察膝关节前交叉韧带(Anterior Cruciate Ligament ACL)重建术前及术后随访的胫骨前移度、膝关节功能水平,探讨量化胫骨前移度在评估ACL断裂及重建术后膝关节稳定性的意义。通过数据的收集、统计初步提出诊断ACL断裂的胫骨前移度诊断参考数值,评估ACL重建术后膝关节稳定性及关节功能的变化情况。 研究方法： 选择2012.01—2014.03于广州中医药大学第一附属医院四骨科行关节镜下前交叉韧带重建手术的患者58例,55例患者完成1年以上随访,没有发生相关并发症。其中男31例,女24例；年龄19-46岁,平均30.8岁。致伤原因：运动损伤为46例,交通事故5例,工伤4例。损伤情况(关节镜下确认)：其中单纯ACL断裂30例,ACL断裂合并半月板损伤21例,ACL断裂合并内侧副韧带损伤4例。所有病例采用腰硬联合麻醉、关节镜下重建前交叉韧带,移植物为自体胭绳肌腱(半腱肌肌腱、半膜肌肌腱)或者同种异体肌腱,所有患者手术由同一组医生完成,术后采取一致的康复计划。全部病例于术前应用Kneelax3关节测量仪(荷兰,MONITORED REHABSYSTEMSB. V.型号：KNEELAX3)测量双膝胫骨前移度,术后1年内每隔3个月返院复查一次,每次复查时均使用Kneelax3关节测量仪进行术后重建交叉韧带膝关节稳定性的评估及行Lysholm膝关节功能评分,并作统计学比较分析。 研究结果： 膝关节屈曲30。下测量双膝前移度,术前测试结果：44N拉力,患膝平均前移(3.35±1.90)mm,双膝平均前移差值(0.64±0.13)mm。66N拉力,患膝平均前移(4.73±1.70)mm,双膝平均前移差值(0.88±0.12)mm。88N拉力,患膝平均前移(6.36±1.21)mm,双膝平均前移差值(1.57±0.22)mm。132N拉力,患膝平均前移(8.63±2.32)mm,双膝平均前移差值(2.51±0.24)mm。在132N拉力时,95%患膝胫骨前移值8.91mm,95%双侧胫骨前移差值2.52mm;95%患膝索引1.63mm,95%双侧索引差值0.68mm。患者术后膝关节胫骨前移度小于术前,差异有统计学意义(P0.05)。在ACL重建术后1年内,术后膝关节的胫骨前移度有一定的上升趋势,提示关节稳定性随时间推移有一定下降,但差异无统计学意义。Lysholm评分由术前的63.58±3.61分增加到术后(1年)的93.26±3.48分,差异有显著性(P0.05)。 研究结论： Kneelax3关节测量仪可用于量化评价膝关节ACL断裂患者的膝关节前向稳定性,ACL断裂的膝关节前向稳定性比健膝差。Kneelax3膝关节测量可作为一种辅助手段用于膝关节前交叉韧带断裂的诊断和疗效评价,提出其诊断ACL断裂的参考值为132N应力时,患膝胫骨前移度8.91mm,索引1.63mm；双侧胫骨前移度差值2.52mm,索引差值0.68mm。关节镜下ACL重建手术能减少患膝胫骨前移度,提高患膝的稳定性,提高Lysholm膝关节功能评分,提高患者的生活质量。随着时间推移,术后1年内膝关节的稳定性有一定的下降趋势,Lysholm膝关节功能评分逐渐提高。
[Abstract]:Objective: the purpose of this study was to observe the anterior tibial movement and knee function before and after (Anterior Cruciate Ligament ACL) reconstruction of the anterior cruciate ligament (ACL) of the knee joint. Objective: to explore the significance of quantitative tibial anterior displacement in evaluating ACL fracture and knee joint stability after reconstruction. Through the collection of data, the diagnostic reference value of tibial anterior displacement for diagnosis of ACL fracture was put forward, and the changes of knee joint stability and joint function after ACL reconstruction were evaluated. Methods: fifty-eight patients who underwent arthroscopic anterior cruciate ligament reconstruction in the Department of four Orthopedics, the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine, were selected in this study. 55 patients were followed up for more than one year and no related complications were found. There were 31 males and 24 females with a mean age of 30.8 years (19 / 46). Cause of injury: 46 cases of sports injury, 5 cases of traffic accident and 4 cases of injury. There were 30 cases of simple ACL rupture, 21 cases of ACL rupture with meniscus injury, and 4 cases of ACL rupture with medial collateral ligament injury. The anterior cruciate ligament was reconstructed by arthroscopic reconstruction of anterior cruciate ligament by combined spinal and epidural anesthesia. The grafts were autogenous rouge tendon (semitendinosus tendon, semimembranous tendon) or allogeneic tendon. All patients were operated on by the same group of doctors. A consistent rehabilitation plan was adopted after operation. Kneelax3 joint measuring instrument was used in all cases before operation (, MONITORED REHABSYSTEMSB., Netherlands). v. Model: KNEELAX3) measured the anterior displacement of both knees and returned to hospital every 3 months within 1 year after operation. The stability of knee joint reconstruction of cruciate ligament after operation was evaluated with Kneelax3 joint measuring instrument and the score of knee joint function of Lysholm was used in each follow-up, and the knee joint stability of cruciate ligament reconstruction after operation was evaluated by Lysholm knee function score. At the same time, statistical comparative analysis was made. Results: flexion of knee joint was 30. 5%. The average forward shift of the affected knees was (3.35 卤1.90) mm, and the average forward shift value of the affected knees was (0.64 卤0.13) mm.66N, and the average forward movement of the affected knees was (4.73 卤1.70) mm,. The results of the preoperative test showed that the average forward shift of the affected knees was (3.35 卤1.90) mm, and (4.73 卤1.70) mm, respectively. The average forward shift value of both knees was (0.88 卤0.12) mm.88N, the average forward shift of the affected knees was (6.36 卤1.21) mm, the average forward shift difference of both knees was (1.57 卤0.22) mm.132N, and the average forward shift of the affected knees was (8.63 卤2.32) mm,. The average forward difference of both knees was (2.51 卤0.24) mm.. At 132N tension, 95% of patients suffered from knee tibial anterior displacement of 8.91mm, 95% of bilateral tibial anteversion difference of 2.52mm to 95% of knee index 1.63mm, 95% of bilateral index difference of 0.68mm. The anterior movement of knee joint after operation was lower than that before operation, the difference was statistically significant (P0.05). Within 1 year after ACL reconstruction, the anterior tibial displacement of the knee joint increased to a certain extent, suggesting that the stability of the knee joint decreased with the passage of time. Lysholm score increased from 63.58 卤3.61 before operation to 93.26 卤3.48 after operation (P0.05). Conclusion: the Kneelax3 joint measuring instrument can be used to quantitatively evaluate the anterior stability of knee joint in patients with ACL fracture of knee joint. The knee anterior stability of ACL fracture is worse than that of healthy knee. Kneelax 3 knee measurement can be used as an auxiliary method to diagnose and evaluate the curative effect of anterior cruciate ligament fracture of knee joint. When the reference value for diagnosing ACL fracture is 132N stress, the measurement of Kneelax 3 knee joint can be used to diagnose the fracture of anterior cruciate ligament. The anterior displacement of knee tibia was 8.91mm, and the index was 1.63mm. The difference of bilateral tibial forward displacement is 2.52mm, and the index difference is 0.68mm. Arthroscopic ACL reconstruction can reduce the anterior displacement of the knee, improve the stability of the knee, improve the Lysholm knee function score, and improve the quality of life of the patients. With the passage of time, the stability of knee joint decreased within 1 year after operation, and the Lysholm knee function score increased gradually.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.4
本文编号：2470386
[Abstract]:Objective: the purpose of this study was to observe the anterior tibial movement and knee function before and after (Anterior Cruciate Ligament ACL) reconstruction of the anterior cruciate ligament (ACL) of the knee joint. Objective: to explore the significance of quantitative tibial anterior displacement in evaluating ACL fracture and knee joint stability after reconstruction. Through the collection of data, the diagnostic reference value of tibial anterior displacement for diagnosis of ACL fracture was put forward, and the changes of knee joint stability and joint function after ACL reconstruction were evaluated. Methods: fifty-eight patients who underwent arthroscopic anterior cruciate ligament reconstruction in the Department of four Orthopedics, the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine, were selected in this study. 55 patients were followed up for more than one year and no related complications were found. There were 31 males and 24 females with a mean age of 30.8 years (19 / 46). Cause of injury: 46 cases of sports injury, 5 cases of traffic accident and 4 cases of injury. There were 30 cases of simple ACL rupture, 21 cases of ACL rupture with meniscus injury, and 4 cases of ACL rupture with medial collateral ligament injury. The anterior cruciate ligament was reconstructed by arthroscopic reconstruction of anterior cruciate ligament by combined spinal and epidural anesthesia. The grafts were autogenous rouge tendon (semitendinosus tendon, semimembranous tendon) or allogeneic tendon. All patients were operated on by the same group of doctors. A consistent rehabilitation plan was adopted after operation. Kneelax3 joint measuring instrument was used in all cases before operation (, MONITORED REHABSYSTEMSB., Netherlands). v. Model: KNEELAX3) measured the anterior displacement of both knees and returned to hospital every 3 months within 1 year after operation. The stability of knee joint reconstruction of cruciate ligament after operation was evaluated with Kneelax3 joint measuring instrument and the score of knee joint function of Lysholm was used in each follow-up, and the knee joint stability of cruciate ligament reconstruction after operation was evaluated by Lysholm knee function score. At the same time, statistical comparative analysis was made. Results: flexion of knee joint was 30. 5%. The average forward shift of the affected knees was (3.35 卤1.90) mm, and the average forward shift value of the affected knees was (0.64 卤0.13) mm.66N, and the average forward movement of the affected knees was (4.73 卤1.70) mm,. The results of the preoperative test showed that the average forward shift of the affected knees was (3.35 卤1.90) mm, and (4.73 卤1.70) mm, respectively. The average forward shift value of both knees was (0.88 卤0.12) mm.88N, the average forward shift of the affected knees was (6.36 卤1.21) mm, the average forward shift difference of both knees was (1.57 卤0.22) mm.132N, and the average forward shift of the affected knees was (8.63 卤2.32) mm,. The average forward difference of both knees was (2.51 卤0.24) mm.. At 132N tension, 95% of patients suffered from knee tibial anterior displacement of 8.91mm, 95% of bilateral tibial anteversion difference of 2.52mm to 95% of knee index 1.63mm, 95% of bilateral index difference of 0.68mm. The anterior movement of knee joint after operation was lower than that before operation, the difference was statistically significant (P0.05). Within 1 year after ACL reconstruction, the anterior tibial displacement of the knee joint increased to a certain extent, suggesting that the stability of the knee joint decreased with the passage of time. Lysholm score increased from 63.58 卤3.61 before operation to 93.26 卤3.48 after operation (P0.05). Conclusion: the Kneelax3 joint measuring instrument can be used to quantitatively evaluate the anterior stability of knee joint in patients with ACL fracture of knee joint. The knee anterior stability of ACL fracture is worse than that of healthy knee. Kneelax 3 knee measurement can be used as an auxiliary method to diagnose and evaluate the curative effect of anterior cruciate ligament fracture of knee joint. When the reference value for diagnosing ACL fracture is 132N stress, the measurement of Kneelax 3 knee joint can be used to diagnose the fracture of anterior cruciate ligament. The anterior displacement of knee tibia was 8.91mm, and the index was 1.63mm. The difference of bilateral tibial forward displacement is 2.52mm, and the index difference is 0.68mm. Arthroscopic ACL reconstruction can reduce the anterior displacement of the knee, improve the stability of the knee, improve the Lysholm knee function score, and improve the quality of life of the patients. With the passage of time, the stability of knee joint decreased within 1 year after operation, and the Lysholm knee function score increased gradually.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.4
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