前交叉韧带重建术股骨止点定位的临床研究

发布时间：2018-01-23 22:34

本文关键词： 关节镜前交叉韧带单束重建解剖重建临床疗效　出处：《河北北方学院》2015年硕士论文　论文类型：学位论文

【摘要】：前瞻性对比关节镜下前交叉韧带(Anterior Cruciate ligament,ACL)股骨止点的解剖重建和传统重建两种不同定位方法的术后近期临床疗效。选取自2013年3月到2014年6月解放军第252医院骨关节外科收治的ACL断裂患者,根据制定的选择条件和排除条件进行选择,符合条件的患者共62例,其中男性患者50例,女性患者12例,年龄19~51岁,平均(30.90±9.18)岁,对所有患者进行术前Lysholm膝关节评分。根据拟实施关节镜下ACL重建手术股骨隧道定位点的不同,术前随机抽取将全部患者分为解剖重建组和对照组。其中解剖重建组32例,在术中股骨止点定位方式上采用单束解剖重建,即建立的股骨隧道定位点为髁间窝过顶点与“裸区”(我们将外髁的内侧面没有被软骨覆盖的区域称为“裸区”)凹点切迹的连线中心点,对照组30例则采用传统的单束重建即通过胫骨隧道,在股骨外髁内侧壁相当于钟表面11点(右膝)或1点(左膝)的位置确定重建韧带的股骨止点。两组患者术后通过膝关节稳定性、活动度及Lysholm膝关节评分评估膝关节的功能,比较两种股骨止点定位方法术后6~15个月膝关节的功能。结果显示全部患者术后获6~15个月,平均(9.50±2.63)个月的随访,最后随访时,解剖重建组:全部患者膝关节屈伸活动度正常,Lysholm膝关节评分从术前的17~73分,平均(50.18±15.60)分提高至随访结束时的82~100分,平均(95.83±4.98),术后评分优于术前且差异具有显著性意义(P0.05)。对照组:全部患者膝关节屈伸活动度正常,Lysholm膝关节评分从术前的15~74分平均(49.93±18.16)分提高至随访结束时的74~100分,平均(88.00±8.84)分,术后评分优于术前且差异具有显著性意义(P0.05)。解剖重建组与对照组术前Lysholm评分没有显著性差异(P0.05),两组术后随访结束时的Lysholm评分解剖重建组优于对照组且差异具有显著性意义(P0.05)。根据结果两种手术方式术后都能使患者的膝关节功能得到基本的恢复,均能取得较好的临床疗效。结果显示关节镜下ACL股骨止点的单束解剖重建与传统的单束重建相比,术后近期临床疗效和膝关节功能恢复具有优势。但是由于本研究病例数较少,随访时间短,仍需增加样本量,远期疗效的差异也需要进一步观察。
[Abstract]:Anterior Cruciate ligament of anterior cruciate ligament was prospectively contrasted with arthroscopy. ACL). The short term clinical effect of two different localization methods: anatomical reconstruction and traditional reconstruction of femur. ACL from March 2013 to June 2014 in osteoarticular surgery of 252nd Hospital of PLA. A broken patient. According to the selection conditions and exclusion conditions, 62 patients were selected, including 50 male patients and 12 female patients aged 1951 years. The average age was 30. 90 卤9. 18 years. All patients were evaluated with Lysholm knee joint score before operation. According to the location of femoral tunnel under arthroscopic ACL reconstruction. All the patients were randomly divided into anatomic reconstruction group and control group. 32 cases in anatomic reconstruction group were reconstructed by single bundle anatomical reconstruction. The established femoral tunnel location point is the line center of the notch of the intercondylar fossa and the "bare area" (we call the area not covered by cartilage on the medial side of the external condyle as the "bare area"). 30 cases in the control group were treated with traditional single-bundle reconstruction through tibial tunnel. The medial wall of the lateral femoral condyle was located at 11:00 (right knee) or 1 o'clock (left knee) on the surface of the bell to determine the femoral insertion of the reconstructed ligament. The stability of the knee joint was obtained after operation in both groups. The range of motion and Lysholm knee joint score were used to evaluate the function of knee joint, and to compare the function of knee joint between 6 and 15 months after operation by two methods of femoral insertion location. The results showed that all the patients received 6 ~ 15 months after operation. The average follow-up was 9.50 卤2.63 months. At the last follow-up, in the anatomic reconstruction group, the Lysholm knee joint score of all the patients with normal knee flexion and extension activity was 1773 points before operation. The average score of 50.18 卤15.60 was increased to 82-100 at the end of follow-up, with an average of 95.83 卤4.98). The postoperative score was better than that before operation and the difference was significant (P 0.05). Control group: the knee flexion and extension of all the patients had normal range of motion. The Lysholm knee joint score increased from 159.93 卤18.16 to 74-100 at the end of follow-up. The average score was 88.00 卤8.84. The postoperative score was better than that before operation and the difference was significant (P 0.05). There was no significant difference in preoperative Lysholm score between the anatomical reconstruction group and the control group (P 0.05). The Lysholm score of the two groups at the end of follow-up was better than that of the control group (P 0.05). According to the results, the knee joint function of the patients was basically recovered after operation. The results showed that the single bundle anatomical reconstruction of the femoral insertion point of ACL under arthroscopy was better than that of the traditional single bundle reconstruction. The short-term clinical effect and the recovery of knee joint function have advantages, but because of the small number of cases and the short follow-up time, we still need to increase the sample size, and the difference of long-term curative effect also needs to be further observed.
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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