手术与保守治疗对合并前交叉韧带损伤的Ⅲ度内侧副韧带损伤的临床疗效分析与比较

发布时间：2018-02-07 11:39

  本文关键词： 关节镜 前交叉韧带损伤 内侧副韧带损伤 膝关节　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨合并前交叉韧带(ACL)损伤的Ⅲ度内侧副韧带(MCL)损伤时,在ACL重建后内侧副韧带手术修复与保守治疗的临床疗效比较。方法:将大连医科大学附属第一医院2013年06月至2016年06月收治的38例前交叉韧带损伤合并Ⅲ度内侧副韧带损伤诊断明确的患者,在前交叉韧带重建后,根据是否修复MCL,将患者分为两组(MCL修补组和MCL保守治疗组),38例患者均于1-2周后手术,膝关节镜下行自体前交叉韧带重建,ACL重建后,选取17例手术修复MCL的患者为MCL修补组,于一期行膝关节内侧有限直切口,予以缝合锚钉修复内侧副韧带,术后患肢石膏或膝关节支具固定制动2-3周,2-3周后开始进行功能锻炼;选取21例保守治疗MCL损伤的患者为MCL保守治疗组,经前叉韧带重建后,予以患肢石膏或膝关节支具固定制动4-6周之后逐渐进行患肢功能锻炼。内侧副韧带修复组及内侧副韧带保守治疗组均采用Lysholm评分及IKDC评分;收集患者外翻应力试验及前抽屉试验结果、手术时间、治疗相关费用及术后住院日。结果:两组患者手术均顺利完成,术后经过平均18个月随访,随访中术后切口均甲级愈合,术后随访中均无意外损伤。随访发现:1.21例内侧副韧带保守治疗组患者中前抽屉试验(+)5例,前抽屉试验(++)1例,均为硬止点,外翻应力试验Ⅰ度5例、外翻应力试验Ⅱ度2例;17例内侧副韧带手术治疗组患者中前抽屉试验(+)3例,均为硬止点,外翻应力试验Ⅰ度3例。2.内侧副韧带修复组(91.12±1.99)术后Lysholm评分高于内侧副韧带保守治疗组(87.55±1.67),有统计学意义(P0.05)。3.内侧副韧带修复组术(93.5±1.5)后IKDC评分高于内侧副韧带保守治疗组(89.5±1.33),有统计学意义(P0.05)。4.内侧副韧带修复组治疗相关费用(49588.24±3161.66元)明显高于内侧副韧带保守治疗组(44595.00±5485.82元),有统计学意义(P0.05)。5.内侧副韧带修复组重返工作时间(86.29±4.42天)明显低于内侧副韧带保守治疗组(90.65±3.91天),有统计学意义(P0.05)。6.MCL修复组术后住院日(14.88±4.31天)与MCL保守治疗组(13.90±5.22天)的差异,无明显统计学意义(P0.05)。7.MCL修复组手术时长(128.82±36.91分钟)与MCL保守治疗组(98.50±30.44分钟)的差异,无明显统计学意义(P0.05)。结论:前交叉韧带损伤合并Ⅲ度内侧副韧带损伤时,在ACL重建后,内侧副韧带手术修复与保守治疗相比,手术修复组具有更好的恢复膝关节稳定性、重返工作时间短等优点,但治疗相关费用明显高于保守治疗组。前交叉韧带损伤合并Ⅲ度内侧副韧带损伤时,重建前交叉韧带后外翻试验者Ⅱ度到Ⅲ度者同时进行手术修复内侧副韧带对患者膝关节功能恢复更加有利。
[Abstract]:Objective: To investigate the combined anterior cruciate ligament (ACL) injury of medial collateral ligament (MCL) injury, compare the clinical efficacy in the repair of the medial collateral ligament surgery and conservative treatment after ACL reconstruction. Methods: the First Affiliated Hospital of Dalian Medical University in 2013 06 to 2016 06 months of receiving treatment of 38 patients with anterior cruciate ligament injury third degree of medial collateral ligament injury diagnosed in patients after anterior cruciate ligament reconstruction, according to whether the repair of MCL, the patients were divided into two groups (MCL group and MCL repair conservative treatment group), 38 patients were in 1-2 weeks after surgery, knee arthroscopic autologous anterior cruciate ligament reconstruction, ACL reconstruction, selection 17 patients underwent MCL repair repair group MCL, in a row of medial limited straight incision, suture anchor to repair the medial collateral ligament, postoperative limb plaster or knee brace immobilization for 2-3 weeks, 2-3 weeks after the start of functional exercise; Selection of conservative treatment in patients with MCL injury 21 cases MCL conservative treatment group, after anterior cruciate ligament reconstruction, be patient after limb plaster or knee brace immobilization 4-6 weeks gradually limb function exercise. Repair of the medial collateral ligament and medial collateral ligament in conservative treatment group were treated with Lysholm and IKDC scores were collected; valgus stress test and anterior drawer test results, operation time, treatment costs and postoperative hospitalization. Results: two groups of patients were successfully completed surgery, postoperative after a mean follow-up of 18 months of follow-up, postoperative incision healing, postoperative follow-up there were no accidental injury: 1.21 cases were found. The medial collateral ligament of conservative treatment in patients with anterior drawer test (+) in 5 cases, anterior drawer test (+ +) 1 cases, are hard point valgus stress test were 5 cases, valgus stress test of 2 cases; 17 cases of medial collateral ligament surgery patients in the treatment group before Drawer test (+) 3 cases, are hard point valgus stress test of 3 cases of.2. of medial collateral ligament repair group (91.12 + 1.99) postoperative Lysholm score was higher than that of the medial collateral ligament of the conservative treatment group (87.55 + 1.67), there was statistical significance (P0.05) and.3. group (medial collateral ligament repair 93.5 + 1.5) after the IKDC score was higher than that of the medial collateral ligament of the conservative treatment group (89.5 + 1.33), there was statistical significance (P0.05).4. medial collateral ligament repair group treatment related costs (49588.24 + 3161.66) was significantly higher than that of the medial collateral ligament of the conservative treatment group (44595 + 5485.82), there was statistical significance (P0.05) inside.5. collateral ligament repair group to return to work time (86.29 + 4.42 days) was significantly lower than that of the medial collateral ligament of the conservative treatment group (90.65 + 3.91 days), there was statistical significance (P0.05).6.MCL repair group, postoperative hospital stay (14.88 + 4.31 days) and conservative treatment group MCL (13.90 + 5.22 days) difference, no statistically significant (meaning P0. 05).7.MCL repair group operation time (128.82 + 36.91 minutes) and conservative treatment group MCL (98.50 + 30.44 minutes) the difference was not statistically significant (P0.05). Conclusion: the degree of injury of medial collateral ligament with third anterior cruciate ligament injury, in ACL reconstruction, medial collateral ligament repair surgery compared with conservative treatment, surgical repair group with knee joint stability better, the advantages of short time to return to work, but the treatment cost was higher than the conservative treatment group. The damage degree of medial collateral ligament with third anterior cruciate ligament injury, anterior cruciate ligament reconstruction after valgus test II to III degree and surgical repair of the medial side ligament of knee joint function recovery of patients is more favorable.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4
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本文编号：1494289