膝关节镜下复位内固定与切开复位内固定治疗胫骨髁间嵴撕脱骨折的比较研究

发布时间：2018-03-07 03:24

  本文选题：胫骨髁间嵴撕脱骨折　切入点：关节镜下复位内固定　出处：《延安大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:通过回顾性分析胫骨髁间嵴撕脱骨折关节镜下空心拉力螺钉内固定和传统切开复位内固定的临床疗效,对比两种手术治疗胫骨髁间嵴撕脱骨折的优缺点,为临床治疗胫骨髁间嵴撕脱骨折手术方式的选择提供更好的理论依据。方法:回顾性分析2012年1月~2015年1月延安大学附属医院骨科收住入院的胫骨髁间嵴撕脱骨折患者47例,关节镜下空心拉力螺钉内固定组(治疗组)25例,传统切开复位内固定组(对照组)22例,根据Meyers和Mckeekver分型,分别记录每个患者手术时间、术中出血量、住院时间;两组术前、术后2周、术后3月膝关节屈伸活动度;两组术前、术后2周、术后3月Lysholm膝关节评分;治疗组和对照组术后并发症比较,进行统计分析,评价两种手术治疗的临床疗效。结果:经过对比分析,治疗组与对照组患者在一般资料方面相比较差异无统计学意义(P0.05);治疗组手术时间为(56.12±10.68min),对照组手术时间(75.45±12.43min),两组经统计分析,P0.05,差异有统计学意义。治疗组术中出血量(81.96±10.42ml),对照组术中出血量(134.65±17.58ml),两组相比较,差异有统计学意义,P0.05;治疗组住院时间(10.42±4.26d),对照组住院时间(14.73±5.81d),两组比较,差异无统计学意义,P0.05。两组患者术前、术后2周、术后3月膝关节活动度比较:治疗组术前膝关节活动度(1.43±2.78),对照组术前膝关节活动度(34.81±2.64),两组经统计学分析,差异无统计学意义,P0.05;治疗组术后2周膝关节活动度(87.74±4.65),对照组术后2周膝关节活动度(85.42±5.26),两组统计学比较,差异无统计学意义,P0.05;治疗组术后3月膝关节活动度(127.36±10.34),对照组术后3月膝关节活动度(114.82±9.81),两组统计学比较,差异有统计学意义,P0.05。治疗组术前、术后3月相比较,差异有统计学意义,P0.05;对照组术前、术后3月相比较,差异有统计学意义,P0.05。术前、术后2周、术后3月膝关节Lysholm评分结果显示:①治疗组术前膝关节Lysholm(40.25±13.65),经治疗术后可达(84.71±12.43),随访术后3月为(92.68±6.73),术前、术后2周、术后3月相比较,差异有统计学意义,P0.05;对照组术前膝关节Lysholm(38.95±14.68),经治疗术后2周可达(80.69±14.52),随访术后3月(85.64±4.75),术前、术后2周、术后3月相比较,差异有统计学意义,P0.05。②术前膝关节Lysholm治疗组和对照组相比较,差异无明显统计学意义,P0.05;术后2周膝关节Lysholm治疗组和对照组相比较,差异无明显统计学意义,P0.05;术后3月两组膝关节Lysholm评分比较差异有统计学意义,P0.05。治疗组和对照组术后并发症比较:两组患者均无术后感染、内固定失败,治疗组出现术后疼痛1例,术后关节僵硬1例,总并发症2例,占总数的8.0%;对照组出现术后疼痛4例,术后关节僵硬3例,总并发症7例,占总数的31.82%,两组经X2检验,p0.05,即两组并发症发生率存在显著差异。结论:①对于胫骨髁间嵴撕脱骨折患者,关节镜下空心拉力螺钉内固定和传统切开复位内固定,都能获得较好的临床疗效。②从患者术中出血量、手术时间、术后膝关节Lysholm评分、术后膝关节功能活动度、术后膝关节并发症等方面比较,治疗组明显优于对照组。③胫骨髁间嵴撕脱骨折关节镜下空心拉力螺钉内固定治疗,手术时间较短,切口小、创伤小、内固定牢固可靠,术后膝关节可以早期进行康复训练,减少术后膝关节僵硬、局部组织粘连,临床疗效满意。④虽然本组病例在进行两种手术方法的组间比较分析时,也作统计学处理,不过仍属小样本研究,在反映结果的准确性及全面性上存在一定局限,但仍可为临床处理胫骨髁间嵴骨折提供参考。
[Abstract]:Objective: through the retrospective analysis of the tibial intercondylar eminence fracture under arthroscopic cannulated screws internal fixation and the clinical effect of open reduction and internal fixation, comparing the two kinds of surgical treatment of tibial intercondylar eminence fracture and the advantages and disadvantages, for the clinical treatment of avulsion fracture of tibial intercondylar eminence and provide a theoretical basis for better operation mode choice. Methods: a retrospective analysis of January 2012 January ~2015 were admitted to the Department of orthopedics of Affiliated Hospital of Yan'an University of avulsion fracture of tibial intercondylar eminence in 47 cases, cannulated screws internal fixation under arthroscopy group (treatment group) 25 cases, conventional cut open reduction and internal fixation group (control group) 22 cases, according to the Meyers and Mckeekver type each of the patients were recorded, the operation time, bleeding volume, operation time; two groups before surgery, 2 weeks after operation, postoperative knee joint flexion and extension in March; two groups before surgery, 2 weeks after operation, postoperative March Lysholm knee score; treatment Comparison group and postoperative complications in the control group, statistical analysis, evaluation of clinical curative effect of the treatment of two types of surgery. Results: by comparison, the treatment group and the control group of patients in the general data comparison showed no significant difference (P0.05); the treatment group operation time was (56.12 + 10.68min), control group (operation time 75.45 + 12.43min), the two groups by statistical analysis, P0.05, the difference was statistically significant. The treatment group blood loss (81.96 + 10.42ml), the control group blood loss (134.65 + 17.58ml), compared the two groups, the difference was statistically significant, P0.05; the treatment group hospitalization time (10.42 + 4.26d). The control group hospitalization time (14.73 + 5.81d), the two groups, the difference was not statistically significant, P0.05. two groups of patients before and 2 weeks after operation, postoperative knee joint activity in March: in the treatment group before surgery of knee joint (1.43 + 2.78), the control group before surgery of knee joint (34.81 + 2.64), 涓ょ粍缁忕粺璁″�﹀垎鏋�,宸�寮傛棤缁熻�″�︽剰涔�,P0.05;娌荤枟缁勬湳鍚，

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