膝关节多发韧带损伤分期重建的疗效观察

发布时间：2018-03-16 07:00

  本文选题：膝关节　切入点：多发韧带损伤　出处：《吉林大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的： 通过对膝关节多发韧带损伤患者不同阶段的治疗，探讨多发韧带损伤后同期重建治疗与分期重建治疗的临床疗效对比。 方法： 选取自2009年6月至2014年3月间，于本院骨科治疗的67例多发韧带损伤患者进行随访，男性患者42例，女性患者25例，年龄18-54岁，平均年龄37岁。交通事故28例，高处跌落16例，高空坠物14例，滑雪等扭伤9例,均为闭合伤。伤后手术时间2～20天，平均7天。Schenk分型（KDII~KDV）：KDII型（ACL+PCL）37例、KDIIIM型（ACL+PCL+MCL）14例、KDIIIL型（ACL+PCL+LCL）11例、KDIV型（ACL+PCL+MCL+LCL）5例，间或伴有半月板损伤。患者患膝关节前、后抽屉实验均为阳性，Lachman实验阳性，IKDC评分D。手术方案：分期治疗：一期重建后交叉韧带，修复内、外侧副韧带或及损伤的半月板，二期重建前交叉韧带；同期治疗：同期重建前、后交叉韧带或及修复内、外侧副韧带，损伤的半月板；并早期开始功能康复锻炼。记录患者术前、术后Lysholm评分、IKDC评分，评估手术疗效。 结果： 术后患者恢复良好，切口均Ⅰ期愈合，少数患者存在肿胀、疼痛等并发症，，患者随访6~24个月。同期治疗：手术术后3个月复查，后抽屉试验阴性；内、外侧研磨试验阴性；内外侧方应力试验阴性；3例Luchman试验弱阳性；分期治疗：一期手术术后3个月复查，后抽屉试验阴性；内、外侧研磨试验阴性；内外侧方应力试验阴性；前抽屉试、Luchman试验阳性。二期手术术后三个月复查，前抽屉试及后抽屉试验阴性；Luchman试验阴性。将记录数据行统计学分析，术后复查数据对比术前Lysholm功能评分有明显改善，分期重建与同期重建Lysholm评分对比有统计学差异。 结论： 1.膝关节多发韧带损伤镜下分期重建及同期重建均效果良好。 2.膝关节多发韧带损伤分期重建临床疗效优秀率要高于同期重建。 3.关节镜下韧带重建安全可行、创伤小、副作用少。
[Abstract]:Objective:. Through the treatment of multiple ligament injury of knee joint at different stages, the clinical effect of reconstruction after multiple ligament injury was compared with that of stage reconstruction. Methods:. From June 2009 to March 2014, 67 patients with multiple ligament injury treated in our hospital were followed up. There were 42 male patients and 25 female patients, aged 18-54 years, with an average age of 37 years. There were 16 cases of high fall, 14 cases of falling objects and 9 cases of sprain, all of which were closed injuries. The operative time after injury was 220 days, with an average of 7 days. Schenk's classification included KDIIIM / KDII / PCL)37, KDIIIM / KDII / ACL PCL MCL)14 / KDIIIL / ACL PCL LCL)11 / KDIV PCL MCL LCL)5, respectively. The anterior and posterior drawer tests were all positive Lachman test positive and IKDC score D.Surgical scheme: stage treatment: reconstruction of posterior cruciate ligament, repair of medial and lateral collateral ligament or injured meniscus. Second stage reconstruction of anterior cruciate ligament; simultaneous treatment: before and after reconstruction of posterior cruciate ligament and repair of medial and lateral collateral ligaments and injured meniscus; and early functional rehabilitation exercise. The Lysholm score of patients before and after operation was recorded. To evaluate the curative effect of the operation. Results:. The patients recovered well, the incisions healed in the first stage, and a few patients had complications such as swelling and pain. The patients were followed up for 624 months. At the same time, 3 months after operation, the posterior drawer test was negative, the medial and lateral lapping tests were negative. Luchman test was weakly positive in 3 cases with stress test on both sides of the inner and outer side, and was treated by stages: 3 months after primary operation, the posterior drawer test was negative, the inner and outer side lapping test was negative, the inner and outer side stress test was negative, and the internal and external side stress test was negative. The anterior drawer test was positive for Luchman test. Three months after secondary operation, the former drawer test and posterior drawer test negative Luchman test were negative. The recorded data were statistically analyzed, and the postoperative reexamination data were significantly improved compared with the preoperative Lysholm score. There was statistical difference between Lysholm score of stage reconstruction and that of reconstruction at the same time. Conclusion:. 1. Arthroscopic reconstruction and simultaneous reconstruction of multiple ligament injury of knee joint were effective. 2. The rate of clinical effect of multiple ligament injury reconstruction by stages was higher than that of simultaneous reconstruction. 3. Arthroscopic ligament reconstruction is safe and feasible, with less trauma and less side effects.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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中国期刊全文数据库 前1条

1 陈君洁;梁峭嵘;石星;汤书华;刘照宏;;膝关节交叉韧带损伤高频超声诊断的价值[J];中国超声诊断杂志;2006年09期

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