不同原因所致踝关节肿痛的关节镜疗效分析

发布时间：2018-03-17 22:31

本文选题：踝关节　切入点：关节镜　出处：《石河子大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:对不同原因所致踝关节肿痛接受关节镜治疗后的临床疗效进行评价。方法:回顾性分析于2010到2015年间在石河子大学第一附属医院接受关节镜检查并进行微创手术的30例有踝关节肿痛患者的临床资料。其中男性15例,女性15例,年龄16-76岁(平均48岁);单纯左踝损伤为10例,单纯右踝损伤为19例,双侧踝关节损伤为1例;16例疼痛部位为前外侧痛,5例疼痛部位为前内侧痛,5例疼痛部位为前侧痛,4例疼痛部位为后侧痛。病因:8例骨性关节炎,8例滑膜炎(包含急性和慢性),7例创伤性关节炎,3例骨性关节炎合并滑膜炎,1例类风湿性关节炎合并创伤性关节炎,1例痛风性关节炎合并滑膜炎,1例类风湿性关节炎,1例痛风性关节炎。排除踝关节关节间隙完全消失;手术部位软组织感染;有出血的倾向;高弓足、足内翻等严重畸形的患者。病程1个月-21年,平均48个月。所有患者均常规行踝关节正侧位X线和踝关节MRI,12例患者出现增生骨赘和游离体,6例有陈旧性撕脱骨折。MRI示18例患者有踝关节有少量积液,15例患者有软组织嵌夹,踝关节前侧和前外侧最常发生肿胀。关节镜下需对患者进行以下操作,包含了单纯滑膜清理术、增生骨赘切除术、游离体摘除术;通过美国足踝外科协会(AOFAS)踝后足评分,Meislin criterie(迈斯林标准)以及可视化疼痛评分(VAS)对每个病人术前、术后3个月时以及术后6个月时的踝关节功能状态进行评估。使用SPSS 22.0统计学软件对本次收集数据进行统计学处理,对患者术前、术后3个月、术后6个月时的AOFAS评分采用配对t检验进行统计学分析,p0.05为差异有统计学意义;对患者术前、术后3个月、术后6个月时的随访结果VASFA评分采用秩和检验比较,p0.05表示差异有统计学意义;对患者术后3个月、术后6个月的Meislin criterie(迈斯林标准)进行总优良率的计算。结果:在术后3个月及6个月的随访中,AOFAS评分由术前的61.73±5.70增加至术后3个月84.90±1.97、6个月89.53±4.66,术前术后比较差异有统计学意义(P0.05);Meislin criterie(迈斯林标准)评估结果:术后3个月时分数为优良的有9例患者(占30%的比例);术后6个月时分数为优良的有26例患者(占86.7%的比例)。随访过程中VAS评分也得到了改善。结论:关节镜对各种原因所致的踝关节肿痛确有较好的临床疗效,值得推广应用。
[Abstract]:Objective: to evaluate the clinical effect of arthroscopic treatment for ankle swelling and pain caused by different causes. Methods: from 2010 to 2015, the arthroscopic examination was performed in the first affiliated Hospital of Shihezi University. Clinical data of 30 patients with ankle swelling and pain, including 15 males, 15 women, aged 16-76 years (mean 48 years old), had 10 left ankle injuries and 19 right ankle injuries. Bilateral ankle joint injury: 1 case: 16 cases pain site: anterolateral pain site 5 cases anterior and medial pain site 5 cases anterior side pain 4 cases anterior side pain 4 cases posterior side pain. Etiology of 8 cases of osteoarthritis and 8 cases of synovitis (including 5 cases of anterior medial pain 5 cases of pain site of anterior side pain of 4 cases of pain site of pain site of 4 cases of pain site of posterior side pain. Acute and chronic arthritis 7 cases of traumatic arthritis 3 cases of osteoarthritis with synovitis 1 case of rheumatoid arthritis with traumatic arthritis 1 case of gouty arthritis with synovitis 1 case of gouty arthritis. Ganglitis. Eliminating the complete disappearance of ankle joint space; Surgical site soft tissue infection; tendency to bleed; patients with severe deformities such as high arch foot, foot varus, etc. The course of disease ranged from 1 month to 21 years. Mean 48 months. All patients were routinely treated with X-ray and MRI of ankle joint, 12 cases with osteophyte hyperplasia and 6 cases with old avulsion fracture. MRI showed that 18 cases had ankle joint with a small amount of effusion and 15 cases had soft tissue clamp. Anterior and anterolateral ankle swelling is most common. Arthroscopic procedures include simple synovial debridement, excision of osteophytes and excision of free body. Meislin criteriee (Meislin criteria) and visual pain score (VASS) were used for each patient before operation. The functional status of ankle was evaluated 3 months after operation and 6 months after operation. The collected data were statistically processed with SPSS 22.0 statistical software. The AOFAS score at 6 months after operation was statistically analyzed by paired t test, and there was significant difference between the two groups before and 3 months after operation. The VASFA score at 6 months after operation was compared with the rank sum test, and the difference was statistically significant at 3 months after operation. The total excellent and good rate of Meislin was calculated at 6 months after operation. Results: the scores of Meislin were increased from 61.73 卤5.70 before operation to 84.90 卤1.97 and 89.53 卤4.66 at 3 months and 6 months after operation, respectively. There was a significant difference before and after operation. Results of Meislin criteria: 9 patients (30%%) had good scores at 3 months after operation, 26 patients (86.7%%) had good scores at 6 months after operation. Conclusion: arthroscopy has a good clinical effect on ankle swelling and pain caused by various causes. It is worth popularizing and applying.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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