膝关节韧带损伤所致关节僵硬早期治疗的研究进展

发布时间：2018-03-24 23:17

本文选题：膝关节韧带损伤　切入点：早期　出处：《大连医科大学》2015年硕士论文

【摘要】：研究背景和目的:膝关节韧带损伤属于常见损伤,处理不及时,易导致膝关节明显松弛,从而引发膝关节功能障碍。而多数患者因患肢体征表现不明显错过急诊最佳治疗期。所以本研究旨在探讨膝关节韧带损伤所致关节僵硬是否能通过早期功能锻炼而起到有效的临床治疗疗效。方法:收集2013年七月至2015年二月于大连医科大学附属第一医院门诊收治的35例膝关节韧带损伤所致关节僵硬患者,其中男性15例,女性20例,年龄12岁至45岁,就诊时间均大于伤后两周,均为单膝闭合性损伤,损伤韧带未完全断裂,无其他部位骨折。总计左膝15例,右膝20例,其中内侧副韧带损伤12例,后交叉韧带损伤4例,前交叉韧带损伤3例,内侧副韧带合并后交叉韧带损伤8例,内侧副韧带合并前交叉韧带损伤8例。所有患者以系统康复功能锻炼保守治疗为主。通过对比治疗前后膝关节活动度,下肢肌力评定,采用IKDC膝关节功能主观评价表,Lysholm评分来评估治疗效果。采用t检验对计数资料进行比较,将P0.05具有统计学意义的因素纳入回归模型中进行分析;检验水准α=0.05,当P0.05认为有统计学意义,所有数据分析均通过SPSS17.0完成。结果:本组35例患者均获得随访治疗,随访治疗时间均为一年,随访时35例较治疗前有明显改善,可满足日常生活,查体见:治疗后患者膝关节活动范围良好;患肢主动伸直2°(±2°)至屈曲130°(±10°),基本与健侧相同;所有患肢前抽屉试验及后抽屉试验均为(-)或(+-);Lachman实验屈膝10°-15°时抽屉试验均为(-)或(+-);膝关节0°位和30°位侧方应力试验均为(-)或(+-);轴移实验3人为(+)性,其余均为(-),双膝90°时被动内旋和外旋,两侧对比无明显差异。膝关节力线正常;关节稳定性良好。通过对股四头肌的抗阻力检测,股四头肌抗阻力测定为4级,部分患者股四头肌的抗阻力检测可达5级。MRI随访见韧带损伤部位均存在自愈现象。膝关节IKDC膝关节功能主观评价表:35例患者治疗前评分情况如下,其中有3人评分为D级,28人为C级,4人为B级。治疗后一年随访,其中3人评分为C级,30人评分为B级,2人评分为A级.治疗前后膝关节功能活动度有明显改善;膝关节Lysholm评分:治疗前27.09±9.76分,治疗后末次随访84.51±8.51分。治疗前后随访比较差异有统计学意义(P0.05),即治疗有效。结果:膝关节韧带损伤所致关节僵硬早期通过系统的功能锻炼可及时有效地保护膝关节,使膝关节达到正常功能,该方法损伤小,恢复快,临床效果好。尤其是适合膝关节韧带部分损伤的患者。
[Abstract]:Background and objective: ligament injury of knee joint is a common injury. This study was designed to investigate whether joint stiffness caused by ligamentous injury of the knee joint can be achieved by early functional exercise. Methods: from July 2013 to February 2015, 35 cases of knee joint stiffness caused by ligament injury were collected from the first affiliated Hospital of Dalian Medical University. There were 15 males and 20 females, aged from 12 to 45 years old. The time of seeing a doctor was longer than that of two weeks after injury. All of them were closed injury of one knee, incomplete rupture of the injured ligament and no fracture of other parts. There were 15 cases of left knee and 20 cases of right knee. There were 12 cases of medial collateral ligament injury, 4 cases of posterior cruciate ligament injury, 3 cases of anterior cruciate ligament injury, 8 cases of medial collateral ligament combined with posterior cruciate ligament injury. There were 8 cases of medial collateral ligament associated with anterior cruciate ligament injury. The IKDC knee joint function subjective evaluation table was used to evaluate the therapeutic effect. T test was used to compare the count data, and P0.05 factors with statistical significance were analyzed in the regression model. Results: all the 35 patients were followed up for one year, and 35 cases were improved after treatment. After treatment, the range of knee joint motion was good, the active extension of the affected limb was 2 掳(卤2 掳) to flexion 130 掳(卤10 掳), which was basically the same as that of the normal side. All the anterior drawer tests and posterior drawer tests of the affected limbs were either -) or (-) or (-) or (-) or (-) or (-) when the knee flexion was 10 掳-15 掳; the lateral stress tests of the knee joints at 0 掳and 30 掳were either -) or (-) or (-) or (-); The rest of the patients were in the same position. The passive internal rotation and external rotation at 90 掳were not significantly different between the two sides. The strength line of the knee joint was normal, and the joint stability was good. The anti-resistance of quadriceps femoris muscle was determined to be grade 4 by detecting the resistance of quadriceps femoris muscle. The anti-resistance test of quadriceps femoris muscle in some patients can be up to grade 5. Follow-up showed that there was self-healing in the site of ligament injury. The subjective evaluation table of knee joint function of IKDC: 35 patients before treatment were as follows. One year after the treatment, 30 patients with grade C and 30 patients with grade C were graded as grade B and 2 patients with grade A. the functional range of knee joint improved significantly before and after treatment. Lysholm score of knee joint: 27.09 卤9.76 before treatment, The last follow-up after treatment was 84.51 卤8.51 points. There was significant difference between the two groups before and after treatment, that is, the treatment was effective. Results: the knee joint stiffness caused by ligamentous injury of knee joint could be protected in time and effectively by systematic functional exercise. This method has the advantages of little injury, quick recovery and good clinical effect, especially for the patients with partial ligament injury of the knee joint.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R684

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