自体四股与五股半腱肌肌腱和股薄肌肌腱重建前交叉韧带的术后MRI信号改变的对比研究

发布时间：2018-04-03 15:37

本文选题：前交叉韧带重建(ACLR)　切入点：磁共振成像(MRI)　出处：《广西医科大学》2017年硕士论文

【摘要】：背景:前交叉韧带断裂是一种常见的损伤,在美国每年大约有250000人发病。ACL损伤导致严重功能障碍[1]。在这个运动医学时代,ACL重建对病人生活质量起着至关重要的作用。事实证明,ACL撕裂不能采取保守治疗让它自己修复。而ACL重建被认为是治疗ACL撕裂的标准手术方式。在评价ACL移植物完整性和诊断ACL撕裂的并发症上MRI起着重要作用。首次ACL重建后的复发性不稳发病率为3%到10%。移植物失败是复发性不稳最重要的原因[27]。由于乆绳肌自身的生物力学特性,它被用于移植物的首选,而乆绳肌自体移植较自身的ACL有更强大的抗拉载荷、刚度和横截面积。目的:评估4束和5束半腱肌、股薄肌自体移植物行膝关节前交叉韧带重建术后的MRI表现,比较两者之间的不同。方法:回顾从2015年1月至2016年12月之间ACL重建术后的40例患者的MRI。将ACL重建患者分为两组:A组和B组.A组20例用5束自体半腱肌、股薄肌移植,B组20例用4束自体半腱肌、股薄肌移植。进行MRI评价,包括移植物撕裂、移植物强度、移植物信号、移植物粗细、移植物不连续、骨道位置和后交叉韧带的过度屈曲。术后随访1个月,3个月和6个月时行MRI检查。结果:对40例病人进行的研究。在这项研究中,我们分为两组:20例用5束自体半腱肌、股薄肌移植,20例用4束自体半腱肌、股薄肌移植。A组和B组的平均年龄是29.85岁和31.3岁,不分性别。两组比较点为术后6个月移植物信号、移植物强度。A组和B组患者的移植物强度、信号在MRI评估上的差异有统计学意义,但其他观察指标在1月、3月、6月的MRI评估上都一致而移植物纤维连续性和完整的移植物厚度是诊断移植物完好的最有价值的征象义。完全不连续的移植物在诊断完全撕裂上非常有价值而移植物局部薄弱正像在诊断部分撕裂上有价值。结论:4束和5束半腱肌、股薄肌自体移植物行膝关节前交叉韧带重建术后的两组病人,MRI评估两者的差异没有统计学意义。4束和5束半腱肌、股薄肌自体移植物完全可以满足ACL重建的需求。
[Abstract]:Background: anterior cruciate ligament rupture (ACL) is a common injury. In the United States, about 250000 people suffer from ACL injury every year, which results in severe dysfunction [1].In this era of sports medicine, ACL reconstruction plays a vital role in the quality of life of patients.It turns out that ACL tears cannot be treated conservatively to repair them themselves.ACL reconstruction is considered to be the standard procedure for the treatment of ACL tears.MRI plays an important role in evaluating the integrity of ACL grafts and in diagnosing the complications of ACL laceration.The incidence of recurrent instability after first ACL reconstruction ranged from 3% to 10%.Graft failure is the most important cause of recurrent instability [27].Because of the biomechanical characteristics of the human chorda muscle, it is the first choice for grafts, while the human chorda autograft has a stronger tensile load, stiffness and cross-sectional area than its own ACL.Aim: to evaluate the MRI findings of 4 and 5 semitendinosus and thin femoral muscle autografts after anterior cruciate ligament reconstruction (ACL) reconstruction.Methods: 40 patients after ACL reconstruction from January 2015 to December 2016 were reviewed.The patients with ACL reconstruction were divided into two groups: group A (n = 20) and group B. Group A (n = 20) were treated with autologous semitendinosus (group A) and group B (group B) were transplanted with autogenous semitendinosus (group B).MRI evaluation was performed, including graft tear, graft intensity, graft signal, graft thickness, graft discontinuity, osseous location and overflexion of posterior cruciate ligament.All patients were followed up for 1 month, 3 months and 6 months for MRI examination.Results: 40 patients were studied.In this study, we were divided into two groups: 20 cases were treated with 5 bands of autogenous semitendinosus, 20 cases with thin femoral muscle were transplanted with 4 bundle of autologous semitendinosus, the average age of group A and group B were 29.85 years and 31.3 years, regardless of sex.The graft intensity of patients in group A and group B was significantly different from that in group A and group B, and the difference in MRI evaluation between the two groups was statistically significant.But other observational indicators were consistent in MRI evaluation in January, March and June. The continuity of plant fibers and the complete thickness of the graft were the most valuable signs for the diagnosis of graft integrity.Completely discontinuous grafts are of great value in the diagnosis of complete laceration and weak grafts are just as valuable in diagnosing partial laceration.Conclusion there was no significant difference in MRI evaluation between the two groups after anterior cruciate ligament reconstruction (ACL) reconstruction. There was no significant difference between the two groups in assessing the semitendinosus muscle by MRI. There was no significant difference between the two groups in the evaluation of the semitendinosus muscle in the 4th bundle and the 5th bundle.The thin femoral muscle autograft can completely meet the need of ACL reconstruction.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

【相似文献】