多针穿刺的内侧副韧带拉网样松解技术在膝关节置换术中的应用

发布时间：2018-05-03 11:45

本文选题：关节成形术 + 置换　；参考：《中国人民解放军医学院》2015年硕士论文

【摘要】：目的：①针对术中采用拉网样松解的TKA病例,不同的内侧紧张程度往往需要不同的穿刺次数,分析研究屈伸膝内外侧胫股间隙差及术前KSS评分与穿刺次数的关系,以期为内侧胫骨间隙过窄的TKA病例如何采用MCL拉网样松解提供理论依据,避免穿刺次数过少导致松解不完全或者穿刺针数过多导致MCL松弛甚至撕裂。②通过分析比较采用拉网样松解的TKA病例与未采用拉网样松解的TKA病历的术后KSS评分及术后活动度,论证拉网样松解对TKA的影响。方法：筛选本院2013年6月1日至2014年8月15日的住院手术病历,按照是否采用MCL拉网样松解分为实验组与对照组,其中对照组共纳入32膝,实验组纳入29膝。①在实验组中,分别统计分析屈伸膝内外侧间隙差及术前KSS评分与松解所需穿刺次数的相关性;②统计分析实验组中术后较术前KSS评分及膝关节活动度的差异；③比较分析实验组与对照组所有患者术后3个月随访时KSS评分及膝关节活动度的差异。结果：①屈伸膝内外侧胫股间隙差与松解所需要的穿刺次数间存在着正相关关系,且相关性有统计学意义(屈膝：P=0.0000.05,相关系数=0.64;伸膝：P=0.0040.05,相关系数=0.51),与之相反,术前KSS评分与穿刺次数见存在具有统计学意义的负相关关系(P=0.0000.05,相关系数=-0.72)。②通过术后3个月的随访发现,两组间KSS评分及膝关节活动度无明显差异(KSS评分：实验组70.8±6.9,对照组73.8±6.0,P=0.110.05；膝关节活动度：实验组113.8°士8.0°,对照组109.7°±9.3°,P=0.070.05)。结论：①在本研究中,采用9号针头穿刺的拉网样松解可有效松解挛缩的MCL,所有病例在术中均获得了良好的软组织平衡,且未出现过度松解及MCL撕脱的病例,在术后3个月的随访中所有病例均未出现膝关节不稳的情况；②MCL的挛缩程度往往决定着内侧间隙的紧张程度,同时也决定着欲达到间隙平衡所需要的针头穿刺次数,通过研究发现,屈伸膝内外侧胫股间隙差与所需要的穿刺次数间存在着正相关关系,而术前KSS评分与穿刺次数间存在着负相关关系,所有相关性均有统计学意义;③在术后3个月的随访中发现,采用MCL拉网样松解的患者,膝关节功能均较术前有明显改善,该研究表明,MCL拉网样松解并不会影响TKA术后的疗效及患者生活质量的提高;④在实验组与对照组的对比中我们发现,术后3个月时,采用MCL拉网样松解的TKA患者与常规TKA患者,无论是在KSS评分还是膝关节活动度上均已无明显差异,这表示MCL拉网样松解在平衡内外侧胫股间隙的同时不会对手术的其它方面造成不利影响。MCL拉网样松解可以通过穿刺次数的增加而使MCL逐渐延长,最终获得满意的软组织平衡,尤其在TKA中面对较严重的内侧胫股间隙紧张(内侧胫股间隙较外侧小3mm以上)时,熟练的运用MCL拉网样松解可安全有效的平衡膝关节间隙,最终获得满意的临床结果。
[Abstract]:Objective to analyze the relationship between the difference of tibiofemoral space between flexion and extension knee, the preoperative KSS score and the number of puncture times in TKA patients with different medial tension and different medial tension. The aim of this study was to provide a theoretical basis for the use of MCL mesh loosening in cases of TKA with narrow medial tibial space. To avoid too few puncture times leading to incomplete release or excessive number of puncture needles to cause MCL relaxation or tear .2 by analyzing and comparing the postoperative KSS score and postoperative activity between TKA cases with net-like loosening and TKA cases without netting loosening. The effect of mesh loosening on TKA is demonstrated. Methods: the inpatient surgical records of our hospital from June 1, 2013 to August 15, 2014 were selected and divided into experimental group and control group according to whether or not to use MCL net-like release. The control group included 32 knees, and the experimental group included 29 knees .1 in the experimental group. The correlation between KSS score and puncture times in flexion and extension knee was statistically analyzed. The difference of KSS score and knee motion in experimental group was compared with that before operation. 3 the differences of KSS score and knee joint motion were compared between the experimental group and the control group at 3 months follow-up. Results there was a positive correlation between the tibiofemoral space difference and the puncture times needed to release the knee, and the correlation was statistically significant (flexion: P0. 0000.05, correlation coefficient 0. 64; knee extension: P0. 0040.05, correlation coefficient: 0. 51%, contrary to that of knee: P0. 0000. 05, r = 0. 64, P = 0. 0040.05, r = 0. 51). There was a significant negative correlation between preoperative KSS score and puncture frequency (P < 0. 0000. 05). The correlation coefficient was found by 3 months follow-up. There was no significant difference in KSS score and knee motion between the two groups: 70.8 卤6.9 in the experimental group, 73.8 卤6.0 in the control group, 0.110.05 in the control group, and 113.8 掳卤8.0 掳in the experimental group and 109.7 掳卤9.3 掳in the control group. Conclusion in this study, the retention-like release of contracture can be effectively achieved by using the tenelike release through 9 needle puncture. All cases obtained good soft tissue balance during the operation, and there were no cases with excessive loosening and MCL avulsion. No instability of the knee joint occurred in all the patients during the 3 months follow-up. The contracture degree of MCL often determined the tension of the medial space and the number of needle punctures needed to achieve gap balance. It was found that there was a positive correlation between the tibiofemoral space difference and the number of puncture, while the preoperative KSS score had a negative correlation with the number of puncture, and all the correlations were statistically significant. 3in the follow-up of 3 months after operation, the knee joint function of the patients treated with MCL net-like loosening was significantly improved than that of the patients before operation. This study showed that the effect of TKA and the improvement of the quality of life of the patients were not affected by this study. 4 in the comparison between the experimental group and the control group, we found that there was no significant difference in KSS score and knee motion between the TKA patients treated with MCL mesh loosening and the routine TKA patients at 3 months after operation. The results indicated that the MCL mesh like release could gradually prolong the MCL by increasing the number of punctures, while balancing the internal and external tibiofemoral space without adversely affecting other aspects of the operation. Finally, a satisfactory soft tissue balance was obtained. Especially in TKA, when the medial tibiofemoral space is tense (the medial tibiofemoral space is smaller than that in the lateral tibiofemoral space), it is safe and effective to balance the knee joint space by using MCL net-like release skillfully, and the clinical results are satisfactory.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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