膝关节多发韧带损伤经关节镜分期修复与重建的临床疗效研究

发布时间：2018-08-21 08:17

【摘要】：目的:此次研究旨在探讨膝关节的多发韧带的损伤经关节镜分期修复与重建的技术方法与临床效果。方法:收集从2014年1月至2016年12月于忻州市人民医院分期行关节镜诊疗的膝关节多发韧带损伤患者38例,此中男患者为20例,女患者为18例,年龄区间为19~68岁,平均年龄36岁;入选患者均为单膝伤,此中右膝22例,左膝16例。其中ACL、PCL、MCL和LCL 4条韧带均损伤4例,ACL、PCL和MCL损伤15例,ACL、PCL和LCL损伤11例,仅ACL、PCL损伤8例,其中并发软骨损伤患者8例,半月板损伤患者14例。对本组所有患者均采用先关节镜下重建后十字韧带(PCL),同时修复断裂的内侧副韧带(MCL)或外侧副韧带(LCL),膝关节锻炼3月功能得到恢复后,再重建或修复前十字韧带(ACL)及损伤的软骨和半月板,术后均指导进行系统化的康复训练。根据患者术前、术后膝关节主动活动度计量、Lysholm标准评分、IKDC评分进行疗效评价。结果:对本组38例膝关节多发韧带损伤患者分别进行术后随访6~24个月,平均13.6个月,21例(55.3%)患者膝关节功能恢复接近至伤前程度;17例(44.7%)患者功能有显著改善,无需辅助器材即可自力行走。患者术后膝关节疼痛、肿胀、屈伸活动受限等症状改善,复查X线片示关节力线及对合均良好,所有患者均未发生感染。膝关节的抽屉试验和内外翻试验以及Lachman试验、轴移试验等检测均为阴性。术后Lysholm膝关节功能评分、膝关节IKDC评分、关节活动范围均有显著提高。术前Lysholm膝关节功能评分(35.4±3.6)分,最后一次随访Lysholm膝关节功能评分(88.7±7.4)分。术前膝关节IKDC评分(23.4±4.2)分,最后一次随访膝关节IKDC评分(79.7±5.2)分。术前膝关节活动范围(62.4±4.3)°,最后一次随访膝关节活动范围(119.28±5.3)°术后评分与术前比较差异有统计学意义(P0.05)。结论:关节镜下分期修复和重建膝关节的后十字韧带及前十字韧带等其他膝关节构造对于多发韧带损伤的治疗效果确切,是一种破坏性小,并发症少,疗程短,安全有效的治疗方法。
[Abstract]:Objective: to investigate the technique and clinical effect of arthroscopic repair and reconstruction of multiple ligament injury of knee joint. Methods: from January 2014 to December 2016, 38 patients with multiple ligament injuries of knee joint were treated by arthroscopy in Xinzhou people's Hospital. 20 cases were male and 18 cases were female. The age range was 1968 years, with an average age of 36 years. All the patients were single knee injury, including 22 cases of right knee and 16 cases of left knee. The four ligaments of LCL and LCL were all injured in 4 cases. There were 15 cases with MCL and 15 cases with LCL injury. Only 8 cases were injured by LCL, including 8 cases complicated with cartilage injury and 14 cases with meniscus injury. All the patients underwent arthroscopic reconstruction of posterior cruciate ligament (PCL),) and repair of the broken medial collateral ligament (MCL) or lateral collateral ligament (LCL),) for 3 months. (ACL) and injured cartilage and meniscus were reconstructed or repaired. The curative effect was evaluated according to the Lysholm standard score and IKDC score before and after operation. Results: 38 patients with multiple ligament injury of knee joint were followed up for 6 ~ 24 months, the average of 13.6 months was 13.6 months, 21 cases (55.3%) had knee joint function recovery close to the degree of injury, 17 cases (44.7%) had significant improvement in the function of knee joint. You can walk on your own without auxiliary equipment. The symptoms of knee joint pain, swelling, limited flexion and extension were improved after operation. X-ray examination showed that the joint force line and involution were good, and no infection occurred in all the patients. Drawer test, varus test, Lachman test and axial shift test were all negative. Postoperative Lysholm knee function score, knee joint IKDC score, joint motion range were significantly improved. Preoperative Lysholm knee function score was (35.4 卤3.6) and Lysholm knee function score was (88.7 卤7.4) points at the last follow-up. The preoperative IKDC score was (23.4 卤4.2) and the last follow-up was (79.7 卤5.2). The preoperative range of knee motion was (62.4 卤4.3) 掳, and the postoperative score of the last follow-up was (119.28 卤5.3) 掳, which was significantly different from that before operation (P0.05). Conclusion: arthroscopic repair and reconstruction of the posterior cruciate ligament and anterior cruciate ligament are effective in the treatment of multiple ligament injuries. A safe and effective treatment.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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