内侧副韧带股骨止点上移术与重建术治疗膝关节内侧松弛的对比研究

发布时间：2018-11-11 17:50

【摘要】：目的探讨内侧副韧带股骨止点上移术与重建术治疗陈旧性膝内侧结构松弛的临床疗效,为临床治疗陈旧性膝内侧结构松弛提供参考。方法以华北理工大学附属骨科医院(唐山市第二医院)于2010年1月至2015年1月收治的64例陈旧性膝关节内侧结构松弛患者为研究对象,根据不同的手术方式分为上移组(31例)和重建组(33例)。上移组采用内侧副韧带股骨止点上移术进行治疗,重建组采用自体肌腱内侧副韧带重建术进行治疗。于术前及术后18个月分别采用国际膝关节文献委员会膝关节评估表(IKDC)、Lysholm评分、Tegner评分等评测两组患者膝关节功能,拍摄患侧膝关节外翻应力位X线测量内侧间隙开口大小及关节间隙夹角(JS)评价两组患者膝关节稳定性;于术后18个月采用《膝内侧副韧带临床效果评定表》评测两组患者的临床总体疗效。结果两组患者病例数、年龄、性别、病程、手术侧别等一般资料比较,差异无统计学意义(P0.05)。术后两组患者切口均为Ⅰ期愈合,无下肢深静脉血栓形成等术后并发症发生。64例患者均获得随访,上移组随访时间为19~24月,平均(21.05±1.55)个月,重建组随访时间为18~23月,平均(20.95±1.47)个月。随访的所有患者中,均无僵硬、强直、再次损伤及感染等情况发生。术前两组患者IKDC评分、Lysholm评分、Tegner评分、VAS评分、膝关节内侧间隙开口及JS比较,差异不具有统计学意义,具有可比性(P0.05)。与术前比较,术后18个月,两组患者IKDC评分、Lysholm评分、Tegner评分、VAS评分、膝关节内侧关节间隙开口及JS显著改善(P0.05)。术后18个月,与上移组比较,重建组IKDC评分、Lysholm评分、Tegner评分、临床总体疗效优良率升高;膝关节内侧关节间隙开口及JS减小(P0.05);膝关节VAS评分无明显变化(P0.05)。结论1内侧副韧带股骨止点上移术与重建术均能有效治疗陈旧性膝关节内侧结构松弛;2内侧副韧带重建术在改善膝关节功能、提高膝关节稳定性及临床总体疗效方面优于股骨止点上移术,而在改善膝关节内侧疼痛方面两种手术无明显差异。
[Abstract]:Objective to investigate the clinical effect of medial collateral ligament (MCL) insertion and reconstruction in the treatment of old medial knee structural relaxation, and to provide reference for clinical treatment of old medial knee structural relaxation. Methods from January 2010 to January 2015, 64 patients with old medial structural relaxation of knee joint were treated in the affiliated Orthopaedic Hospital of North China University of Technology (Tangshan second Hospital). According to different operation methods, the patients were divided into upper displacement group (31 cases) and reconstruction group (33 cases). The upper group was treated by the femoral insertion of medial collateral ligament and the reconstruction group was treated by reconstruction of the medial collateral ligament of autogenous tendon. The knee joint function of the two groups was evaluated by (IKDC), Lysholm score and Tegner score before operation and 18 months after operation. Knee joint stability was evaluated by measuring the size of medial space and joint space angle (JS). At 18 months after operation, the clinical efficacy of medial collateral ligament of knee was evaluated by evaluating the clinical effect of the two groups. Results there was no significant difference between the two groups in the number of cases, age, sex, course of disease, surgical side and other general data (P0.05). There was no postoperative complications such as deep vein thrombosis of lower extremity in both groups. The follow-up time of upper shift group was 19 ~ 24 months (mean (21.05 卤1.55) months). The follow-up time of the reconstruction group was from 18 to 23 months (mean (20.95 卤1.47) months). No stiffness, ankylosis, reinjury or infection occurred in all patients followed up. Preoperative IKDC score, Lysholm score, Tegner score, VAS score, the medial space of knee joint opening and JS comparison, the difference was not statistically significant, comparable (P0.05). Compared with preoperative 18 months, IKDC score, Lysholm score, Tegner score, VAS score, medial articular space of knee joint and JS were significantly improved in both groups (P0.05). At 18 months after operation, the IKDC score, Lysholm score, Tegner score, total curative effect of the reconstruction group increased, and the opening of medial articular space and JS decreased in the reconstruction group (P0.05). There was no significant change in VAS score of knee joint (P0.05). Conclusion (1) the medial collateral ligament can be effectively used for the treatment of old medial relaxation of knee joint. 2the reconstruction of medial collateral ligament was superior to that of femoral upshift in improving the function of knee joint, improving the stability of knee joint and the overall clinical curative effect, but there was no significant difference between the two operations in improving medial knee pain.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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