膝关节多发韧带损伤一期关节镜手术治疗的中远期随访研究
发布时间：2018-11-17 09:40
【摘要】：研究目的:回顾性研究关节镜治疗膝关节多发韧带损伤的临床疗效。并探讨影响手术疗效的因素。研究资料与方法:回顾2006年1月至2015年10月山东大学齐鲁医院收治确诊为膝关节多发韧带损伤且应用关节镜治疗的52例患者的临床资料,成功随访23例,随访成功率为44.2%。其中男16例,女7例,年龄18至58岁,平均35岁。受伤至手术时间为4天至15个月,平均75天。所有患者行一期手术治疗。12例行早期手术治疗,11例行延期手术治疗。其中前交叉韧带(anterior cruciate liga-ment,ACL)重建 + 内侧副韧带(medial collateral ligament,MCL)修补 6 例,ACL重建+后交叉韧带(posteri-or cruciate ligament,PCL)重建+MCL 修补 3 例,ACL 重建+PCL 重建 8 例,ACL 重建+外侧副韧带(lateral collateral ligam-ent,LCL)修补2例,ACL重建+LCL重建2例,ACL重建+MCL重建1例,ACL重建+PCL重建+LCL重建1例。记录患者术后膝关节的恢复情况以及术后相关并发症的发生情况,并于术前及末次随访时应用国际膝关节文献委员会(International Knee Documentation Committee,IKDC)评分,Tegner 评分,Lysholm 评分评估膝关节的功能状况。根据手术时机、性别、年龄、损伤的韧带数、随访时间等因素分组,并分别统计分析各组间的优良率。研究结果:23例患者随访13至122个月,平均54.6个月。1例患者出现膝关节活动受限(活动度90°),14例患者出现偶发膝关节疼痛(气候变化,久站等情况下出现膝关节疼痛),发生率为60.9%;3例患者在重劳动后可出现膝关节轻微肿胀,发生率为13.0%;8例患者在运动或重劳动时偶现"打软腿"的情况,发生率为34.8%。所有随访患者均未出现移植物断裂、关节感染、顽固性疼痛等严重并发症。部分患者末次随访时行磁共振成像(Magnetic Resonance Imaging,MRI)示:重建韧带形态良好,走形正常,关节腔内无明显异常信号。患者术前IKDC评分为(31.5±10.5)分,末次随访时为(79.6±11.0)分,差异有统计学意义(t=16.836 p0.01);术前Lysholm评分为(37.9±11.9)分,末次随访时为(89.6±8.3)分,差异有统计学意义(t=16.089 p0.01);术前Tegner评分为(0.9±0.7)分,末次随访时为(4.0±0.8)分,差异有统计学意义(t=15.486 p0.01)。根据IKDC评分划分术后疗效等级,总体优良率为69.6%。手术时机、性别、随访时间、是否存在合并伤的组间优良率无统计学差异。损伤韧带数目为2条的患者的术后优良率为91.7%,损伤数目大于2条的患者的术后优良率为45.5%,差异有统计学意义;大于50岁的患者术后优良率为0%,与其余两组的优良率具有显著差异,差异具有统计学意义。根据Lysholm评分,总体优良率为82.6%,各组间的优良率无统计学差异。研究结论:1、一期关节镜下修复与重建膝关节多发韧带损伤可有效改善膝关节功能,显著提高膝关节稳定性,是治疗膝关节多发韧带损伤的有效治疗方法。2、早期手术治疗与延期手术治疗均可获得满意的手术疗效,两者在术后膝关节功能评价方面并无差异,临床工作中应根据膝关节韧带受损情况,关节肿胀程度等实际情况选择手术时机,早期或延期行一期手术治疗。3、患者的性别、术后随访时间以及术前是否存在合并伤对手术后的优良率并无显著影响;而患者的年龄以及合并PCL损伤可影响术后的疗效,对于年轻的、无PCL的患者,手术后的优良率可显著提高。
[Abstract]:Objective: To study the clinical effect of arthroscopy in the treatment of multiple ligament injury of knee joint. and the factors that influence the operation of the operation are discussed. The data and methods of the study were as follows: From January 2006 to October 2015, the clinical data of 52 patients with the diagnosis of multiple ligament injury and the application of arthroscopy in Qilu Hospital of Shandong University were reviewed. The successful follow-up of 23 cases was followed up with a follow-up success rate of 42.2%. Of these, 16 males and 7 females, aged 18 to 58, were 35 years of age. The duration of the injury was 4 days to 15 months, with an average of 75 days. All patients underwent a first-stage surgical treatment. 12 cases of early-stage operation and 11 cases of delayed operation. In this study, 6 cases of anterior cruciate ligament (ACL) reconstruction, 6 cases of medial-medial collateral ligament (MCL), 3 cases of ACL reconstruction + posterior cruciate ligament (PCL) reconstruction + MCL repair, 8 cases of ACL reconstruction + PCL, 2 cases of ACL reconstruction + lateral collateralligan-ent (LCL) were repaired. ACL reconstruction + LCL reconstruction 2 cases, ACL reconstruction + MCL reconstruction 1 case, ACL reconstruction + PCL reconstruction + LCL reconstruction 1 case. The recovery of the knee and the occurrence of postoperative complications were recorded and the functional status of the knee was assessed by the International Knee Documentation Committee (IKDC) score, the Tegner score, and the Lysholm score at the pre-and end-time follow-up. According to the time of operation, the number of ligaments, the number of ligaments, the follow-up time and other factors, the rate of good and good was statistically analyzed. Results: 23 patients were followed up for 13 to 122 months, with an average of 54. 6 months. One patient experienced limited knee joint activity (range of motion 90 掳) and 14 patients with occasional knee pain (knee pain in the case of climate change, long standing, etc.), with an incidence of 60. 9%; The incidence of slight swelling of the knee was 13. 0% in 3 cases, and the incidence rate was 34.8% in 8 cases. There were no serious complications such as graft fracture, joint infection, and intractable pain in all follow-up patients. Magnetic resonance imaging (MRI) was performed at the last follow-up of a part of the patient. The reconstruction of the ligament was good, the shape of the ligament was normal, and there was no obvious abnormal signal in the joint cavity. The pre-operative IKDC score was (31.5 to 10.5), and at the end of the last follow-up (79.6 to 11.0), the difference was of statistical significance (t = 16. 836 p0.01); the preoperative Lysholm score was (37.9 to 11. 9), and at the end of the follow-up (89.6 to 8.3), the difference was statistically significant (t = 16.089 p0.01); The pre-operative Tegner score was (0.9 to 0.7), and at the end of the last follow-up (4.0 to 0.8), the difference was statistically significant (t = 15.486 p0.01). The overall good and good rate was 66.9%, according to IKDC score. There was no statistical difference between the time of operation, sex, follow-up time, and whether there was a group of combined injuries. The excellent rate of good and good rate was 95.7%, the rate of good and good was 45.5%, the difference was statistically significant, and the rate of excellent and good was 0% after the 50-year-old patients, and the excellent and good rate was significantly different from the other two groups. The difference was of statistical significance. The excellent and good rate was 82.6% according to the Lysholm score, and there was no statistical difference between the groups. Conclusion: 1. The repair and reconstruction of the multiple ligament of the knee joint under the first-stage arthroscope can improve the function of the knee joint, improve the stability of the knee joint, and is an effective treatment method for the treatment of the multiple-ligament injury of the knee joint. Both the early operative treatment and the delayed operation treatment can achieve satisfactory operation effect, both of which have no difference in the function evaluation of the knee joint after operation, and the operation timing should be selected according to the actual conditions such as the damage of the ligament of the knee joint, the degree of the swelling of the joint and the like in the clinical work, 3. The patient's sex, the post-operative follow-up time and the pre-operation have no significant effect on the good and good rate after operation; the age of the patient and the combined PCL injury can affect the curative effect after operation, and for the young, non-PCL-free patients, The rate of good and good after operation can be improved significantly.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4
本文编号：2337328
[Abstract]:Objective: To study the clinical effect of arthroscopy in the treatment of multiple ligament injury of knee joint. and the factors that influence the operation of the operation are discussed. The data and methods of the study were as follows: From January 2006 to October 2015, the clinical data of 52 patients with the diagnosis of multiple ligament injury and the application of arthroscopy in Qilu Hospital of Shandong University were reviewed. The successful follow-up of 23 cases was followed up with a follow-up success rate of 42.2%. Of these, 16 males and 7 females, aged 18 to 58, were 35 years of age. The duration of the injury was 4 days to 15 months, with an average of 75 days. All patients underwent a first-stage surgical treatment. 12 cases of early-stage operation and 11 cases of delayed operation. In this study, 6 cases of anterior cruciate ligament (ACL) reconstruction, 6 cases of medial-medial collateral ligament (MCL), 3 cases of ACL reconstruction + posterior cruciate ligament (PCL) reconstruction + MCL repair, 8 cases of ACL reconstruction + PCL, 2 cases of ACL reconstruction + lateral collateralligan-ent (LCL) were repaired. ACL reconstruction + LCL reconstruction 2 cases, ACL reconstruction + MCL reconstruction 1 case, ACL reconstruction + PCL reconstruction + LCL reconstruction 1 case. The recovery of the knee and the occurrence of postoperative complications were recorded and the functional status of the knee was assessed by the International Knee Documentation Committee (IKDC) score, the Tegner score, and the Lysholm score at the pre-and end-time follow-up. According to the time of operation, the number of ligaments, the number of ligaments, the follow-up time and other factors, the rate of good and good was statistically analyzed. Results: 23 patients were followed up for 13 to 122 months, with an average of 54. 6 months. One patient experienced limited knee joint activity (range of motion 90 掳) and 14 patients with occasional knee pain (knee pain in the case of climate change, long standing, etc.), with an incidence of 60. 9%; The incidence of slight swelling of the knee was 13. 0% in 3 cases, and the incidence rate was 34.8% in 8 cases. There were no serious complications such as graft fracture, joint infection, and intractable pain in all follow-up patients. Magnetic resonance imaging (MRI) was performed at the last follow-up of a part of the patient. The reconstruction of the ligament was good, the shape of the ligament was normal, and there was no obvious abnormal signal in the joint cavity. The pre-operative IKDC score was (31.5 to 10.5), and at the end of the last follow-up (79.6 to 11.0), the difference was of statistical significance (t = 16. 836 p0.01); the preoperative Lysholm score was (37.9 to 11. 9), and at the end of the follow-up (89.6 to 8.3), the difference was statistically significant (t = 16.089 p0.01); The pre-operative Tegner score was (0.9 to 0.7), and at the end of the last follow-up (4.0 to 0.8), the difference was statistically significant (t = 15.486 p0.01). The overall good and good rate was 66.9%, according to IKDC score. There was no statistical difference between the time of operation, sex, follow-up time, and whether there was a group of combined injuries. The excellent rate of good and good rate was 95.7%, the rate of good and good was 45.5%, the difference was statistically significant, and the rate of excellent and good was 0% after the 50-year-old patients, and the excellent and good rate was significantly different from the other two groups. The difference was of statistical significance. The excellent and good rate was 82.6% according to the Lysholm score, and there was no statistical difference between the groups. Conclusion: 1. The repair and reconstruction of the multiple ligament of the knee joint under the first-stage arthroscope can improve the function of the knee joint, improve the stability of the knee joint, and is an effective treatment method for the treatment of the multiple-ligament injury of the knee joint. Both the early operative treatment and the delayed operation treatment can achieve satisfactory operation effect, both of which have no difference in the function evaluation of the knee joint after operation, and the operation timing should be selected according to the actual conditions such as the damage of the ligament of the knee joint, the degree of the swelling of the joint and the like in the clinical work, 3. The patient's sex, the post-operative follow-up time and the pre-operation have no significant effect on the good and good rate after operation; the age of the patient and the combined PCL injury can affect the curative effect after operation, and for the young, non-PCL-free patients, The rate of good and good after operation can be improved significantly.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4
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