膝关节多韧带损伤关节镜下一期重建与修复的疗效分析
发布时间：2019-01-27 16:14
【摘要】：背景:膝关节韧带是保证膝关节正常运动功能的重要稳定结构,随着膝关节多韧带损伤的发病率的逐年升高,其已成为近些年讨论及研究的热点。较早的认识与治疗对该疾病的康复及预后有着至关重要的作用。随着现代膝关节镜技术的发展,膝关节内韧带断裂修复与重建的传统开放手术逐渐被关节镜手术取代,但仍对手术时期选择上存在分歧,目前较为明显的两观点为一期重建与修复或分期重建与修复,至于哪种时期的选择更有利于该病的治疗,今后仍需较大的临床试验与回顾研究进行总结。目的:探讨膝关节多韧带损伤的临床特点及关节镜下一期重建与修复的临床疗效分析。方法:收集我科自2012年2月至2014年12月收治的膝关节多韧带损伤患者42例,其中男性患者29例,女性患者13例,平均年龄为33.5岁;损伤类型分别为:ACL+MCL损伤19例,ACL+PCL损伤12例,PCL+MCL损伤3例,ACL+PCL+MCL损伤13例,ACL+PCL+MCL+LCL损伤5例,其中同时合并外侧半月板损伤14例,合并内侧半月板损伤10例。42例患者均在关节镜下行一期韧带重建或修复,术后给予系统的康复锻炼,分别于术前、术后对患膝进行Lysholm评分、IKDC评分及主动关节活动度计量,收集术前、术后记录数据,比较治疗疗效。结果:42例无一失访,随访时间为6-36个月,平均随访12.6个月,42例患者均在3周内进行手术。随访见42例患者屈伸膝均无明显受限,无关节感染等并发症发生,查体见:42例患者患膝前、后抽屉试验(-),lachman试验(-),外旋拨号试验(-),0°及30°位内外翻应力试验(-)。术后复查X线及MRI检查见内固定物位置良好,无松动、移位,重建骨道无扩大及不愈合,重建韧带无断裂,复查时详细记录各项数据后得出:膝关节IKDC评分:术前(22.3±4.5)分,末次随访时(78.4±5.4)分;lysholm评分术前(32.4±4.5)分,末次随访时(89.4±9.6)分;患膝关节活动度术前(63.5±6.2)°,末次随访时(118.6±4.7)°,手术前与末次随访时比较,差异均有统计学意义(P0.05)。结论:对膝关节多韧带损伤患者而言,早期关节镜下一期重建ACL、PCL或联合修复内外侧副韧带可有效恢复膝关节稳定性与功能,是治疗膝关节多发韧带损伤的有效方法。
[Abstract]:Background: knee ligament is an important and stable structure to ensure the normal motor function of knee joint. With the increasing incidence of multiple ligament injury of knee joint, it has become a hot topic of discussion and research in recent years. Early recognition and treatment are crucial to the recovery and prognosis of the disease. With the development of modern knee arthroscopy, the traditional open surgery for the repair and reconstruction of the internal ligament of the knee joint is gradually replaced by arthroscopic surgery, but there are still differences on the choice of the operative period. At present, the two obvious viewpoints are one-stage reconstruction and repair or phased reconstruction and repair. As to which stage is more favorable to the treatment of the disease, there is still a need for a large clinical trial and retrospective study to sum up in the future. Objective: to investigate the clinical features of multiple ligament injury of knee joint and the clinical effect of one stage reconstruction and repair under arthroscopy. Methods: from February 2012 to December 2014, 42 patients with multiple ligament injury of knee joint were collected, including 29 male patients and 13 female patients, with an average age of 33.5 years. The types of injury were: ACL MCL injury in 19 cases, ACL PCL injury in 12 cases, PCL MCL injury in 3 cases, ACL PCL MCL injury in 13 cases and, ACL PCL MCL LCL injury in 5 cases, in which 14 cases were accompanied with lateral meniscus injury. There were 10 cases with medial meniscus injury. 42 patients underwent primary ligament reconstruction or repair under arthroscopy. Systemic rehabilitation exercises were performed before and after operation. Lysholm score, IKDC score and active joint activity were measured before and after operation. Collect the data before and after operation and compare the curative effect. Results: 42 cases were followed up for 6 to 36 months, with an average follow-up of 12.6 months. 42 patients underwent surgery within 3 weeks. 42 cases of knee flexion and extension were not significantly limited, and no complications such as joint infection occurred. The results showed that 42 patients had anterior and posterior drawer test (-), lachman test), external rotation dialing test (-). Internal and external stress test at 0 掳and 30 掳(-). After operation, X-ray and MRI examination showed that the internal fixator was in good position, no loosening, displacement, no enlargement and nonunion of the reconstructed bone canal, no rupture of the reconstructed ligament, The IKDC score of knee joint was (22.3 卤4.5) points before operation and (78.4 卤5.4) points at the last follow-up. The lysholm score was (32.4 卤4.5) before operation and (89.4 卤9.6) at the last follow-up. The range of knee motion was (63.5 卤6.2) 掳before operation and (118.6 卤4.7) 掳at the last follow-up. The difference was statistically significant before operation and at the last follow-up (P0.05). Conclusion: early arthroscopic reconstruction of ACL,PCL or combined repair of internal and external collateral ligaments can effectively restore the stability and function of knee joint and is an effective method for the treatment of multiple ligament injury of knee joint.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4
本文编号：2416434
[Abstract]:Background: knee ligament is an important and stable structure to ensure the normal motor function of knee joint. With the increasing incidence of multiple ligament injury of knee joint, it has become a hot topic of discussion and research in recent years. Early recognition and treatment are crucial to the recovery and prognosis of the disease. With the development of modern knee arthroscopy, the traditional open surgery for the repair and reconstruction of the internal ligament of the knee joint is gradually replaced by arthroscopic surgery, but there are still differences on the choice of the operative period. At present, the two obvious viewpoints are one-stage reconstruction and repair or phased reconstruction and repair. As to which stage is more favorable to the treatment of the disease, there is still a need for a large clinical trial and retrospective study to sum up in the future. Objective: to investigate the clinical features of multiple ligament injury of knee joint and the clinical effect of one stage reconstruction and repair under arthroscopy. Methods: from February 2012 to December 2014, 42 patients with multiple ligament injury of knee joint were collected, including 29 male patients and 13 female patients, with an average age of 33.5 years. The types of injury were: ACL MCL injury in 19 cases, ACL PCL injury in 12 cases, PCL MCL injury in 3 cases, ACL PCL MCL injury in 13 cases and, ACL PCL MCL LCL injury in 5 cases, in which 14 cases were accompanied with lateral meniscus injury. There were 10 cases with medial meniscus injury. 42 patients underwent primary ligament reconstruction or repair under arthroscopy. Systemic rehabilitation exercises were performed before and after operation. Lysholm score, IKDC score and active joint activity were measured before and after operation. Collect the data before and after operation and compare the curative effect. Results: 42 cases were followed up for 6 to 36 months, with an average follow-up of 12.6 months. 42 patients underwent surgery within 3 weeks. 42 cases of knee flexion and extension were not significantly limited, and no complications such as joint infection occurred. The results showed that 42 patients had anterior and posterior drawer test (-), lachman test), external rotation dialing test (-). Internal and external stress test at 0 掳and 30 掳(-). After operation, X-ray and MRI examination showed that the internal fixator was in good position, no loosening, displacement, no enlargement and nonunion of the reconstructed bone canal, no rupture of the reconstructed ligament, The IKDC score of knee joint was (22.3 卤4.5) points before operation and (78.4 卤5.4) points at the last follow-up. The lysholm score was (32.4 卤4.5) before operation and (89.4 卤9.6) at the last follow-up. The range of knee motion was (63.5 卤6.2) 掳before operation and (118.6 卤4.7) 掳at the last follow-up. The difference was statistically significant before operation and at the last follow-up (P0.05). Conclusion: early arthroscopic reconstruction of ACL,PCL or combined repair of internal and external collateral ligaments can effectively restore the stability and function of knee joint and is an effective method for the treatment of multiple ligament injury of knee joint.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4
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相关期刊论文 前2条
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2 张龙君;陈建良;许勇;朱少兵;;侧方应力摄片测量和膝关节MRI诊断内侧副韧带损伤的临床研究[J];中国骨伤;2012年11期
，本文编号：2416434
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