关节镜辅助下同种异体半月板移植术后临床功能评价及1-8年随访研究
发布时间：2019-02-14 06:53
【摘要】：背景近30年来,随着内镜技术的不断进步以及对半月板血液供应,解剖,生物力学的研究不断深入,半月板损伤的诊断、治疗及术后的功能康复有了长足的发展。半月板损伤的治疗一般分为保守治疗及手术干预,适合保守治疗的病例较少且效果较差,常见的手术治疗方式有切除、部分切除、缝合等方法。但半月板切除后会继发并发症,早在1948年,Fairbank等人已经证实有部分骨关节炎(OA)的发生是由既往半月板切除后引起。目前,对于半月板全部切除患者的治疗焦点仍然是如何选择恰当的治疗方法从而避免或减缓关节退变的发生。所以半月板损伤后治疗的难点主要是如何最大可能达到半月板的原始生理功能,恢复膝关节正常的活动功能,减轻疼痛症状,避免并发症的发生。为了尽可能降低半月板切除后所带来的一系列并发症,恢复膝关节正常生物力学环境,避免继发引起的关节磨损,延缓关节退变,中外学者进行了大量的临床及基础研究。认为只有半月板重建可以最大程度上恢复半月板切除后引起的膝关节功能障碍。目前研究的半月板重建材料主要包括自体组织结构重建、半月板假体设计植入、组织工程化研究和同种异体半月板。自体组织重建包括髌韧带,肌腱,软骨膜,但重建后的临床效果不佳,主要原因是这些组织形式和结构和半月板不同,与原半月板在匹配度上相差太大。而且取自体组织对供区也是一次伤害。组织工程半月板发展较快,主要由组织支架材料、细胞及生长因子构成,有良好的发展前景,尚处于实验研究阶段。目前临床应用较多,患者相对容易接受,临床效果较好的半月板重建方法只有同种异体半月板移植。自上世纪后期,学者们对于异体半月板的储存、消毒、匹配及半月板移植的手术技术做了大量的研究。目前,MAT取得了满意的短期效果,但中长期临床效果,尤其在软骨保护,预防或减缓OA的发生,异体半月板在体内的形态学及组织学变化,移植后对膝关节功能中长期的影响等尚无规范的、严谨的询证医学证据。本研究立足于我院既往MAT患者进行1-8年临床功能评价及随访研究。对MAT治疗半月板切除提供一定的理论支持和临床实践经验。目的通过对既往半月板移植的病例进行临床功能评价及术后1-8年随访研究,提高对半月板移植的评估及手术效果的评价。方法随访自2006年12月至2013年12月在我院进行MAT的74例MAT进行电话随访,随访成功例数为56例。随访成功率为75.7%。其中男性30例(53.6%),女性26例(46.4%)。年龄16?50岁,平均为(32.11土9.15)岁,外侧移植20例,内侧移植33例,内外同期移植3例。通过使用IKDC膝关节功能评分、Lysholm评分、Tegner运动评分以及视觉模拟评分(VAS)评估疼痛,进行随访结果的评价。影像学评估包括对标准前后位X线片上的关节间隙以及磁共振成像(MRI)上的评价。结果IKDC评分从术前的54.43提高到随访时的81.16(P0.05),Lysholm评分从69.03提高到89.39(P0.05),Tegner评分从术前的3.91提高到7.41(P0.05)。。VAS评分从5.32显著下降到2.36(P0.05)。影像学包括X平片及MRI评估发现个例随访出现轻微的关节间隙变窄。移植半月板在MRI上表现出外凸征是MAT术后一个常见的结果。结论这项研究表明,平均70个月的MAT可以显著提高膝关节的活动功能,改善疼痛,我们从MRI上观察到了半月板外凸以及皱缩现象,但是外凸的增加与MAT术后时间的长短及膝关节功能评分似乎并没有关系。
[Abstract]:In the last 30 years, with the progress of endoscopic technique and the study of the supply, anatomy and biomechanics of the meniscal blood, the diagnosis, treatment and functional rehabilitation of the meniscus injury have made great progress. The treatment of meniscal injury is generally divided into conservative treatment and surgical intervention. However, after the meniscal resection, complications were secondary and, as early as in 1948, Fairbank et al. have confirmed that some osteoarthritis (OA) occurred after a prior meniscectomy. At present, the focus on the treatment of the total meniscal resection of the patient is still the choice of appropriate treatment methods to avoid or slow the occurrence of a degenerative joint. Therefore, the difficulty of the treatment after meniscus injury is mainly how to maximize the original physiological function of the meniscus, restore the normal function of the knee joint, relieve the pain symptoms, and avoid the occurrence of the complications. In order to reduce the series of complications following the meniscectomy as much as possible, the normal biomechanical environment of the knee joint is restored, the joint wear caused by the secondary injury is avoided, the joint is delayed, and a great deal of clinical and basic research has been conducted by the Chinese and foreign scholars. It is considered that only the meniscal reconstruction can restore the knee joint dysfunction due to the meniscal resection to a maximum extent. The currently studied meniscal reconstruction material mainly includes the reconstruction of the autograft structure, the design of the meniscal prosthesis, the tissue engineering study and the allogenic meniscus. The re-establishment of the autograft includes the patellar tendon, the tendon and the cartilage membrane, but the clinical effect after the reconstruction is not good, the main reason is that the form and structure of the tissue and the meniscus are different, and the difference between the original meniscus and the original meniscus is too large. and the body tissue is also a one-time injury to the supply area. The development of meniscus of tissue engineering is rapid, mainly composed of tissue scaffold material, cell and growth factor, has good development prospect, and is still in the experimental research stage. At present, the clinical application is more, the patient is relatively easy to accept, and the meniscal reconstruction method with better clinical effect is only the allogenic meniscal transplantation. Since the late last century, scholars have done a lot of research on the storage, disinfection, matching and meniscal transplantation of the meniscus. At present, the MAT has a satisfactory short-term effect, but medium and long-term clinical effect, especially in the protection of cartilage, the occurrence of OA, the morphology and the histological change of the meniscus in the body, the long-and long-term effects of the transplantation on the function of the knee joint, etc., are not regulated, a rigorous evidence of medical evidence. This study is based on the clinical function evaluation and follow-up study of the previous MAT patients in our hospital for 1-8 years. To provide some theoretical support and clinical practice experience for MAT treatment of meniscectomy. Objective To evaluate the clinical function and the follow-up of 1-8 years after operation, and to improve the evaluation of the meniscal transplantation and the evaluation of the effect of the operation. Methods 74 patients with MAT were followed up in our hospital from December 2006 to December 2013. The number of successful follow-up was 56 cases. The success rate of follow-up was 75.7%. Among them, 30 were male (53.6%) and 26 (44.6%). The age was 16-50 years, the average was (32. 11, 9.15), the lateral graft was 20 cases, the inner graft was 33 cases, and the internal and external simultaneous transplantation was 3 cases. The results of the follow-up were evaluated by using the IKDC knee function score, the Lysholm score, the Tegner motion score, and the visual analog score (VAS) to assess the pain. Imaging assessments included evaluation of the joint space on the pre-and post-standard X-ray patch and on magnetic resonance imaging (MRI). Results The IIKDC score was increased from 54. 43 before the operation to 81.16 at the follow-up (P0.05). The Lysholm score was increased from 69. 03 to 89. 39 (P0.05), and the Tegner score was increased from 3.91 to 7.41 (P0.05). The VAS score decreased from 5.32 to 2.36 (P0.05). Imaging consisted of an X-plane and an MRI assessment that revealed a slight narrowing of the joint gap in the follow-up. The transplantation of the meniscus on MRI showed a common result after the MAT operation. Conclusion This study shows that the average of 70 months of MAT can significantly improve the activity of the knee joint and improve the pain. We have observed the meniscus of the meniscus and the shrinkage of the meniscus on the MRI, but the increase of the male and the length of the time after the MAT and the score of the function of the knee joint seem to have no relation.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4
本文编号：2421931
[Abstract]:In the last 30 years, with the progress of endoscopic technique and the study of the supply, anatomy and biomechanics of the meniscal blood, the diagnosis, treatment and functional rehabilitation of the meniscus injury have made great progress. The treatment of meniscal injury is generally divided into conservative treatment and surgical intervention. However, after the meniscal resection, complications were secondary and, as early as in 1948, Fairbank et al. have confirmed that some osteoarthritis (OA) occurred after a prior meniscectomy. At present, the focus on the treatment of the total meniscal resection of the patient is still the choice of appropriate treatment methods to avoid or slow the occurrence of a degenerative joint. Therefore, the difficulty of the treatment after meniscus injury is mainly how to maximize the original physiological function of the meniscus, restore the normal function of the knee joint, relieve the pain symptoms, and avoid the occurrence of the complications. In order to reduce the series of complications following the meniscectomy as much as possible, the normal biomechanical environment of the knee joint is restored, the joint wear caused by the secondary injury is avoided, the joint is delayed, and a great deal of clinical and basic research has been conducted by the Chinese and foreign scholars. It is considered that only the meniscal reconstruction can restore the knee joint dysfunction due to the meniscal resection to a maximum extent. The currently studied meniscal reconstruction material mainly includes the reconstruction of the autograft structure, the design of the meniscal prosthesis, the tissue engineering study and the allogenic meniscus. The re-establishment of the autograft includes the patellar tendon, the tendon and the cartilage membrane, but the clinical effect after the reconstruction is not good, the main reason is that the form and structure of the tissue and the meniscus are different, and the difference between the original meniscus and the original meniscus is too large. and the body tissue is also a one-time injury to the supply area. The development of meniscus of tissue engineering is rapid, mainly composed of tissue scaffold material, cell and growth factor, has good development prospect, and is still in the experimental research stage. At present, the clinical application is more, the patient is relatively easy to accept, and the meniscal reconstruction method with better clinical effect is only the allogenic meniscal transplantation. Since the late last century, scholars have done a lot of research on the storage, disinfection, matching and meniscal transplantation of the meniscus. At present, the MAT has a satisfactory short-term effect, but medium and long-term clinical effect, especially in the protection of cartilage, the occurrence of OA, the morphology and the histological change of the meniscus in the body, the long-and long-term effects of the transplantation on the function of the knee joint, etc., are not regulated, a rigorous evidence of medical evidence. This study is based on the clinical function evaluation and follow-up study of the previous MAT patients in our hospital for 1-8 years. To provide some theoretical support and clinical practice experience for MAT treatment of meniscectomy. Objective To evaluate the clinical function and the follow-up of 1-8 years after operation, and to improve the evaluation of the meniscal transplantation and the evaluation of the effect of the operation. Methods 74 patients with MAT were followed up in our hospital from December 2006 to December 2013. The number of successful follow-up was 56 cases. The success rate of follow-up was 75.7%. Among them, 30 were male (53.6%) and 26 (44.6%). The age was 16-50 years, the average was (32. 11, 9.15), the lateral graft was 20 cases, the inner graft was 33 cases, and the internal and external simultaneous transplantation was 3 cases. The results of the follow-up were evaluated by using the IKDC knee function score, the Lysholm score, the Tegner motion score, and the visual analog score (VAS) to assess the pain. Imaging assessments included evaluation of the joint space on the pre-and post-standard X-ray patch and on magnetic resonance imaging (MRI). Results The IIKDC score was increased from 54. 43 before the operation to 81.16 at the follow-up (P0.05). The Lysholm score was increased from 69. 03 to 89. 39 (P0.05), and the Tegner score was increased from 3.91 to 7.41 (P0.05). The VAS score decreased from 5.32 to 2.36 (P0.05). Imaging consisted of an X-plane and an MRI assessment that revealed a slight narrowing of the joint gap in the follow-up. The transplantation of the meniscus on MRI showed a common result after the MAT operation. Conclusion This study shows that the average of 70 months of MAT can significantly improve the activity of the knee joint and improve the pain. We have observed the meniscus of the meniscus and the shrinkage of the meniscus on the MRI, but the increase of the male and the length of the time after the MAT and the score of the function of the knee joint seem to have no relation.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4
【参考文献】
相关期刊论文 前1条
1 罗殿中;章亚东;侯树勋;杨家斐;赵庆;张轶超;薛超;;半月板相关间接测量指标的匹配性探讨[J];军医进修学院学报;2011年08期
，本文编号：2421931
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