高轴移前交叉韧带损伤的危险因素研究

发布时间：2019-04-10 07:13

【摘要】：【目的】探讨高轴移(high grade pivot shift HGPS)前交叉韧(anterior cruciate ligament ACL)损伤的危险因素,为提高高轴移ACL损伤患者的疗效提供依据和参考。【方法】回顾性取2014年04月至2015年10月解放军401医院骨科收治的前交叉韧带损伤患者60例,随机数字法分为普通组、轻度轴移组、高轴移组,每组20例。患者均行ACL重建术治疗,术前完善相关检查,收集3组患者基本资料(包括患者的性别、年龄、受伤到手术时间)、MRI影象资料(包括测量外侧胫骨平台后倾角(posterior-inferior tibial slope PITS)、内侧胫骨平台后倾角及观察前外侧韧带(anterolateral ligament ALL)异常状况及术中外侧半月板及内侧半月板损伤情况,对采集的数据应用SPSS17.0软件进行处理并进行单因素Logistic分析与多因素Logistic回归分析,分析高轴移前交叉韧带损伤的危险因素。【结果】高轴移组中外侧胫骨平台后倾角,与轻度轴移组与普通组有明显差异(P0.05);轻度轴移组MRI测量外侧胫骨平台后倾角,与普通组有明显差异(P0.05);单因素结果显示:三个组中高轴移前交叉韧带损伤发生率与性别、年龄、受伤到手术时间、内侧胫骨平台后倾角、内侧半月板损伤无明显相关性(P0.05);高轴移前交叉韧带损伤发生率与外侧胫骨平台后倾角、前外侧韧带、外侧半月板损伤有明显相关性(P0.05),Logistic回归分析显示:高轴移前交叉韧带损伤发生率与外侧胫骨平台后倾角、前外侧韧带损伤、外侧半月板损伤有显著相关性(P0.05)。【结论】(1)高轴移前交叉韧带损伤的危险因素有外侧胫骨平台后倾角偏大、合并前外侧韧带损伤、合并半月板损伤;(2)根据危险因素在治疗高轴移前交叉韧带的过程中除单纯重建前交叉韧带外,还应纠正外侧胫骨平台后倾角,对损伤的半月板进行缝合修复,同时要对前外侧韧带进行加强或重建,有利于提高治疗效果,改善愈后,减少远期并发症的发生。
[Abstract]:[objective] to investigate the risk factors of (anterior cruciate ligament ACL) damage in the anterior cross ligament of high axis shifted (high grade pivot shift HGPS). [methods] from April 2014 to October 2015, 60 patients with anterior cruciate ligament injury in the Department of Orthopaedics of Chinese PLA 401 Hospital were randomly divided into the normal group and the control group, and the patients were divided into two groups: the normal group (n = 60) and the control group (n = 60). Mild shift group, high axis shift group, 20 cases in each group. All the patients were treated with ACL reconstruction, the relevant examinations were improved before operation, and the basic data of three groups of patients (including gender, age, time from injury to operation) were collected. MRI imaging data (including measurement of lateral tibial plateau posterior obliquity (posterior-inferior tibial slope PITS), medial tibial plateau posterior inclination) and observation of anterior lateral ligament (anterolateral ligament ALL) abnormalities and medial lateral meniscus and medial meniscus injury. The collected data were processed by SPSS17.0 software and analyzed by univariate Logistic analysis and multi-factor Logistic regression analysis to analyze the risk factors of the injury of the anterior cruciate ligament with high axis shift. [results] the posterior inclination of the middle-lateral tibial plateau in the high-axis shift group was significantly higher than that in the control group (P < 0.05). There was a significant difference between the mild axis shift group and the ordinary group (P0.05). The posterior inclination of lateral tibial plateau measured by MRI in mild axisymmetric group was significantly different from that in normal group (P0.05). Univariate results showed that there was no significant correlation between the incidence of high axial displacement anterior cruciate ligament injury and gender, age, time from injury to operation, posterior inclination of medial tibial plateau and medial meniscus injury in the three groups (P0.05). The incidence of high axial displacement anterior cruciate ligament injury was significantly correlated with the posterior obliquity of lateral tibial plateau, anterior lateral ligament and lateral meniscus injury (P0.05). Logistic regression analysis showed that the incidence of high axial displacement of the anterior cruciate ligament was associated with the posterior inclination of the lateral tibial plateau and the injury of the anterior lateral ligament. There was significant correlation between lateral meniscus injury (P0.05). [conclusion] (1) the risk factors of high axial displacement anterior cruciate ligament injury are lateral tibial plateau posterior obliquity, anterior lateral ligament injury and meniscus injury; (2) according to the risk factors, the posterior inclination of the lateral tibial plateau should be corrected and the injured meniscus should be sutured and repaired in addition to reconstruction of the anterior cruciate ligament in the treatment of high axial displacement of the anterior cruciate ligament. At the same time, strengthening or reconstruction of the anterior lateral ligament is helpful to improve the therapeutic effect, improve the recovery and reduce the occurrence of long-term complications.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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