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急性期与慢性期关节镜下解剖重建ACL的疗效对比分析

发布时间:2019-01-11 12:30
【摘要】:一.目的本文通过应用膝关节镜下前交叉韧带(anterior cruciate ligament,ACL)解剖重建治疗61例急性期与慢性期前交叉韧带损伤的患者,对比分析急性期与慢性期膝关节镜下前交叉韧带重建术后疗效差异是否存在统计学意义,意图给骨科临床医生手术时机选择提供参考。二.资料与方法资料:本文选取了吉林大学附属中日联谊医院骨科患者中单纯ACL损伤于2014年10月—2015年12月期间、年龄在18岁-55岁之间的由同年资教授完成的61例手术患者。这些患者以损伤时间与手术时间间隔2周为界限,分为损伤急性期与慢性期。急性期23例,年龄18-53岁,平均30.82±9.41岁,其中男18例、女5例;左侧膝关节13例,右侧膝关节10例,双侧膝关节0例。受伤原因:5例摔伤,14例运动性损伤,4例扭伤。慢性期38例,年龄18-55岁,平均31.02±11.51岁,其中男26例,女12例;左侧膝关节17例,右侧膝关节22例,双侧膝关节0例。受伤原因:11例无明显诱因,10例摔伤,3例运动性损伤,14例扭伤。方法:本文对患者进行术后1、3、12个月的随访,检查患者前抽屉试验、Lachman试验、轴移试验(Pivot shift)、术后12个月复查膝关节MRI影像学表现、膝关节活动度(ROM)、IKDC评分及Lysholm评分行术后组间比较。使用SPSS 21.0统计软件进行数据分析,包括一般数据描述(均数±标准差)和t检验。以P0.05作为检验标准。三.结果两组患者术后随访时间最短12个月,最长26个月,平均随访时间17.6个月。膝关节镜下解剖重建急性期与慢性期前交叉韧带损伤临床疗效均满意。术后1个月膝关节活动度急性期组均值为102.95±7.22,慢性期组均值为97.36±6.74,经t检验P0.05,有统计学意义。术后3个月膝关节活动度急性期组均值为125.47±3.82,慢性期组均值为124.65±4.57,经t检验P0.05,无统计学意义。术后随访12个月时Lysholm评分急性期重建组均值为85.13±6.71、慢性期重建组均值为78.50±8.21,经t检验P0.05,具有统计学意义。术后随访12个月时IKDC评分急性期重建组均值为85.82±5.72、慢性期重建组均值为81.70±4.52,经t检验P0.05,具有统计学意义。四.结论膝关节镜下解剖重建治疗ACL损伤利于患肢早期功能锻炼,最大恢复患肢膝关节功能有明显优势。急性期重建治疗在术后早期恢复膝关节活动度及膝关节功能较慢性期有优势。患者术后远期膝关节功能恢复程度急性期韧带重建组优于慢性期。
[Abstract]:I. Objective to treat 61 patients with acute and chronic anterior cruciate ligament injury by arthroscopic anterior cruciate ligament (anterior cruciate ligament,ACL) anatomical reconstruction. To compare and analyze the difference between acute and chronic arthroscopic anterior cruciate ligament reconstruction (ACL) reconstruction in order to provide reference for orthopedic clinicians. II. Materials and methods: 61 patients with simple ACL injury between October 2014 and December 2015 were selected from orthopaedic department of Sino-Japanese Friendship Hospital affiliated to Jilin University, aged between 18 and 55 years. These patients were divided into acute and chronic injury by 2 weeks interval between injury time and operation time. 23 cases (aged 18-53 years, mean 30.82 卤9.41 years) in acute stage, including 18 males and 5 females, 13 cases of left knee joint, 10 cases of right knee joint and 0 cases of bilateral knee joint. The causes of injury were: 5 cases fell, 14 cases sports injury, 4 cases sprain. There were 38 cases of chronic stage, aged 18-55 years (mean 31.02 卤11.51 years), including 26 males and 12 females, 17 cases of left knee joint, 22 cases of right knee joint and 0 cases of bilateral knee joint. The causes of injury were: 11 cases without obvious inducement, 10 cases with fall, 3 cases with sports injury and 14 cases with sprain. Methods: the patients were followed up for 1 and 12 months after operation. The anterior drawer test, Lachman test, axial shift test and (Pivot shift), were performed 12 months after operation to review the imaging findings of knee joint MRI and the range of knee motion (ROM),. IKDC score and Lysholm score were compared after operation. SPSS 21. 0 statistical software was used for data analysis, including general data description (mean 卤standard deviation) and t test. Take P0.05 as the test standard. Three Results the follow-up time was 12 months and 26 months, with an average follow-up time of 17.6 months. Arthroscopic anatomical reconstruction of acute and chronic anterior cruciate ligament injury was satisfactory. One month after operation, the mean value of knee motion was 102.95 卤7.22 in acute stage group and 97.36 卤6.74 in chronic stage group. There was statistical significance by t test (P0.05). 3 months after operation, the mean value of knee motion was 125.47 卤3.82 in the acute stage group and 124.65 卤4.57 in the chronic stage group. There was no significant difference between the two groups by t test (P0.05). The mean value of Lysholm score was 85.13 卤6.71 in acute stage and 78.50 卤8.21 in chronic stage after 12 months follow-up. There was statistical significance by t test (P0.05). The mean value of IKDC score was 85.82 卤5.72 in acute reconstruction group and 81.70 卤4.52 in chronic stage reconstruction group after 12 months follow-up. There was statistical significance by t test (P0.05). four Conclusion the anatomical reconstruction under knee arthroscopy is beneficial to the early functional exercise of the affected limb, and the maximum recovery of the knee joint function of the affected limb has obvious advantages. Acute stage reconstruction has advantages over chronic stage in early recovery of knee motion and knee function. The long-term recovery of knee joint function in patients with acute ligament reconstruction was superior to that in chronic stage.
【学位授予单位】:吉林大学
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R687.4

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