本文關(guān)鍵詞： 關(guān)節(jié)鏡 前交叉韌帶損傷 內(nèi)側(cè)副韌帶損傷 膝關(guān)節(jié)　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:探討合并前交叉韌帶(ACL)損傷的Ⅲ度內(nèi)側(cè)副韌帶(MCL)損傷時,在ACL重建后內(nèi)側(cè)副韌帶手術(shù)修復(fù)與保守治療的臨床療效比較。方法:將大連醫(yī)科大學附屬第一醫(yī)院2013年06月至2016年06月收治的38例前交叉韌帶損傷合并Ⅲ度內(nèi)側(cè)副韌帶損傷診斷明確的患者,在前交叉韌帶重建后,根據(jù)是否修復(fù)MCL,將患者分為兩組(MCL修補組和MCL保守治療組),38例患者均于1-2周后手術(shù),膝關(guān)節(jié)鏡下行自體前交叉韌帶重建,ACL重建后,選取17例手術(shù)修復(fù)MCL的患者為MCL修補組,于一期行膝關(guān)節(jié)內(nèi)側(cè)有限直切口,予以縫合錨釘修復(fù)內(nèi)側(cè)副韌帶,術(shù)后患肢石膏或膝關(guān)節(jié)支具固定制動2-3周,2-3周后開始進行功能鍛煉;選取21例保守治療MCL損傷的患者為MCL保守治療組,經(jīng)前叉韌帶重建后,予以患肢石膏或膝關(guān)節(jié)支具固定制動4-6周之后逐漸進行患肢功能鍛煉。內(nèi)側(cè)副韌帶修復(fù)組及內(nèi)側(cè)副韌帶保守治療組均采用Lysholm評分及IKDC評分;收集患者外翻應(yīng)力試驗及前抽屜試驗結(jié)果、手術(shù)時間、治療相關(guān)費用及術(shù)后住院日。結(jié)果:兩組患者手術(shù)均順利完成,術(shù)后經(jīng)過平均18個月隨訪,隨訪中術(shù)后切口均甲級愈合,術(shù)后隨訪中均無意外損傷。隨訪發(fā)現(xiàn):1.21例內(nèi)側(cè)副韌帶保守治療組患者中前抽屜試驗(+)5例,前抽屜試驗(++)1例,均為硬止點,外翻應(yīng)力試驗Ⅰ度5例、外翻應(yīng)力試驗Ⅱ度2例;17例內(nèi)側(cè)副韌帶手術(shù)治療組患者中前抽屜試驗(+)3例,均為硬止點,外翻應(yīng)力試驗Ⅰ度3例。2.內(nèi)側(cè)副韌帶修復(fù)組(91.12±1.99)術(shù)后Lysholm評分高于內(nèi)側(cè)副韌帶保守治療組(87.55±1.67),有統(tǒng)計學意義(P0.05)。3.內(nèi)側(cè)副韌帶修復(fù)組術(shù)(93.5±1.5)后IKDC評分高于內(nèi)側(cè)副韌帶保守治療組(89.5±1.33),有統(tǒng)計學意義(P0.05)。4.內(nèi)側(cè)副韌帶修復(fù)組治療相關(guān)費用(49588.24±3161.66元)明顯高于內(nèi)側(cè)副韌帶保守治療組(44595.00±5485.82元),有統(tǒng)計學意義(P0.05)。5.內(nèi)側(cè)副韌帶修復(fù)組重返工作時間(86.29±4.42天)明顯低于內(nèi)側(cè)副韌帶保守治療組(90.65±3.91天),有統(tǒng)計學意義(P0.05)。6.MCL修復(fù)組術(shù)后住院日(14.88±4.31天)與MCL保守治療組(13.90±5.22天)的差異,無明顯統(tǒng)計學意義(P0.05)。7.MCL修復(fù)組手術(shù)時長(128.82±36.91分鐘)與MCL保守治療組(98.50±30.44分鐘)的差異,無明顯統(tǒng)計學意義(P0.05)。結(jié)論:前交叉韌帶損傷合并Ⅲ度內(nèi)側(cè)副韌帶損傷時,在ACL重建后,內(nèi)側(cè)副韌帶手術(shù)修復(fù)與保守治療相比,手術(shù)修復(fù)組具有更好的恢復(fù)膝關(guān)節(jié)穩(wěn)定性、重返工作時間短等優(yōu)點,但治療相關(guān)費用明顯高于保守治療組。前交叉韌帶損傷合并Ⅲ度內(nèi)側(cè)副韌帶損傷時,重建前交叉韌帶后外翻試驗者Ⅱ度到Ⅲ度者同時進行手術(shù)修復(fù)內(nèi)側(cè)副韌帶對患者膝關(guān)節(jié)功能恢復(fù)更加有利。
[Abstract]:Objective: To investigate the combined anterior cruciate ligament (ACL) injury of medial collateral ligament (MCL) injury, compare the clinical efficacy in the repair of the medial collateral ligament surgery and conservative treatment after ACL reconstruction. Methods: the First Affiliated Hospital of Dalian Medical University in 2013 06 to 2016 06 months of receiving treatment of 38 patients with anterior cruciate ligament injury third degree of medial collateral ligament injury diagnosed in patients after anterior cruciate ligament reconstruction, according to whether the repair of MCL, the patients were divided into two groups (MCL group and MCL repair conservative treatment group), 38 patients were in 1-2 weeks after surgery, knee arthroscopic autologous anterior cruciate ligament reconstruction, ACL reconstruction, selection 17 patients underwent MCL repair repair group MCL, in a row of medial limited straight incision, suture anchor to repair the medial collateral ligament, postoperative limb plaster or knee brace immobilization for 2-3 weeks, 2-3 weeks after the start of functional exercise; Selection of conservative treatment in patients with MCL injury 21 cases MCL conservative treatment group, after anterior cruciate ligament reconstruction, be patient after limb plaster or knee brace immobilization 4-6 weeks gradually limb function exercise. Repair of the medial collateral ligament and medial collateral ligament in conservative treatment group were treated with Lysholm and IKDC scores were collected; valgus stress test and anterior drawer test results, operation time, treatment costs and postoperative hospitalization. Results: two groups of patients were successfully completed surgery, postoperative after a mean follow-up of 18 months of follow-up, postoperative incision healing, postoperative follow-up there were no accidental injury: 1.21 cases were found. The medial collateral ligament of conservative treatment in patients with anterior drawer test (+) in 5 cases, anterior drawer test (+ +) 1 cases, are hard point valgus stress test were 5 cases, valgus stress test of 2 cases; 17 cases of medial collateral ligament surgery patients in the treatment group before Drawer test (+) 3 cases, are hard point valgus stress test of 3 cases of.2. of medial collateral ligament repair group (91.12 + 1.99) postoperative Lysholm score was higher than that of the medial collateral ligament of the conservative treatment group (87.55 + 1.67), there was statistical significance (P0.05) and.3. group (medial collateral ligament repair 93.5 + 1.5) after the IKDC score was higher than that of the medial collateral ligament of the conservative treatment group (89.5 + 1.33), there was statistical significance (P0.05).4. medial collateral ligament repair group treatment related costs (49588.24 + 3161.66) was significantly higher than that of the medial collateral ligament of the conservative treatment group (44595 + 5485.82), there was statistical significance (P0.05) inside.5. collateral ligament repair group to return to work time (86.29 + 4.42 days) was significantly lower than that of the medial collateral ligament of the conservative treatment group (90.65 + 3.91 days), there was statistical significance (P0.05).6.MCL repair group, postoperative hospital stay (14.88 + 4.31 days) and conservative treatment group MCL (13.90 + 5.22 days) difference, no statistically significant (meaning P0. 05).7.MCL repair group operation time (128.82 + 36.91 minutes) and conservative treatment group MCL (98.50 + 30.44 minutes) the difference was not statistically significant (P0.05). Conclusion: the degree of injury of medial collateral ligament with third anterior cruciate ligament injury, in ACL reconstruction, medial collateral ligament repair surgery compared with conservative treatment, surgical repair group with knee joint stability better, the advantages of short time to return to work, but the treatment cost was higher than the conservative treatment group. The damage degree of medial collateral ligament with third anterior cruciate ligament injury, anterior cruciate ligament reconstruction after valgus test II to III degree and surgical repair of the medial side ligament of knee joint function recovery of patients is more favorable.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.4
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本文編號：1494289