本文選題：關(guān)節(jié)成形術(shù) + 置換�。� 參考：《中國人民解放軍醫(yī)學(xué)院》2015年碩士論文

【摘要】：目的：①針對術(shù)中采用拉網(wǎng)樣松解的TKA病例,不同的內(nèi)側(cè)緊張程度往往需要不同的穿刺次數(shù),分析研究屈伸膝內(nèi)外側(cè)脛股間隙差及術(shù)前KSS評分與穿刺次數(shù)的關(guān)系,以期為內(nèi)側(cè)脛骨間隙過窄的TKA病例如何采用MCL拉網(wǎng)樣松解提供理論依據(jù),避免穿刺次數(shù)過少導(dǎo)致松解不完全或者穿刺針數(shù)過多導(dǎo)致MCL松弛甚至撕裂。②通過分析比較采用拉網(wǎng)樣松解的TKA病例與未采用拉網(wǎng)樣松解的TKA病歷的術(shù)后KSS評分及術(shù)后活動度,論證拉網(wǎng)樣松解對TKA的影響。方法：篩選本院2013年6月1日至2014年8月15日的住院手術(shù)病歷,按照是否采用MCL拉網(wǎng)樣松解分為實驗組與對照組,其中對照組共納入32膝,實驗組納入29膝。①在實驗組中,分別統(tǒng)計分析屈伸膝內(nèi)外側(cè)間隙差及術(shù)前KSS評分與松解所需穿刺次數(shù)的相關(guān)性;②統(tǒng)計分析實驗組中術(shù)后較術(shù)前KSS評分及膝關(guān)節(jié)活動度的差異；③比較分析實驗組與對照組所有患者術(shù)后3個月隨訪時KSS評分及膝關(guān)節(jié)活動度的差異。結(jié)果：①屈伸膝內(nèi)外側(cè)脛股間隙差與松解所需要的穿刺次數(shù)間存在著正相關(guān)關(guān)系,且相關(guān)性有統(tǒng)計學(xué)意義(屈膝：P=0.0000.05,相關(guān)系數(shù)=0.64;伸膝：P=0.0040.05,相關(guān)系數(shù)=0.51),與之相反,術(shù)前KSS評分與穿刺次數(shù)見存在具有統(tǒng)計學(xué)意義的負(fù)相關(guān)關(guān)系(P=0.0000.05,相關(guān)系數(shù)=-0.72)。②通過術(shù)后3個月的隨訪發(fā)現(xiàn),兩組間KSS評分及膝關(guān)節(jié)活動度無明顯差異(KSS評分：實驗組70.8±6.9,對照組73.8±6.0,P=0.110.05；膝關(guān)節(jié)活動度：實驗組113.8°士8.0°,對照組109.7°±9.3°,P=0.070.05)。結(jié)論：①在本研究中,采用9號針頭穿刺的拉網(wǎng)樣松解可有效松解攣縮的MCL,所有病例在術(shù)中均獲得了良好的軟組織平衡,且未出現(xiàn)過度松解及MCL撕脫的病例,在術(shù)后3個月的隨訪中所有病例均未出現(xiàn)膝關(guān)節(jié)不穩(wěn)的情況；②MCL的攣縮程度往往決定著內(nèi)側(cè)間隙的緊張程度,同時也決定著欲達到間隙平衡所需要的針頭穿刺次數(shù),通過研究發(fā)現(xiàn),屈伸膝內(nèi)外側(cè)脛股間隙差與所需要的穿刺次數(shù)間存在著正相關(guān)關(guān)系,而術(shù)前KSS評分與穿刺次數(shù)間存在著負(fù)相關(guān)關(guān)系,所有相關(guān)性均有統(tǒng)計學(xué)意義;③在術(shù)后3個月的隨訪中發(fā)現(xiàn),采用MCL拉網(wǎng)樣松解的患者,膝關(guān)節(jié)功能均較術(shù)前有明顯改善,該研究表明,MCL拉網(wǎng)樣松解并不會影響TKA術(shù)后的療效及患者生活質(zhì)量的提高;④在實驗組與對照組的對比中我們發(fā)現(xiàn),術(shù)后3個月時,采用MCL拉網(wǎng)樣松解的TKA患者與常規(guī)TKA患者,無論是在KSS評分還是膝關(guān)節(jié)活動度上均已無明顯差異,這表示MCL拉網(wǎng)樣松解在平衡內(nèi)外側(cè)脛股間隙的同時不會對手術(shù)的其它方面造成不利影響。MCL拉網(wǎng)樣松解可以通過穿刺次數(shù)的增加而使MCL逐漸延長,最終獲得滿意的軟組織平衡,尤其在TKA中面對較嚴(yán)重的內(nèi)側(cè)脛股間隙緊張(內(nèi)側(cè)脛股間隙較外側(cè)小3mm以上)時,熟練的運用MCL拉網(wǎng)樣松解可安全有效的平衡膝關(guān)節(jié)間隙,最終獲得滿意的臨床結(jié)果。
[Abstract]:Objective to analyze the relationship between the difference of tibiofemoral space between flexion and extension knee, the preoperative KSS score and the number of puncture times in TKA patients with different medial tension and different medial tension. The aim of this study was to provide a theoretical basis for the use of MCL mesh loosening in cases of TKA with narrow medial tibial space. To avoid too few puncture times leading to incomplete release or excessive number of puncture needles to cause MCL relaxation or tear .2 by analyzing and comparing the postoperative KSS score and postoperative activity between TKA cases with net-like loosening and TKA cases without netting loosening. The effect of mesh loosening on TKA is demonstrated. Methods: the inpatient surgical records of our hospital from June 1, 2013 to August 15, 2014 were selected and divided into experimental group and control group according to whether or not to use MCL net-like release. The control group included 32 knees, and the experimental group included 29 knees .1 in the experimental group. The correlation between KSS score and puncture times in flexion and extension knee was statistically analyzed. The difference of KSS score and knee motion in experimental group was compared with that before operation. 3 the differences of KSS score and knee joint motion were compared between the experimental group and the control group at 3 months follow-up. Results there was a positive correlation between the tibiofemoral space difference and the puncture times needed to release the knee, and the correlation was statistically significant (flexion: P0. 0000.05, correlation coefficient 0. 64; knee extension: P0. 0040.05, correlation coefficient: 0. 51%, contrary to that of knee: P0. 0000. 05, r = 0. 64, P = 0. 0040.05, r = 0. 51). There was a significant negative correlation between preoperative KSS score and puncture frequency (P < 0. 0000. 05). The correlation coefficient was found by 3 months follow-up. There was no significant difference in KSS score and knee motion between the two groups: 70.8 鹵6.9 in the experimental group, 73.8 鹵6.0 in the control group, 0.110.05 in the control group, and 113.8 擄鹵8.0 擄in the experimental group and 109.7 擄鹵9.3 擄in the control group. Conclusion in this study, the retention-like release of contracture can be effectively achieved by using the tenelike release through 9 needle puncture. All cases obtained good soft tissue balance during the operation, and there were no cases with excessive loosening and MCL avulsion. No instability of the knee joint occurred in all the patients during the 3 months follow-up. The contracture degree of MCL often determined the tension of the medial space and the number of needle punctures needed to achieve gap balance. It was found that there was a positive correlation between the tibiofemoral space difference and the number of puncture, while the preoperative KSS score had a negative correlation with the number of puncture, and all the correlations were statistically significant. 3in the follow-up of 3 months after operation, the knee joint function of the patients treated with MCL net-like loosening was significantly improved than that of the patients before operation. This study showed that the effect of TKA and the improvement of the quality of life of the patients were not affected by this study. 4 in the comparison between the experimental group and the control group, we found that there was no significant difference in KSS score and knee motion between the TKA patients treated with MCL mesh loosening and the routine TKA patients at 3 months after operation. The results indicated that the MCL mesh like release could gradually prolong the MCL by increasing the number of punctures, while balancing the internal and external tibiofemoral space without adversely affecting other aspects of the operation. Finally, a satisfactory soft tissue balance was obtained. Especially in TKA, when the medial tibiofemoral space is tense (the medial tibiofemoral space is smaller than that in the lateral tibiofemoral space), it is safe and effective to balance the knee joint space by using MCL net-like release skillfully, and the clinical results are satisfactory.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.4

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