髕骨內推治療髕股關節炎前后髕股關節相關參數變化的影像學研究(碩士)

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髕骨內推治療髕股關節炎前后髕股關節相關參數變化的影像學研究(碩士)(論文20000字)
摘 要
目的:
通過對比髕骨內推手法治療髕股關節炎前后Q角的變化以及關節軟骨的變化,為髕骨內推提供影像學支持;對髕股內推治療前后髕股關節髕骨相關參數變化(外側髕骨角、髕骨吻合角、髕骨指數)以及骨髓水腫容積變化規律及相關性研究,并對髕骨內推治療髕股關節炎的臨床研究進行推廣應用。
方法:
收集解放軍三七一中心醫院2018年1月至2018年6月髕股關節炎患者45例,年齡從40至70歲,按有無行髕骨內推手法治療進行分組,以15例為單位隨機分實驗組(A)、空白組(B)、治療組(C),A組關節腔內注射玻璃酸鈉+髕骨內推手法治療;B組標準量口服鹽酸氨基葡萄糖+關節腔內注射玻璃酸鈉;C組標準量口服鹽酸氨基葡萄糖、關節腔內注射玻璃酸鈉+髕骨內推手法治療。堅持隨訪6個月后,進行觀察指標對比。通過建立相關模型,分析相關因素,應用X線、MRI分析髕骨內推治療前后外側髕骨角、髕骨吻合角、髕骨指數、髕骨骨髓水腫容積的變化規律。
結果:
1.A組和C組患者均順利接受手術,其中A組平均手術時間、平均臥床時間和平均住院時間均高于C組。隨訪時間6個月以上。
2.治療組所有患者膝前痛癥狀均明顯緩解,三組治療后3個月、末次隨訪時VAS評分較術前明顯下降,差異具有統計學意義(P<0.05),A組、C組與B組相比,差異具有統計意義(P<0.05)。C組與A組相比,差異具有統計意義(P<0.05)。
3.所有患者膝關節功能均明顯改善,三組患者治療后3個月、末次隨訪時Lysholm評分、Kujala評分較術前明顯增高,差異有統計學意義(P<0.05)。A組、C組與B組相比,差異具有統計意義(P<0.05)。C組與A組相比,差異具有統計意義(P<0.05)。
4.三組患者治療后3個月影像學指標髕股吻合角、髕骨傾斜角和髕骨外移測量結果較治療前顯著減小,差異具有統計學意義(P<0.05)。A組、C組與B組相比,差異具有統計意義(P<0.05)。C組與A組相比,差異具有統計意義(P<0.05)。
結論:
通過本研究,為髕股關節炎的早期預防和診斷提供影像支持,為髕骨內推治療髕股關節炎及髕股不穩提供影像檢查方案,為更多髕股關節炎患者提供安全、無創、低價且簡便的治療方案,延緩膝骨關節炎的發展,減輕患者膝關節疼痛。為膝骨關節炎患者提供一種嶄新的治療方案,提高患者的生活質量,減少醫療費用,提高社會經濟效益。
關鍵詞:髕股關節炎;髕骨內推;參數變化;影像學

Imaging Study of the Changes of Patellofemoral Joint Parameters before and after Patellofemoral Internal Push Therapy for Patellofemoral Arthritis
Abstract
Objective:
By comparing the changes of Q Angle and articular cartilage before and after the treatment of patellofemoral arthritis with patellar internal push manipulation, the imaging support for patellar internal push was provided. This paper was to study the changes and correlation of patellar parameters (lateral patellar Angle, patellar anastomotic Angle, patellar index) of patellofemoral joint before and after patellofemoral internal push treatment, and to promote the clinical study of patellar internal push treatment of patellofemoral arthritis.
Methods:
Collection in the People's Liberation Army 371 Hospital from January 2018 and June 2018, 45 patients with patellofemoral arthritis, aged 40 to 70, according to push has no conduct patellar manipulation treatment group, experimental group in 15 cases of random points, the blank group (A) (B) (C), treatment group, intra-articular injection of sodium hyaluronate of group A + patellar push technique treatment; In group B, standard oral dose of glucosamine hydrochloride and intra-articular injection of sodium hyaluronate were used. Group C was treated by standard oral administration of glucosamine hydrochloride and intra-articular injection of sodium hyaluronate + patellar internal push manipulation. After 6 months of follow-up, the observation indexes were compared. Through the establishment of relevant models and the analysis of relevant factors, X-ray and MRI were used to analyze the changes of lateral patella Angle, patella anastomosis Angle, and patella index and patella bone marrow edema volume before and after the treatment of patella internal push.
Results:
1. All patients in group A and group C received surgery successfully, and the average operation time, average bed rest time and average hospital stay in group A were all higher than that in group C. The follow-up period was more than 6 months.
2. All the patients in the treatment group showed significant relief of knee pain, and the VAS scores in the three groups decreased significantly 3 months after treatment and at the last follow-up compared with that before surgery, with statistically significant differences (P<0.05). Compared with group B, the differences in group A and C were statistically significant (P<0.05). The difference between group C and group A was statistically significant (P<0.05).
3. Knee joint function of all the patients was significantly improved, and Lysholm score and Kujala score of the three groups were significantly increased 3 months after treatment and at the last follow-up, with statistically significant differences (P<0.05). The differences between group A and group C and group B were statistically significant (P<0.05). The difference between group C and group A was statistically significant (P<0.05).
4. Imaging indexes of patellofemoral fitness Angle, patellar inclination Angle and patellar external displacement were significantly reduced in the three groups 3 months after treatment, with statistically significant differences (P<0.05). The differences between group A and group C and group B were statistically significant (P<0.05). The difference between group C and group A was statistically significant (P<0.05).
Conclusion:
Through this research, prevention and early diagnosis for patellar arthritis to provide image support, in the treatment of patellar push patellofemoral arthritis and patellofemoral instability, providing imaging solutions for more patients with patellofemoral arthritis to provide a safe, noninvasive, low price and simple treatment, delay the development of knee osteoarthritis, relieve pain in patients with knee joint. To provide a new treatment for patients with knee osteoarthritis, improve the quality of life of patients, reduce medical costs, and improve social and economic benefits.

Keywords: Patella osteoarthritis; Internal patellar push; Parameter variation; Imaging

目 錄
摘要    I
Abstract    III
1 前言    1
2 資料及方法    3
2.1 研究對象    3
2.2 納入與排除標準    3
2.2.1 納入標準    3
2.2.2 排除標準    3
2.3 病例分組    3
2.4 治療方法    4
2.5 觀察指標    4
2.6 統計學處理    5
3 結果    6
3.1 A組和C組手術的相關指標比較    6
3.2 三組患者治療前后的VAS評分比較    6
3.5 三組患者治療前后影像學測量結果比較    7
4 討論    9
5 結論    14
參考文獻    15
綜 述    19
致謝    29

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