本文選題：前交叉韌帶重建(ACLR)　切入點：磁共振成像(MRI)　出處：《廣西醫科大學》2017年碩士論文

【摘要】：背景:前交叉韌帶斷裂是一種常見的損傷,在美國每年大約有250000人發病。ACL損傷導致嚴重功能障礙[1]。在這個運動醫學時代,ACL重建對病人生活質量起著至關重要的作用。事實證明,ACL撕裂不能采取保守治療讓它自己修復。而ACL重建被認為是治療ACL撕裂的標準手術方式。在評價ACL移植物完整性和診斷ACL撕裂的并發癥上MRI起著重要作用。首次ACL重建后的復發性不穩發病率為3%到10%。移植物失敗是復發性不穩最重要的原因[27]。由于乆繩肌自身的生物力學特性,它被用于移植物的首選,而乆繩肌自體移植較自身的ACL有更強大的抗拉載荷、剛度和橫截面積。目的:評估4束和5束半腱肌、股薄肌自體移植物行膝關節前交叉韌帶重建術后的MRI表現,比較兩者之間的不同。方法:回顧從2015年1月至2016年12月之間ACL重建術后的40例患者的MRI。將ACL重建患者分為兩組:A組和B組.A組20例用5束自體半腱肌、股薄肌移植,B組20例用4束自體半腱肌、股薄肌移植。進行MRI評價,包括移植物撕裂、移植物強度、移植物信號、移植物粗細、移植物不連續、骨道位置和后交叉韌帶的過度屈曲。術后隨訪1個月,3個月和6個月時行MRI檢查。結果:對40例病人進行的研究。在這項研究中,我們分為兩組:20例用5束自體半腱肌、股薄肌移植,20例用4束自體半腱肌、股薄肌移植。A組和B組的平均年齡是29.85歲和31.3歲,不分性別。兩組比較點為術后6個月移植物信號、移植物強度。A組和B組患者的移植物強度、信號在MRI評估上的差異有統計學意義,但其他觀察指標在1月、3月、6月的MRI評估上都一致而移植物纖維連續性和完整的移植物厚度是診斷移植物完好的最有價值的征象義。完全不連續的移植物在診斷完全撕裂上非常有價值而移植物局部薄弱正像在診斷部分撕裂上有價值。結論:4束和5束半腱肌、股薄肌自體移植物行膝關節前交叉韌帶重建術后的兩組病人,MRI評估兩者的差異沒有統計學意義。4束和5束半腱肌、股薄肌自體移植物完全可以滿足ACL重建的需求。
[Abstract]:Background: anterior cruciate ligament rupture (ACL) is a common injury. In the United States, about 250000 people suffer from ACL injury every year, which results in severe dysfunction [1].In this era of sports medicine, ACL reconstruction plays a vital role in the quality of life of patients.It turns out that ACL tears cannot be treated conservatively to repair them themselves.ACL reconstruction is considered to be the standard procedure for the treatment of ACL tears.MRI plays an important role in evaluating the integrity of ACL grafts and in diagnosing the complications of ACL laceration.The incidence of recurrent instability after first ACL reconstruction ranged from 3% to 10%.Graft failure is the most important cause of recurrent instability [27].Because of the biomechanical characteristics of the human chorda muscle, it is the first choice for grafts, while the human chorda autograft has a stronger tensile load, stiffness and cross-sectional area than its own ACL.Aim: to evaluate the MRI findings of 4 and 5 semitendinosus and thin femoral muscle autografts after anterior cruciate ligament reconstruction (ACL) reconstruction.Methods: 40 patients after ACL reconstruction from January 2015 to December 2016 were reviewed.The patients with ACL reconstruction were divided into two groups: group A (n = 20) and group B. Group A (n = 20) were treated with autologous semitendinosus (group A) and group B (group B) were transplanted with autogenous semitendinosus (group B).MRI evaluation was performed, including graft tear, graft intensity, graft signal, graft thickness, graft discontinuity, osseous location and overflexion of posterior cruciate ligament.All patients were followed up for 1 month, 3 months and 6 months for MRI examination.Results: 40 patients were studied.In this study, we were divided into two groups: 20 cases were treated with 5 bands of autogenous semitendinosus, 20 cases with thin femoral muscle were transplanted with 4 bundle of autologous semitendinosus, the average age of group A and group B were 29.85 years and 31.3 years, regardless of sex.The graft intensity of patients in group A and group B was significantly different from that in group A and group B, and the difference in MRI evaluation between the two groups was statistically significant.But other observational indicators were consistent in MRI evaluation in January, March and June. The continuity of plant fibers and the complete thickness of the graft were the most valuable signs for the diagnosis of graft integrity.Completely discontinuous grafts are of great value in the diagnosis of complete laceration and weak grafts are just as valuable in diagnosing partial laceration.Conclusion there was no significant difference in MRI evaluation between the two groups after anterior cruciate ligament reconstruction (ACL) reconstruction. There was no significant difference between the two groups in assessing the semitendinosus muscle by MRI. There was no significant difference between the two groups in the evaluation of the semitendinosus muscle in the 4th bundle and the 5th bundle.The thin femoral muscle autograft can completely meet the need of ACL reconstruction.
【學位授予單位】：廣西醫科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.4

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