髌骨内推治疗髌股关节炎前后髌股关节相关参数变化的影像学研究(硕士)

髌骨内推治疗髌股关节炎前后髌股关节相关参数变化的影像学研究(硕士)(论文20000字)
摘 要
目的：
通过对比髌骨内推手法治疗髌股关节炎前后Q角的变化以及关节软骨的变化，为髌骨内推提供影像学支持；对髌股内推治疗前后髌股关节髌骨相关参数变化（外侧髌骨角、髌骨吻合角、髌骨指数）以及骨髓水肿容积变化规律及相关性研究，并对髌骨内推治疗髌股关节炎的临床研究进行推广应用。
方法：
收集解放军三七一中心医院2018年1月至2018年6月髌股关节炎患者45例，年龄从40至70岁，按有无行髌骨内推手法治疗进行分组，以15例为单位随机分实验组（A）、空白组（B）、治疗组（C），A组关节腔内注射玻璃酸钠+髌骨内推手法治疗；B组标准量口服盐酸氨基葡萄糖+关节腔内注射玻璃酸钠；C组标准量口服盐酸氨基葡萄糖、关节腔内注射玻璃酸钠+髌骨内推手法治疗。坚持随访6个月后，进行观察指标对比。通过建立相关模型，分析相关因素，应用X线、MRI分析髌骨内推治疗前后外侧髌骨角、髌骨吻合角、髌骨指数、髌骨骨髓水肿容积的变化规律。
结果：
1.A组和C组患者均顺利接受手术，其中A组平均手术时间、平均卧床时间和平均住院时间均高于C组。随访时间6个月以上。
2.治疗组所有患者膝前痛症状均明显缓解，三组治疗后3个月、末次随访时VAS评分较术前明显下降，差异具有统计学意义（P<0.05），A组、C组与B组相比，差异具有统计意义（P<0.05）。C组与A组相比，差异具有统计意义（P<0.05）。
3.所有患者膝关节功能均明显改善，三组患者治疗后3个月、末次随访时Lysholm评分、Kujala评分较术前明显增高，差异有统计学意义（P<0.05）。A组、C组与B组相比，差异具有统计意义（P<0.05）。C组与A组相比，差异具有统计意义（P<0.05）。
4.三组患者治疗后3个月影像学指标髌股吻合角、髌骨倾斜角和髌骨外移测量结果较治疗前显著减小，差异具有统计学意义（P<0.05）。A组、C组与B组相比，差异具有统计意义（P<0.05）。C组与A组相比，差异具有统计意义（P<0.05）。
结论：
通过本研究，为髌股关节炎的早期预防和诊断提供影像支持，为髌骨内推治疗髌股关节炎及髌股不稳提供影像检查方案，为更多髌股关节炎患者提供安全、无创、低价且简便的治疗方案，延缓膝骨关节炎的发展，减轻患者膝关节疼痛。为膝骨关节炎患者提供一种崭新的治疗方案，提高患者的生活质量，减少医疗费用，提高社会经济效益。
关键词：髌股关节炎；髌骨内推；参数变化；影像学

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 录
摘要    I
Abstract    III
1 前言    1
2 资料及方法    3
2.1 研究对象    3
2.2 纳入与排除标准    3
2.2.1 纳入标准    3
2.2.2 排除标准    3
2.3 病例分组    3
2.4 治疗方法    4
2.5 观察指标    4
2.6 统计学处理    5
3 结果    6
3.1 A组和C组手术的相关指标比较    6
3.2 三组患者治疗前后的VAS评分比较    6
3.5 三组患者治疗前后影像学测量结果比较    7
4 讨论    9
5 结论    14
参考文献    15
综 述    19
致谢    29