前十字韧带疾病简介

前十字韧带疾病简介 前十字韧带疾病简介 前十字韧带是膝关节重要的前向稳定结构断裂后可以产生明显的膝关节不稳严重影响膝关节功能如果不及时治疗关节出现反复扭伤容易引起关节软骨半月板等重要结构的损害导致关节过早老化和骨关节病的发生 前十字韧带又称前交叉韧带位于膝关节内连接股骨与胫骨主要作用是限制胫骨向前过度移位它与膝关节内其他结构共同作用来维持膝关节的稳定性使人体能完成各种复杂和高难度的下肢动作解剖和生物力学特点决定了前十字韧带在人群分布损伤机制及合并损伤等方面显现出与其他膝关节损伤不同的疾病特征文献报道美国普通人群的前十字韧带断裂发病率约为/而足球运动员每年前十字韧带断裂的发生率为/万对我国现役运动员的普查发现前十字韧带断裂的发病率是% 疾病分类 急性(新鲜伤) 受伤时间在周以内的前十字韧带断裂; 亚急性 受伤时间在周到个月的前十字韧带断裂; 陈旧性 受伤时间在个月以上的前十字韧带断裂 发病原因 allied mechanical maintenance group, lawn maintenance, plant protection group. Establishment of conservation of garden plants in long sections, professional engineers, professional technicians and other related jobs. 1, the maintenance lead responsibilities (1) familiar with the Group's foundations of political thought, technology, culture, work attitudes, feelings and emotions, habits and other personal problems, easy to work. (2) before work, quality of work, requirements engineering, safety, mechanical equipment and some of the technical issues seriously disclosure to workers, and keep the information in writing. (3) when assigning production tasks to the workers, to implement safety measures, complete the task to do self-examination record. (4) section chiefs be vanguard of work, must step forward are familiar with the relevant business, work in the field, hard, dirty work, heavy work need to be at the head of work to do "before charge in and retreat." (5) pay attention to every team, every process of close cooperation and coordination, based on the situation as any, check "play clean" construction diaries and day information. (6) the community "active conservation, waste crimes", section chiefs be sure to lead the staff do thrift and combat waste. (7) for violation of construction laws, adverse quality, safety and engineering progress of unusual to have the courage to succeed, stop. (8) Unity is strength, section chief is the core of the conservation work, so modest. 2, professional engineer job description of garden plants (1) implement the national construction engineering quality and safety standards, norms and regulations, combined with engineering, development, implementing specific measures. (2) to process the project has overall responsibility for all technical work, their sacred responsibilities given to technical work, according to the technical requirements, serious research ... Groups and plant groups. Section with garden plant 前十字韧带断裂的主要原因是运动损伤约占%以上患病人数最多的项目是篮球和足球此外在从事柔道摔跤和田径的专业运动员中和在爱好滑雪羽毛球排球运动的普通人中前十字韧带断裂比较多见非运动损伤包括交通伤生产生活意外伤约占% 发病机制 有身体冲撞或者高速度的运动容易发生前十字韧带断裂常见的受伤机制包括屈膝外翻伤外旋伤过伸伤等常见的受伤动作例如足球运动中与对方球员对脚发生外翻伤篮球运动中带球过人时支撑腿膝关节发生急速扭转发生外旋伤投篮后单腿落地扭伤滑雪运动中高速下滑时滑板插入积雪运动员被绊倒发生过伸伤都容易导致前十字韧带损伤一些群众性运动例如拔河跳马跳箱等也容易出现前十字韧带损伤高能量的交通事故中的行人骑电动自行车跌倒或是一些体质弱的人不慎跌倒也可能导致前十字韧带损伤 病理生理 前十字韧带在解剖上为一根但因为一根当中的纤维在关节不同屈曲角度时松紧度不同可以分为大部分角度均紧张的前内束和接近伸直时紧张的后外束理论上单纯损伤一束称为部分断裂两束同时损伤称为完全断裂还有一种前十字韧带胫骨止点处连同骨一起撕起的称为髁间棘撕脱骨折实际上临床中很少见到真正的部分断裂最多见的是完全性断裂经过一定时间后粘连容易造成部分断裂的假象 临床表现 allied mechanical maintenance group, lawn maintenance, plant protection group. Establishment of conservation of garden plants in long sections, professional engineers, professional technicians and other related jobs. 1, the maintenance lead responsibilities (1) familiar with the Group's foundations of political thought, technology, culture, work attitudes, feelings and emotions, habits and other personal problems, easy to work. (2) before work, quality of work, requirements engineering, safety, mechanical equipment and some of the technical issues seriously disclosure to workers, and keep the information in writing. (3) when assigning production tasks to the workers, to implement safety measures, complete the task to do self-examination record. (4) section chiefs be vanguard of work, must step forward are familiar with the relevant business, work in the field, hard, dirty work, heavy work need to be at the head of work to do "before charge in and retreat." (5) pay attention to every team, every process of close cooperation and coordination, based on the situation as any, check "play clean" construction diaries and day information. (6) the community "active conservation, waste crimes", section chiefs be sure to lead the staff do thrift and combat waste. (7) for violation of construction laws, adverse quality, safety and engineering progress of unusual to have the courage to succeed, stop. (8) Unity is strength, section chief is the core of the conservation work, so modest. 2, professional engineer job description of garden plants (1) implement the national construction engineering quality and safety standards, norms and regulations, combined with engineering, development, implementing specific measures. (2) to process the project has overall responsibility for all technical work, their sacred responsibilities given to technical work, according to the technical requirements, serious research ... Groups and plant groups. Section with garden plant 好发群体 一岁以内的专业运动员-岁的非运动员; 二男性发生率约为女性的倍但运动员中女性发生率高于男性; 三一些特殊职业如军人舞蹈演员和杂技演员发病率高于一般人群 疾病症状 新鲜和陈旧性的前十字韧带断裂在临床表现上有所不同 新鲜前十字韧带断裂主要表现为: ()韧带撕裂时伴有撕裂声和关节错动感关节内出血导致关节肿胀疼痛多数不能继续从事原来的运动甚至伸直和过屈活动受限; ()查体时浮髌试验阳性Lachman检查松弛无抵抗; ()膝关节核磁检查提示:关节内积血前十字韧带肿胀或连续性中断可以看到残端股骨髁间窝外侧壁或股骨外髁后方和相对应的胫骨平台骨挫伤表现 " 陈旧性前十字韧带断裂主要表现为: ()关节松弛不稳患者在运动中有膝关节错动感或打软腿不能急停急转不能用患腿单腿支撑; ()运动中膝关节容易反复扭伤疼痛造成半月板损伤后甚至出现反复交锁; ()查体:Lachman检查松弛无抵抗前抽屉试验阳性; allied mechanical maintenance group, lawn maintenance, plant protection group. Establishment of conservation of garden plants in long sections, professional engineers, professional technicians and other related jobs. 1, the maintenance lead responsibilities (1) familiar with the Group's foundations of political thought, technology, culture, work attitudes, feelings and emotions, habits and other personal problems, easy to work. (2) before work, quality of work, requirements engineering, safety, mechanical equipment and some of the technical issues seriously disclosure to workers, and keep the information in writing. (3) when assigning production tasks to the workers, to implement safety measures, complete the task to do self-examination record. (4) section chiefs be vanguard of work, must step forward are familiar with the relevant business, work in the field, hard, dirty work, heavy work need to be at the head of work to do "before charge in and retreat." (5) pay attention to every team, every process of close cooperation and coordination, based on the situation as any, check "play clean" construction diaries and day information. (6) the community "active conservation, waste crimes", section chiefs be sure to lead the staff do thrift and combat waste. (7) for violation of construction laws, adverse quality, safety and engineering progress of unusual to have the courage to succeed, stop. (8) Unity is strength, section chief is the core of the conservation work, so modest. 2, professional engineer job description of garden plants (1) implement the national construction engineering quality and safety standards, norms and regulations, combined with engineering, development, implementing specific measures. (2) to process the project has overall responsibility for all technical work, their sacred responsibilities given to technical work, according to the technical requirements, serious research ... Groups and plant groups. Section with garden plant ()膝关节核磁检查提示:前十字韧带连续性中断可以看到残端股骨外髁和胫骨平台骨挫伤表现时间过久的韧带的形态消失出现骨质增生表现 ()KTKT可以定量检查膝关节前向移位的程度与对侧相比移动大于mm以上; ()反复扭伤的患者往往继发关节软骨和半月板损伤 鉴别诊断 后十字韧带断裂 往往也有明确的外伤史及伤后膝关节不稳的症状但后十字韧带断裂主要表现为膝关节后向不稳 ()交通事故多见后十字韧带断裂运动损伤中多见前十字韧带断裂; ()后十字韧带损伤导致轻度不稳的患者可以没有症状严重不稳的患者表现为关节疼痛下楼时打软腿有错动感; ()查体:后抽屉试验阳性胫骨结节塌陷; ()膝关节核磁检查提示:后十字韧带连续性中断 复发性髌骨脱位 多数有膝关节外旋外翻扭伤史与前十字韧带断裂类似急性期关节肿胀疼痛运动时有患膝不稳感 ()新鲜损伤患者表现为髌股内侧支持带肿胀疼痛; ()陈旧损伤患者表现为运动中反复髌股关节不稳脱膝感;严重的可以有髌前疼痛或膝关节交锁 allied mechanical maintenance group, lawn maintenance, plant protection group. Establishment of conservation of garden plants in long sections, professional engineers, professional technicians and other related jobs. 1, the maintenance lead responsibilities (1) familiar with the Group's foundations of political thought, technology, culture, work attitudes, feelings and emotions, habits and other personal problems, easy to work. (2) before work, quality of work, requirements engineering, safety, mechanical equipment and some of the technical issues seriously disclosure to workers, and keep the information in writing. (3) when assigning production tasks to the workers, to implement safety measures, complete the task to do self-examination record. (4) section chiefs be vanguard of work, must step forward are familiar with the relevant business, work in the field, hard, dirty work, heavy work need to be at the head of work to do "before charge in and retreat." (5) pay attention to every team, every process of close cooperation and coordination, based on the situation as any, check "play clean" construction diaries and day information. (6) the community "active conservation, waste crimes", section chiefs be sure to lead the staff do thrift and combat waste. (7) for violation of construction laws, adverse quality, safety and engineering progress of unusual to have the courage to succeed, stop. (8) Unity is strength, section chief is the core of the conservation work, so modest. 2, professional engineer job description of garden plants (1) implement the national construction engineering quality and safety standards, norms and regulations, combined with engineering, development, implementing specific measures. (2) to process the project has overall responsibility for all technical work, their sacred responsibilities given to technical work, according to the technical requirements, serious research ... Groups and plant groups. Section with garden plant ()查体:髌股内侧支持带松弛推髌恐惧试验阳性; ()膝关节影像学检查提示:髌骨内缘和股骨外髁外缘镜像骨软骨损伤或者存在膝关节游离体 疾病治疗 急性期处理 ()膝关节冰敷以便消肿止痛; ()关节制动必要时加压包扎减少再出血; ()如没有条件近期手术在肿痛减轻后进行膝关节活动度练习和下肢肌力练习; ()合并内侧副韧带损伤时要在损伤后天内限期行急诊手术治疗如果存在关节活动障碍的要在关节活动范围接近正常后再手术 " 手术治疗 前十字韧带完全断裂的最佳治疗方案是手术重建前十字韧带; ()手术的最佳时机是在术后三个月之内; ()关节镜下前十字韧带重建手术技术成熟创伤小恢复快; ()目前重建前十字韧带的手术方式包括:单束重建双束重建等;两种手术临床效果没有明显差异 ()重建前十字韧带可以选用的移植物包括:自体材料如腘绳肌腱自体髌腱等效果最佳如果多根韧带同时损伤可以考虑加用异体肌腱或人工韧带等; ()重建前十字韧带需要用到的固定材料包括:金属界面螺钉allied mechanical maintenance group, lawn maintenance, plant protection group. Establishment of conservation of garden plants in long sections, professional engineers, professional technicians and other related jobs. 1, the maintenance lead responsibilities (1) familiar with the Group's foundations of political thought, technology, culture, work attitudes, feelings and emotions, habits and other personal problems, easy to work. (2) before work, quality of work, requirements engineering, safety, mechanical equipment and some of the technical issues seriously disclosure to workers, and keep the information in writing. (3) when assigning production tasks to the workers, to implement safety measures, complete the task to do self-examination record. (4) section chiefs be vanguard of work, must step forward are familiar with the relevant business, work in the field, hard, dirty work, heavy work need to be at the head of work to do "before charge in and retreat." (5) pay attention to every team, every process of close cooperation and coordination, based on the situation as any, check "play clean" construction diaries and day information. (6) the community "active conservation, waste crimes", section chiefs be sure to lead the staff do thrift and combat waste. (7) for violation of construction laws, adverse quality, safety and engineering progress of unusual to have the courage to succeed, stop. (8) Unity is strength, section chief is the core of the conservation work, so modest. 2, professional engineer job description of garden plants (1) implement the national construction engineering quality and safety standards, norms and regulations, combined with engineering, development, implementing specific measures. (2) to process the project has overall responsibility for all technical work, their sacred responsibilities given to technical work, according to the technical requirements, serious research ... Groups and plant groups. Section with garden plant 可吸收界面螺钉EndoButtonIntrofix等; ()合并内侧副韧带损伤或半月板交锁时要限期行急诊手术治疗 疾病预防 ()技术动作;良好的体育道德不采用犯规动作 ()增加下肢肌肉力量练习和协调性练习; ()佩戴必要的比赛护具; ()保持场地灯光地面无安全隐患; ()防治疲劳训练和比赛 合并症 前十字韧带断裂后没有及时治疗或反复扭伤容易引发膝关节继发性损害 膝关节内外侧半月板损伤 半月板是膝关节内月牙形的纤维软骨位于胫骨与股骨形成的关节面之间增加了股骨髁和胫骨平台的接触面积从而增加了膝关节稳定性前十字韧带断裂后由于膝关节存在前向不稳特别是反复扭伤使半月板产生矛盾运动进而导致半月板的继发性损伤依据损伤类型不同可以分为纵裂横裂层裂和复合裂等 膝关节软骨损伤 长期不稳和反复扭伤导致膝关节内包括髌股关节软骨内外侧间室软骨发生退行性改变 骨赘形成和慢性滑膜炎 allied mechanical maintenance group, lawn maintenance, plant protection group. Establishment of conservation of garden plants in long sections, professional engineers, professional technicians and other related jobs. 1, the maintenance lead responsibilities (1) familiar with the Group's foundations of political thought, technology, culture, work attitudes, feelings and emotions, habits and other personal problems, easy to work. (2) before work, quality of work, requirements engineering, safety, mechanical equipment and some of the technical issues seriously disclosure to workers, and keep the information in writing. (3) when assigning production tasks to the workers, to implement safety measures, complete the task to do self-examination record. (4) section chiefs be vanguard of work, must step forward are familiar with the relevant business, work in the field, hard, dirty work, heavy work need to be at the head of work to do "before charge in and retreat." (5) pay attention to every team, every process of close cooperation and coordination, based on the situation as any, check "play clean" construction diaries and day information. (6) the community "active conservation, waste crimes", section chiefs be sure to lead the staff do thrift and combat waste. (7) for violation of construction laws, adverse quality, safety and engineering progress of unusual to have the courage to succeed, stop. (8) Unity is strength, section chief is the core of the conservation work, so modest. 2, professional engineer job description of garden plants (1) implement the national construction engineering quality and safety standards, norms and regulations, combined with engineering, development, implementing specific measures. (2) to process the project has overall responsibility for all technical work, their sacred responsibilities given to technical work, according to the technical requirements, serious research ... Groups and plant groups. Section with garden plant 膝关节退变的最终结果导致骨性关节炎的发生特别是在髁间窝 软骨边缘形成骨赘以及髁间棘增生 allied mechanical maintenance group, lawn maintenance, plant protection group. Establishment of conservation of garden plants in long sections, professional engineers, professional technicians and other related jobs. 1, the maintenance lead responsibilities (1) familiar with the Group's foundations of political thought, technology, culture, work attitudes, feelings and emotions, habits and other personal problems, easy to work. (2) before work, quality of work, requirements engineering, safety, mechanical equipment and some of the technical issues seriously disclosure to workers, and keep the information in writing. (3) when assigning production tasks to the workers, to implement safety measures, complete the task to do self-examination record. (4) section chiefs be vanguard of work, must step forward are familiar with the relevant business, work in the field, hard, dirty work, heavy work need to be at the head of work to do "before charge in and retreat." (5) pay attention to every team, every process of close cooperation and coordination, based on the situation as any, check "play clean" construction diaries and day information. (6) the community "active conservation, waste crimes", section chiefs be sure to lead the staff do thrift and combat waste. (7) for violation of construction laws, adverse quality, safety and engineering progress of unusual to have the courage to succeed, stop. (8) Unity is strength, section chief is the core of the conservation work, so modest. 2, professional engineer job description of garden plants (1) implement the national construction engineering quality and safety standards, norms and regulations, combined with engineering, development, implementing specific measures. (2) to process the project has overall responsibility for all technical work, their sacred responsibilities given to technical work, according to the technical requirements, serious research ... Groups and plant groups. Section with garden plant