关节镜微创手术结合术后功能锻炼对膝关节脱位失稳性的疗效价值分析
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摘要
目的:探讨一期行关节镜下前后交叉韧带重建手术后结合临床专业膝关节功能锻炼对膝关节脱位(knee joint dislocation,KD)失稳性患者的临床疗效与价值。方法:回顾性分析2012年6月-2015年6月在东莞石碣医院及广州市第一人民医院就诊的KD失稳性患者60例的临床资料,均行一期关节镜前后交叉韧带重建+有限切开修复/重建侧副韧带手术治疗,其中30例采取术后常规恢复为对照组;另外30例在对照组基础上采取术后专业膝关节功能锻炼恢复为研究组。比较两组术后恢复情况,术前及术后的膝关节活动度,术后IKDC2000膝关节主观功能评级及生活质量评分。结果:两组术后切口愈合良好且均无术后感染、并发症发生;术后12个月随访中,对照组出现间歇膝关节疼痛现象8例(26.7%),但不影响日常生活,多于研究组的2例(6.7%),比较差异有统计学意义(x~2=4.320,P=0.038);术后1、3、6、12个月,研究组膝关节活动度均大于对照组,比较差异均有统计学意义(P<0.05);术后3、6、12个月,研究组IKDC2000优良率均高于对照组,比较差异均有统计学意义(P<0.05);术后12个月,研究组各项生活质量评分均高于对照组,比较差异均有统计学意义(P<0.05)。结论:一期关节镜下前后交叉韧带重建+有限切开修复/重建侧副韧带手术具有创伤小、恢复快、并发症少的临床优点,能够减轻患者手术痛苦、快速恢复出院。同时,术后及时给予专业膝关节功能锻炼可明显改善患者膝关节功能的恢复,有效保证患者关节稳定性,为患者带来长久的手术预后效果,值得临床推广。
Objective:To explore the clinical effect and value of one stage arthroscopic anterior cruciate ligament reconstruction combined with clinical professional knee function exercise for instability of knee joint dislocation(KD).Method:The clinical data of 60 cases of KD instability in Dongguan Shijie Hospital and Guangzhou No.1 People's Hospital from June 2012 to June 2015 were retrospectively analyzed.They were treated with one stage arthroscopic anterior and posterior cruciate ligament reconstruction+limited incision repair/reconstruction of collateral ligament surgery,30 of them were taken routine postoperative recovery as control group and the other 30 patients received postoperative functional rehabilitation of professional knee joint on basis of control group as research group.The postoperative recovery,preoperative and postoperative knee motion,postoperative IKDC2000 knee subjective function rating and quality of life score in two groups were compared.Result:They healed well after operation,and no postoperative infection or complications occurred,during the 12 month followup,8 cases(26.7%) had intermittent knee pain in control group,but it did not affect the daily life,which was more than 2 cases(6.7%) of study group,the difference was statistically significant( x~2=4.320,P=0.038).After operation 1,3,6 and 12 months,the range of motion of knee joint in study group were larger than those of control group,the differences were statistically significant(P<0.05).After operation 3,6 and 12 months,the excellent and good rate of IKDC2000 in study group were higher than those of control group,the differences were statistically significant(P<0.05).After operation 12 months,the each score of life quality in study group were all higher than those of control group,the differences were statistically significant(P<0.05).Conclusion:One stage arthroscopic anterior and posterior cruciate ligament reconstruction+limited incision repair/reconstruction of collateral ligament surgery has the advantages of less trauma,quicker recovery and fewer complications,can relieve pain and recover quickly.At the same time,timely postoperative professional knee joint functional exercise can significantly improve the recovery of knee function,effectively ensure the stability of patients' joints,bring long-term surgical prognosis for patients,and is worthy of clinical promotion.
Objective:To explore the clinical effect and value of one stage arthroscopic anterior cruciate ligament reconstruction combined with clinical professional knee function exercise for instability of knee joint dislocation(KD).Method:The clinical data of 60 cases of KD instability in Dongguan Shijie Hospital and Guangzhou No.1 People's Hospital from June 2012 to June 2015 were retrospectively analyzed.They were treated with one stage arthroscopic anterior and posterior cruciate ligament reconstruction+limited incision repair/reconstruction of collateral ligament surgery,30 of them were taken routine postoperative recovery as control group and the other 30 patients received postoperative functional rehabilitation of professional knee joint on basis of control group as research group.The postoperative recovery,preoperative and postoperative knee motion,postoperative IKDC2000 knee subjective function rating and quality of life score in two groups were compared.Result:They healed well after operation,and no postoperative infection or complications occurred,during the 12 month followup,8 cases(26.7%) had intermittent knee pain in control group,but it did not affect the daily life,which was more than 2 cases(6.7%) of study group,the difference was statistically significant( x~2=4.320,P=0.038).After operation 1,3,6 and 12 months,the range of motion of knee joint in study group were larger than those of control group,the differences were statistically significant(P<0.05).After operation 3,6 and 12 months,the excellent and good rate of IKDC2000 in study group were higher than those of control group,the differences were statistically significant(P<0.05).After operation 12 months,the each score of life quality in study group were all higher than those of control group,the differences were statistically significant(P<0.05).Conclusion:One stage arthroscopic anterior and posterior cruciate ligament reconstruction+limited incision repair/reconstruction of collateral ligament surgery has the advantages of less trauma,quicker recovery and fewer complications,can relieve pain and recover quickly.At the same time,timely postoperative professional knee joint functional exercise can significantly improve the recovery of knee function,effectively ensure the stability of patients' joints,bring long-term surgical prognosis for patients,and is worthy of clinical promotion.
引文
[1]李进取,王文波.膝关节脱位多韧带损伤临床研究进展[J].国际骨科学杂志,2012,33(4):254-257.
[2]席刚,张民,王祥猛.膝关节多韧带损伤研究进展[J].实用骨科杂志,2015,21(6):525-529.
[3]黄华强,李箭,唐新.膝关节脱位后内侧结构及后外侧角损伤分期分型及诊治体系[J]中国修复重建外科杂志,2017,31(5):614-619.
[4]于海洋,翟云雷,吴昊.关节镜下治疗各型膝关节脱位的中期疗效评价[J].中华解剖与临床杂志,2014,19(2):138-142.
[5]宋晓斌,谢喜波,林立楷,等.膝关节镜下行膝关节交叉韧带重建修复的临床效果观察[J].中国医学创新,2015,12(22):29-31.
[6]谢金元,王志烈,王军海,等.外伤性膝关节脱位临床治疗分析[J].实用骨科杂志,2013,19(2):183-185.
[7]张现超,任栋,王鹏程.膝关节内侧副韧带损伤的临床治疗及研究进展[J].河北医科大学学报,2016,37(1):119-121.
[8]袁志坤,罗鹰,吴小杭,等.一期修复膝关节韧带损伤功能重建术后康复锻炼效果观察[J].海南医学,2017,28(14):2366-2368.
[9]周春英,鲁楠,张爽,等.膝关节脱位患者行韧带重建术的围术期护理[J].解放军护理杂志,2013,30(24):56-58.
[10]龚亚莉,罗毅,陈宏,等.关节镜下前交叉韧带重建的围术期护理和康复训练[J].临床合理用药杂志,2016,9(19):49-51.
[11]熊道海,李玥莹,张云.前交叉韧带重建术后康复治疗中开链与闭链运动的效果观察[J].南京医科大学学报(自然科学版),2013,33(7):994-998.
[12]邹庆,赵新华,钱金黔.创伤性膝关节脱位伴多发韧带损伤的早期手术修复重建[J].临床军医杂志,2014,42(12):1263-1265.
[13]Tocci S L,Heard W M,Fadale P D,et al.Magnetic resonance angiography for the evaluation of vascular injury in knee dislocations[J].J Knee Surg,2010,23(4):201-207.
[14]孙业东,王仁鹏.分期治疗外伤性膝关节脱位合并多韧带损伤的临床观察[J].中国现代药物应用,2016,10(11):66-67.
[15]陈朗新,黄华扬,李宝丰,等.分期微创治疗膝关节多韧带损伤的疗效观察[J].中国骨科临床与基础研究杂志,2013,5(5):290-293.
[16]孙正宇,张承昊,唐新,等.一期修复重建膝关节脱位多发韧带损伤的疗效观察[J].中国修复重建外科杂志,2016,30(6):690-694.
[17]宋航,肖洪,任小宝.一期手术重建治疗膝关节脱位合并多发韧带损伤[J].第三军医大学学报,2012,34(16):1685-1687.
[18]谢杰,徐斌,涂俊.一期和分期多组韧带重建术治疗外伤性膝关节脱位临床效果比较[J].山东医药,2016,56(48):44-46.
[19]皇甫小桥,赵金忠,何耀华,等.膝关节多发韧带损伤的修复与重建[J].中华骨科杂志,2011,31(2):164-168.
[20]罗育润,叶少腾.膝关节镜下不同前交叉韧带重建方式对膝关节功能的影响[J].中国医学创新,2016,13(21):43-46.
[21]张林.交叉韧带重建术后实施系统康复治疗对促进患者膝关节功能恢复的作用[J].中国医学创新,2017,14(3):96-99.
[2]席刚,张民,王祥猛.膝关节多韧带损伤研究进展[J].实用骨科杂志,2015,21(6):525-529.
[3]黄华强,李箭,唐新.膝关节脱位后内侧结构及后外侧角损伤分期分型及诊治体系[J]中国修复重建外科杂志,2017,31(5):614-619.
[4]于海洋,翟云雷,吴昊.关节镜下治疗各型膝关节脱位的中期疗效评价[J].中华解剖与临床杂志,2014,19(2):138-142.
[5]宋晓斌,谢喜波,林立楷,等.膝关节镜下行膝关节交叉韧带重建修复的临床效果观察[J].中国医学创新,2015,12(22):29-31.
[6]谢金元,王志烈,王军海,等.外伤性膝关节脱位临床治疗分析[J].实用骨科杂志,2013,19(2):183-185.
[7]张现超,任栋,王鹏程.膝关节内侧副韧带损伤的临床治疗及研究进展[J].河北医科大学学报,2016,37(1):119-121.
[8]袁志坤,罗鹰,吴小杭,等.一期修复膝关节韧带损伤功能重建术后康复锻炼效果观察[J].海南医学,2017,28(14):2366-2368.
[9]周春英,鲁楠,张爽,等.膝关节脱位患者行韧带重建术的围术期护理[J].解放军护理杂志,2013,30(24):56-58.
[10]龚亚莉,罗毅,陈宏,等.关节镜下前交叉韧带重建的围术期护理和康复训练[J].临床合理用药杂志,2016,9(19):49-51.
[11]熊道海,李玥莹,张云.前交叉韧带重建术后康复治疗中开链与闭链运动的效果观察[J].南京医科大学学报(自然科学版),2013,33(7):994-998.
[12]邹庆,赵新华,钱金黔.创伤性膝关节脱位伴多发韧带损伤的早期手术修复重建[J].临床军医杂志,2014,42(12):1263-1265.
[13]Tocci S L,Heard W M,Fadale P D,et al.Magnetic resonance angiography for the evaluation of vascular injury in knee dislocations[J].J Knee Surg,2010,23(4):201-207.
[14]孙业东,王仁鹏.分期治疗外伤性膝关节脱位合并多韧带损伤的临床观察[J].中国现代药物应用,2016,10(11):66-67.
[15]陈朗新,黄华扬,李宝丰,等.分期微创治疗膝关节多韧带损伤的疗效观察[J].中国骨科临床与基础研究杂志,2013,5(5):290-293.
[16]孙正宇,张承昊,唐新,等.一期修复重建膝关节脱位多发韧带损伤的疗效观察[J].中国修复重建外科杂志,2016,30(6):690-694.
[17]宋航,肖洪,任小宝.一期手术重建治疗膝关节脱位合并多发韧带损伤[J].第三军医大学学报,2012,34(16):1685-1687.
[18]谢杰,徐斌,涂俊.一期和分期多组韧带重建术治疗外伤性膝关节脱位临床效果比较[J].山东医药,2016,56(48):44-46.
[19]皇甫小桥,赵金忠,何耀华,等.膝关节多发韧带损伤的修复与重建[J].中华骨科杂志,2011,31(2):164-168.
[20]罗育润,叶少腾.膝关节镜下不同前交叉韧带重建方式对膝关节功能的影响[J].中国医学创新,2016,13(21):43-46.
[21]张林.交叉韧带重建术后实施系统康复治疗对促进患者膝关节功能恢复的作用[J].中国医学创新,2017,14(3):96-99.