常规康复结合强化本体感觉训练对运动所致膝关节前交叉韧带并半月板损伤患者术后康复效果的观察
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摘要
目的:探讨分析运动所致膝关节前交叉韧带并半月板损伤患者术后康复训练对临床疗效和预后的影响。方法:选取收治的178例运动所致膝关节前交叉韧带并半月板损伤患者进行研究分析,患者均采用高频超声、MRI诊断,关节镜手术治疗。根据术后康复训练方法的不同分为两组,每组89例。研究组采用常规及本体感觉强化康复训练,对照组采用常规康复训练。观察比较两组患者半月板损伤及处理的结果,采用Lysholm评分、IKDC评分评价膝关节功能恢复情况及安全性。结果:全部患者治疗后随访6～12月,研究组愈合时间为(2.16±1.05)月,对照组为(3.87±1.24)月,研究组短于对照组(P<0.05);研究组治疗前、治疗后6月、治疗后12月的IKDC评分分别为(40.38±8.12)分、(65.19±7.54)分、(84.15±6.78)分,Lysholm评分分别为(45.12±5.98)分、(72.38±6.26)分、(89.41±7.50)分;而对照组在此三个时间点的IKDC评分分别为(41.04±8.33)分、(54.06±7.82)分、(70.21±6.90)分,Lysholm评分分别为(45.67±6.44)分、(65.49±7.03)分、(76.35±6.82)分,研究组治疗后IKDC评分和Lysholm评分均小于对照组(P<0.05)。两组治疗后均无韧带断裂、关节粘连、滑膜炎等并发症。结论:运动所致膝关节前交叉韧带并半月板损伤患者术后采用常规康复训练结合强化本体感觉训练效果较佳,能有效减轻膝关节功能障碍,预后良好,适合临床推广。
Objective To investigate the effect of postoperative rehabilitation training on the clinical outcome and prognosis of patients with motion-induced anterior cruciate ligament(ACL) and meniscal injury. Methods A total of 178 patients with anterior cruciate ligament and meniscus injury caused by exercise in our hospital from April 2015 to September 2017 were enrolled. All patients underwent high-frequency ultrasound, MRI diagnosis and arthroscopic surgery. According to the different postoperative rehabilitation training methods, the patients were divided into study group(using conventional + proprioceptive intensive rehabilitation training) and control group(using conventional rehabilitation training), respectively, each group with 89 cases. The meniscus injury and treatment results, knee functionrecovery(using Lysholm score and IKDC score) and safety were compared between the two groups. Results After treatment, the patients were followed up for 6–12 months. The healing time of the study group and control group was(2.16±1.05) months and(3.87±1.24) months(P<0.05). The IKDC scores of the study group before and after 6 and 12 months of treatment were(40.38±8.12),(65.19±7.54) and(84.15±6.78), respectively. The IKDC scores of the control group before and after 6 and 12 months of treatment were(41.04±8.33),(54.06±7.82) and(70.21±6.90)(P<0.05). The Lysholm scores of the study group before and after 6 and 12 months of treatment were(45.12±5.98),(72.38±6.26) and(89.41±7.50), respectively. The Lysholm scores of the control group before and after 6 and 12 months of treatment were( 45. 67 ± 6. 44),( 65. 49 ± 7. 03) and( 76. 35 ± 6. 82), respectively(P < 0. 05). There were no complications such as ligament rupture, joint adhesion and synovitis after treatment in the study group and control group(P>0.05). Conclusion The routine rehabilitation training combined with enhanced proprioceptive training has better effect on patients with exercise-induced knee anterior cruciate ligament and meniscus injury, can effectively reduce knee dysfunction, with good prognosis, and is suitable for clinical promotion.
Objective To investigate the effect of postoperative rehabilitation training on the clinical outcome and prognosis of patients with motion-induced anterior cruciate ligament(ACL) and meniscal injury. Methods A total of 178 patients with anterior cruciate ligament and meniscus injury caused by exercise in our hospital from April 2015 to September 2017 were enrolled. All patients underwent high-frequency ultrasound, MRI diagnosis and arthroscopic surgery. According to the different postoperative rehabilitation training methods, the patients were divided into study group(using conventional + proprioceptive intensive rehabilitation training) and control group(using conventional rehabilitation training), respectively, each group with 89 cases. The meniscus injury and treatment results, knee functionrecovery(using Lysholm score and IKDC score) and safety were compared between the two groups. Results After treatment, the patients were followed up for 6–12 months. The healing time of the study group and control group was(2.16±1.05) months and(3.87±1.24) months(P<0.05). The IKDC scores of the study group before and after 6 and 12 months of treatment were(40.38±8.12),(65.19±7.54) and(84.15±6.78), respectively. The IKDC scores of the control group before and after 6 and 12 months of treatment were(41.04±8.33),(54.06±7.82) and(70.21±6.90)(P<0.05). The Lysholm scores of the study group before and after 6 and 12 months of treatment were(45.12±5.98),(72.38±6.26) and(89.41±7.50), respectively. The Lysholm scores of the control group before and after 6 and 12 months of treatment were( 45. 67 ± 6. 44),( 65. 49 ± 7. 03) and( 76. 35 ± 6. 82), respectively(P < 0. 05). There were no complications such as ligament rupture, joint adhesion and synovitis after treatment in the study group and control group(P>0.05). Conclusion The routine rehabilitation training combined with enhanced proprioceptive training has better effect on patients with exercise-induced knee anterior cruciate ligament and meniscus injury, can effectively reduce knee dysfunction, with good prognosis, and is suitable for clinical promotion.
引文
[1]Liu SH,Osti L,Henry M,et al.The diagnosis of acute complete tears of the anterior cruciate ligament.Comparison of MRI,arthrometry and clinical examination[J].J Bone Joint Surg,1995,77(4):586-588.
[2]Rangger C,Klestil T,Kathrein A,et al.Influence of Magnetic Resonance on Imaging on Indications for Arthroscopy of the Knee[J].Clin Orthop Relat Res,1996,(330):133-142.
[3]Voigt C,Schonaich M,Lil H.Anterior cruciate ligament reconstruction:state of the art[J].Eur J Trauma,2006,32(4):332-339.
[4]Asano H,Muneta T,Ikeda H,et al.Arthroscopic evalua tion of the articular cartilage after anterior cruciate ligament reconstruction:a short-term prospective study of 105 patients[J].Arthroscopy,2004,20(5):474-481.
[5]Tapper EM,Hoover NW.Late results after meniscectomy[J].JBone Joint Surg Am,1969,51(3):517-526.
[6]Andersson-Molina H,Karlsson H,Rockborn P.Arthroscopic partial and total meniscectomy:A long-term follow-up study with matched controls[J].Arthroscopy,2002,18(2):183-189.
[7]徐明义,闫栋,黄硕.系统康复训练对前交叉韧带重建术后膝关节功能恢复的影响[J].中国伤残医学,2017,25(16):32-34.
[8]邓致远.渐进式康复锻炼方法在前交叉韧带断裂合并半月板损伤关节镜术后的临床疗效观察[J].中西医结合心血管病电子杂志,2018,6(5):148-149.
[9]赵晓梅,黄耀渠,伍琼慧,等.2D与3D MR快速自旋回波序列对膝关节交叉韧带及半月板损伤的诊断价值比较[J].放射学实践,2017,32(1):73-78.
[10]宋洋,蒋欢,杜庆钧,等.关节镜下治疗膝关节前交叉韧带损伤合并内侧半月板ramp损伤的疗效观察[J].职业卫生与病伤,2016,31(6):366-368.
[11]闫金明.关节镜下修复重建前交叉韧带合并半月板损伤的临床效果分析[J].中国内镜杂志,2016,22(9):102-104.
[12]杨伟毅,潘建科,韩燕鸿,等.陈旧性前交叉韧带损伤诊治中需要注意的问题[J].中医正骨,2017,29(8):48-49.
[13]杨仙亮,张维康.膝关节前交叉韧带急性损伤早期关节镜下检查和手术治疗分析[J].检验医学,2016,7(9):174-175.
[14]刘心,冯华,洪雷,等.关节镜手术治疗稳定型内侧半月板ramp损伤的前瞻性随机对照研究[J].中华外科杂志,2017,55(3):161-165.
[15]李春江.膝关节内侧结构损伤早期镜下修复疗效浅析[J].中国药物与临床,2017,5(12):1832-1834.
[16]邵鸿,戴刚,李玉吉,等.关节镜下腓骨长肌腱重建后交叉韧带的疗效观察[J].天津医科大学学报,2017,23(2):171-173.
[2]Rangger C,Klestil T,Kathrein A,et al.Influence of Magnetic Resonance on Imaging on Indications for Arthroscopy of the Knee[J].Clin Orthop Relat Res,1996,(330):133-142.
[3]Voigt C,Schonaich M,Lil H.Anterior cruciate ligament reconstruction:state of the art[J].Eur J Trauma,2006,32(4):332-339.
[4]Asano H,Muneta T,Ikeda H,et al.Arthroscopic evalua tion of the articular cartilage after anterior cruciate ligament reconstruction:a short-term prospective study of 105 patients[J].Arthroscopy,2004,20(5):474-481.
[5]Tapper EM,Hoover NW.Late results after meniscectomy[J].JBone Joint Surg Am,1969,51(3):517-526.
[6]Andersson-Molina H,Karlsson H,Rockborn P.Arthroscopic partial and total meniscectomy:A long-term follow-up study with matched controls[J].Arthroscopy,2002,18(2):183-189.
[7]徐明义,闫栋,黄硕.系统康复训练对前交叉韧带重建术后膝关节功能恢复的影响[J].中国伤残医学,2017,25(16):32-34.
[8]邓致远.渐进式康复锻炼方法在前交叉韧带断裂合并半月板损伤关节镜术后的临床疗效观察[J].中西医结合心血管病电子杂志,2018,6(5):148-149.
[9]赵晓梅,黄耀渠,伍琼慧,等.2D与3D MR快速自旋回波序列对膝关节交叉韧带及半月板损伤的诊断价值比较[J].放射学实践,2017,32(1):73-78.
[10]宋洋,蒋欢,杜庆钧,等.关节镜下治疗膝关节前交叉韧带损伤合并内侧半月板ramp损伤的疗效观察[J].职业卫生与病伤,2016,31(6):366-368.
[11]闫金明.关节镜下修复重建前交叉韧带合并半月板损伤的临床效果分析[J].中国内镜杂志,2016,22(9):102-104.
[12]杨伟毅,潘建科,韩燕鸿,等.陈旧性前交叉韧带损伤诊治中需要注意的问题[J].中医正骨,2017,29(8):48-49.
[13]杨仙亮,张维康.膝关节前交叉韧带急性损伤早期关节镜下检查和手术治疗分析[J].检验医学,2016,7(9):174-175.
[14]刘心,冯华,洪雷,等.关节镜手术治疗稳定型内侧半月板ramp损伤的前瞻性随机对照研究[J].中华外科杂志,2017,55(3):161-165.
[15]李春江.膝关节内侧结构损伤早期镜下修复疗效浅析[J].中国药物与临床,2017,5(12):1832-1834.
[16]邵鸿,戴刚,李玉吉,等.关节镜下腓骨长肌腱重建后交叉韧带的疗效观察[J].天津医科大学学报,2017,23(2):171-173.