中医配合锻炼在关节镜前交叉韧带重建术后的应用
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摘要
目的:评价早期中医疗法配合渐进式康复运动锻炼对关节镜前交叉韧带重建术后膝关节功能恢复的作用。方法:将70例前交叉韧带损伤患者随机分为治疗组和对照组各35例,对照组行关节镜术后给予渐进式康复运动锻炼,治疗组在对照组基础上给予中药内服、针刺,3个月为1疗程,并随访12个月。分别采用Lysholm膝关节功能评分、VAS评分、Lachman试验、主动伸膝角度(AAKE)及等速肌力测试,观察术后3月、6月膝关节功能,并进行对比分析。结果:治疗组术后3月和6月Lysholm评分分别为(68.76±5.2)分、(83.78±8.52)分,均明显高于对照组[分别为(54.62±4.57)分、(72.16±7.33)分,P<0.05];治疗组术后3月和术后6月VAS评分分别为(2.05±0.34)分、(1.98±0.22)分,均明显低于对照组[分别为(2.67±0.45)分、(2.24±0.31)分,P<0.05];治疗组术后3月和术后6月Lachman试验值分别为(2.01±0.31)mm、(1.75±0.06)mm,均低于对照组值[分别为(2.36±0.42)mm、(2.05±0.08)mm,P<0.05];治疗组术后3月和术后6月AAKE分别为(–1.84±0.82)°、(–0.57±0.12)°,均明显低于对照组[分别为(–2.06±0.87)°、(–0.84±0.21)°,P<0.05]。结论:早期中医介入配合渐进式康复运动锻炼,能够明显改善膝关节功能及维持膝关节稳定性,安全性高,其可能的机制为增加腘绳肌等屈膝肌力。
Objective To evaluate the clinical curative effect of early intervention with traditional Chinese medicine(TCM) combined with progressive rehabilitation exercise on the functional recovery of knee joint after anterior cruciate ligament reconstruction under arthroscope, and explore the mechanism. Methods In this study, 70 patients selected according to the inclusion criteria were randomly divided into treatment group and control group, 35 cases in each group. The patients in control group were given progressive rehabilitation exercise after arthroscopic surgery, and the patients in treatment group were given internal medicine and acupuncture on the basis of the control group, 3 months for one course and they were followed up for 12 months. Lysholm knee function score, VAS score, Lachman test, AAKE test and isokinetic muscle strength test were used to observe the knee function after 3 months and 6 months of surgery, and comparative analysis was conducted.Results Lysholm scores in the treatment group after 3 months and 6 months of surgery were(68.76±5.2) and(83.78±8.52) score, which were higher than those of the control group [(54.62 ±4.57) and(72.16±7.33)score](P<0.05); VAS scores in the treatment group after 3 months and 6 months of surgery were(2.05±0.34)and(1.98±0.22) score, which were lower than those of the control group [(2.67 ±0.45) and(2.24±0.31)score](P < 0. 05); Lachman test values in the treatment group after 3 months and 6 months of surgery were[(2.01±0.31) and(1.75±0.06) mm, which were lower than those of the control group [(2.36±0.42) and(2.05±0.08) mm](P<0.05); AAKE in the treatment group after 3 months and 6 months of surgery were(– 1. 84 ± 0.82)? and(–0.57 ± 0.12)?, which were lower than those of the control group [(–2.06±0.87)?and(–0.84±0.21)?](P<0.05). Conclusion The early intervention using TCM combined with progressive rehabilitation exercise can improve knee function and maintain knee stability obviously, with high safety and worthy of clinical promotion, and the possible mechanism is to increase the knee muscle strength such as hamstring muscle.
Objective To evaluate the clinical curative effect of early intervention with traditional Chinese medicine(TCM) combined with progressive rehabilitation exercise on the functional recovery of knee joint after anterior cruciate ligament reconstruction under arthroscope, and explore the mechanism. Methods In this study, 70 patients selected according to the inclusion criteria were randomly divided into treatment group and control group, 35 cases in each group. The patients in control group were given progressive rehabilitation exercise after arthroscopic surgery, and the patients in treatment group were given internal medicine and acupuncture on the basis of the control group, 3 months for one course and they were followed up for 12 months. Lysholm knee function score, VAS score, Lachman test, AAKE test and isokinetic muscle strength test were used to observe the knee function after 3 months and 6 months of surgery, and comparative analysis was conducted.Results Lysholm scores in the treatment group after 3 months and 6 months of surgery were(68.76±5.2) and(83.78±8.52) score, which were higher than those of the control group [(54.62 ±4.57) and(72.16±7.33)score](P<0.05); VAS scores in the treatment group after 3 months and 6 months of surgery were(2.05±0.34)and(1.98±0.22) score, which were lower than those of the control group [(2.67 ±0.45) and(2.24±0.31)score](P < 0. 05); Lachman test values in the treatment group after 3 months and 6 months of surgery were[(2.01±0.31) and(1.75±0.06) mm, which were lower than those of the control group [(2.36±0.42) and(2.05±0.08) mm](P<0.05); AAKE in the treatment group after 3 months and 6 months of surgery were(– 1. 84 ± 0.82)? and(–0.57 ± 0.12)?, which were lower than those of the control group [(–2.06±0.87)?and(–0.84±0.21)?](P<0.05). Conclusion The early intervention using TCM combined with progressive rehabilitation exercise can improve knee function and maintain knee stability obviously, with high safety and worthy of clinical promotion, and the possible mechanism is to increase the knee muscle strength such as hamstring muscle.
引文
[1]Lecoq FA,Parienti JJ,Murison J,et al.Graft Choice and the Incidence of Osteoarthritis after Anterior Cruciate Ligament Reconstruction:A Causal Analysis from a Cohort of 541Patients[J].Am J Sports Med,2018,9(10):185-189.
[2]Luetkemeyer CM,Marchi BC,Ashton-Miller JA.Femoral entheseal shape and attachment angle as potential risk factors for anterior cruciate ligament injury[J].J Mech Behav Biomed Mater,2018,88:313-321.
[3]Zhang Q,Kou Y.Ameta-analysis on anterior cruciate ligament reconstruction:Is modified transtibial technique inferior to independent drilling techniques[J]?Exp Ther Med,2018,16(3):1790-1799.
[4]傅涛,吴鹏,赵林梁,等.前交叉韧带重建后移植物愈合和功能恢复:康复训练个案观察[J].中国组织工程研究,2018,22(2):281-287.
[5]Nayak M,Nag HL,Gaba S,et al.Quantitative correlation of mechanoreceptors in tibial remnant of ruptured human anterior cruciate ligament with duration of injury and its significance:an immunohistochemistry-based observational study[J].J Orthop Traumatol,2018,19(1):1-6.
[6]闵重函,周瑛,荆琳,等.手法加中药熏蒸对前交叉韧带断裂重建术后膝关节功能康复的病例对照研究[J].中国骨伤,2016,29(5):397-403.
[7]田麦久,刘大庆.运动训练学[M].北京:人民体育出版社,2012:36-38.
[8]Eggli S,Kohlhof H,Zumstein M,et al.Dynamic intraligamentary stabilization:novel technique for preserving the ruptured ACL[J].Knee Surg Sports Traumatol Arthrosc,2015,23(4):1215-1221.
[9]Lysholm J,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J].Am J Sports Med,1982,10(3):150-154.
[10]章闻捷,叶祥明,张大威,等.腘绳肌等速离心训练对前交叉韧带重建术后膝关节功能的影响[J].中国运动医学杂志,2017,36(9):805-809.
[11]Eggerding V,van Kuijk KS,van Meer BL,et al.Knee shape might predict clinical outcome after an anterior cruciate ligament rupture[J].Bone Joint J,2014,96-B(6):737-742.
[12]向珊珊,傅明,张志奇,等.关节镜下自体或同种异体肌腱移植修复急性和陈旧性前交叉韧带损伤:重建效果评价[J].中国组织工程研究,2018,22(26):4174-4178.
[13]李珂珂,曹曼林.前交叉韧带重建术后的下肢运动学和动力学改变[J].重庆医学,2017,46(34):4860-4862.
[14]Kim Y,Lee BH,Mekuria K,et al.Registration accuracy enhancement of a surgical navigation system for anterior cruciate ligament reconstruction:A phantom and cadaveric study[J].Knee,2017,24(2):329-339.
[15]Magnussen RA,Reinke EK,Huston LJ,et al.Effect of HighGrade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes[J].Am J Sports Med,2016,44(12):3077-3082.
[16]林砚铭.中药熏洗配合康复训练在前交叉韧带重建术后关节功能恢复中的疗效观察[J].四川中医,2017,35(4):147-148.
[17]李嘉祥,黄中强.中药内服外用对关节镜下膝前交叉韧带重建术后早期康复的影响[J].长春中医药大学学报,2017,33(2):292-295.
[18]程桯,王强,周进,等.内服中药促进半月板损伤术后关节功能康复的临床研究[J].中国中医骨伤科杂志,2015,23(10):27-30.
[19]潘孝云,温宏,刘忠堂,等.针刺在治疗膝关节前交叉韧带断裂中的应用[J].中医正骨,2012,24(11):11-13.
[20]李建超,张庆超.益气补肾中药口服、电针联合功能锻炼防治膝关节前交叉韧带重建术后股四头肌萎缩[J].中医正骨,2017,29(8):63-64,67.
[21]刘素云,饶冬霞,罗燕萍.渐进式功能锻炼对膝关节镜术后患肢功能恢复的影响[J].南昌大学学报(医学版),2010,50(10):103-104.
[22]王韵廷,葛茶娜,黎飞猛,等.自体腘绳肌腱与LARS人工韧带重建前交叉韧带临床疗效的荟萃分析[J].中国矫形外科杂志,2017,25(12):1108-1112.
[2]Luetkemeyer CM,Marchi BC,Ashton-Miller JA.Femoral entheseal shape and attachment angle as potential risk factors for anterior cruciate ligament injury[J].J Mech Behav Biomed Mater,2018,88:313-321.
[3]Zhang Q,Kou Y.Ameta-analysis on anterior cruciate ligament reconstruction:Is modified transtibial technique inferior to independent drilling techniques[J]?Exp Ther Med,2018,16(3):1790-1799.
[4]傅涛,吴鹏,赵林梁,等.前交叉韧带重建后移植物愈合和功能恢复:康复训练个案观察[J].中国组织工程研究,2018,22(2):281-287.
[5]Nayak M,Nag HL,Gaba S,et al.Quantitative correlation of mechanoreceptors in tibial remnant of ruptured human anterior cruciate ligament with duration of injury and its significance:an immunohistochemistry-based observational study[J].J Orthop Traumatol,2018,19(1):1-6.
[6]闵重函,周瑛,荆琳,等.手法加中药熏蒸对前交叉韧带断裂重建术后膝关节功能康复的病例对照研究[J].中国骨伤,2016,29(5):397-403.
[7]田麦久,刘大庆.运动训练学[M].北京:人民体育出版社,2012:36-38.
[8]Eggli S,Kohlhof H,Zumstein M,et al.Dynamic intraligamentary stabilization:novel technique for preserving the ruptured ACL[J].Knee Surg Sports Traumatol Arthrosc,2015,23(4):1215-1221.
[9]Lysholm J,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J].Am J Sports Med,1982,10(3):150-154.
[10]章闻捷,叶祥明,张大威,等.腘绳肌等速离心训练对前交叉韧带重建术后膝关节功能的影响[J].中国运动医学杂志,2017,36(9):805-809.
[11]Eggerding V,van Kuijk KS,van Meer BL,et al.Knee shape might predict clinical outcome after an anterior cruciate ligament rupture[J].Bone Joint J,2014,96-B(6):737-742.
[12]向珊珊,傅明,张志奇,等.关节镜下自体或同种异体肌腱移植修复急性和陈旧性前交叉韧带损伤:重建效果评价[J].中国组织工程研究,2018,22(26):4174-4178.
[13]李珂珂,曹曼林.前交叉韧带重建术后的下肢运动学和动力学改变[J].重庆医学,2017,46(34):4860-4862.
[14]Kim Y,Lee BH,Mekuria K,et al.Registration accuracy enhancement of a surgical navigation system for anterior cruciate ligament reconstruction:A phantom and cadaveric study[J].Knee,2017,24(2):329-339.
[15]Magnussen RA,Reinke EK,Huston LJ,et al.Effect of HighGrade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes[J].Am J Sports Med,2016,44(12):3077-3082.
[16]林砚铭.中药熏洗配合康复训练在前交叉韧带重建术后关节功能恢复中的疗效观察[J].四川中医,2017,35(4):147-148.
[17]李嘉祥,黄中强.中药内服外用对关节镜下膝前交叉韧带重建术后早期康复的影响[J].长春中医药大学学报,2017,33(2):292-295.
[18]程桯,王强,周进,等.内服中药促进半月板损伤术后关节功能康复的临床研究[J].中国中医骨伤科杂志,2015,23(10):27-30.
[19]潘孝云,温宏,刘忠堂,等.针刺在治疗膝关节前交叉韧带断裂中的应用[J].中医正骨,2012,24(11):11-13.
[20]李建超,张庆超.益气补肾中药口服、电针联合功能锻炼防治膝关节前交叉韧带重建术后股四头肌萎缩[J].中医正骨,2017,29(8):63-64,67.
[21]刘素云,饶冬霞,罗燕萍.渐进式功能锻炼对膝关节镜术后患肢功能恢复的影响[J].南昌大学学报(医学版),2010,50(10):103-104.
[22]王韵廷,葛茶娜,黎飞猛,等.自体腘绳肌腱与LARS人工韧带重建前交叉韧带临床疗效的荟萃分析[J].中国矫形外科杂志,2017,25(12):1108-1112.