摘要
目的：遵循移植韧带病理生理过程，采用晚负重及恢复关节活动的康复方法，观察四股半腱肌肌腱和钛钮扣钢板重建前交叉韧带术后的疗效。方法：选取2004-01/2006-07吉林大学第一医院骨科采用自体四股半腱肌腱和钛钮扣钢板进行前交叉韧带重建的患者16例，患者对实验和治疗方案均知情同意。术后1-3周主要以恢复肌力练习为主，不进行关节活动及负重练习，做髌骨内推运动，防止髌股关节粘连，术后第4周开始关节活动度练习，第5周行蹬固定自行车练习，第7周开始部分负重，第9周完全负重练习，6个月时恢复正常活动。术后1年评价膝关节活动度、膝关节稳定性（前抽屉试验、Lachman试验及轴移试验），采用Lysholm评分（总分100分，分数愈高，膝关节功能恢复愈好）和IKDC评分（4级评分法，分为正常、接近正常、异常、严重异常）评价其疗效。结果：术后3个月随访16例，术后6个月随访16例，术后12个月随访16例。①膝关节积液情况：患者术后3-6周关节有少量积液，其中积液量达（＋＋）者2例，积液量达（＋）14例，未行特殊处理，均自行吸收。②膝关节活动度情况：术后6周，膝关节活动度均达到120°，术后3个月患膝的屈膝活动度均恢复正常。术后未发现膝关节主动伸展受限者。③膝关节稳定性情况：16例随访患者术后1年行前抽屉试验、Lachman试验及轴移试验检查未见阳性结果。④术后1年Lysholm评分和IKDC评分情况：IKDC评分正常13例，接近正常2例，异常1例；患膝术前Lysholm评分平均44.3分，术后平均91．3分，其中优13例，良2例，中1例，优良率93．75％。结论：自体半腱肌腱和钛钮扣钢板重建前交叉韧带术后，采用晚负重及恢复关节活动的康复疗效确切，能够满意恢复患者一般运动能力，符合半腱肌重建前交叉韧带的病理生理过程。
AIM： Based on the pathophysiological processing of ligament graft, this study observes the curative effect of anterior cruciate ligament （ACL） reconstructed with quadrupled stranded semitendinosus tendon and Ti-alloy button plate by means of rehabilitation, including late weight loading and recovery of range of motion （ROM）.
METHODS： A total of 16 patients, who received ACL reconstruction with autologous semitendinosus tendon and Ti-alloy button plate in the Department of Orthopaedics, the First Affiliated Hospital of Jilin University between January 2004 and July 2006. Informed consents were obtained from each patient. During 1-3 weeks postoperation, the exercise of muscle strength recovery was dominant, without joint activity and loading. Patellofemoral joint adherence could be prevent by patellar interpolation. ROM exercise began on the fourth week, fixed bicycle riding on the fifth week, partly loading on the seventh week, and complete loading on the ninth week. All the patients restored the normal activity six months later. Knee ROM and knee joint stability （anterior drawer test, Lachman test and pivot shift test） were evaluated one year postoperation using Lysholm score （total 100 scores, higher scores indicated better recovery of knee joint function） and IKDC score （4 grades： normal, nearly normal, abnormal and severely abnormal）.
RESULTS： All the patients were followed up at 3, 6, 12 months postoperation.QKnee joint effusion： During 3-6 weeks postoperation, joint effusion occurred in a small quantity, and （＋＋） amount of effusion was revealed in 2 cases while （＋） amount of effusion in 14 cases. All the patients showed self-absorption without ant treatment.②Knee ROM： At 6 weeks postoperation, ROM reached 120° . No active extension limitation occurred and the flexion degree was restored in all cases after 3 months postoperatively.③Knee joint stability： There was no positive results for anterior drawer test, Lachman test and pivot shift test in all the
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第11期2178-2180,共3页
Journal of Clinical Rehabilitative Tissue Engineering Research
