膝关节镜下前交叉韧带重建术后膝关节功能康复研究进展

前交叉韧带(anterior cruciate ligament,ACL)是膝关节重要的稳定结构,损伤后膝关节功能将受到严重影响.目前临床上通常采用膝关节镜下重建手术结合专业化的康复训练对损伤的ACL进行治疗.重建手术是修复ACL解剖结构的关键,康复训练则是恢复膝关节功能和帮助患者重返运动的重要保障.随着重建技术的改进和ACL生物力学及功能研究的深入,ACL术后康复的理念和方法也发生了改变.本文着眼于ACL重建术后相关功能的恢复,重点探讨目前ACL术后康复的研究进展.     

术前康复训练对全膝关节置换的近期疗效

目的：探讨全膝关节置换术前开展功能训练对术后近期的康复效果。方法：回顾分析自2005年6月-2008年6月111例124膝接受全膝关节置换的患者临床资料,43例48膝在术前术后均进行康复训练,68例76膝仅在术后行康复训练。结果：将两组患者术后下床活动时间、术后并发症、以及术后膝关节功能恢复等方面进行比较,差异有显著性意义。结论：加强全膝关节置换患者术前的康复功能训练,有利于减少术后并发症的发生率,并能有效增加术后膝关节的活动度和肌力。     

术前康复训练对全膝关节置换的近期疗效

目的：探讨全膝关节置换术前开展功能训练对术后近期的康复效果。方法：回顾分析自2005年6月。2008年6月111例124膝接受全膝关节置换的患者临床资料,43例48膝在术前术后均进行康复训练,68例76膝仅在术后行康复训练。结果：将两组患者术后下床活动时间、术后并发症、以及术后膝关节功能恢复等方面进行比较,差异有显著性意义。结论：加强全膝关节置换患者术前的康复功能训练,有利于减少术后并发症的发生率,并能有效增加术后膝关节的活动度和肌力。     

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

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(P0.05);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(P0.05)。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。     

虚拟现实技术对全膝关节置换术后功能恢复及心理改善的作用

背景:随着中国老龄化的日益严重,膝骨关节炎(osteoarthritis,OA)患者越来越多,全膝关节置换术(total knee arthroplasty,TKA)是目前治疗中重度膝OA的有效方法。目的:探析TKA术后早期阶段式康复训练中应用虚拟现实技术对其膝关节恢复、心理状态的改善效果及意义。方法:前瞻性选取2015年3月至2016年10月行单侧TKA的120例患者,采用随机数表法,根据术后康复训练模式不同将其分为2组,每组60例,对照组术后早期行阶段式康复训练,试验组在分阶段康复训练间歇期运用虚拟现实技术指导下的康复锻炼,对比两组患者初次主动屈曲达45°和90°的时间及NRS评分、膝关节活动度和功能改善情况、康复积极性以及生活质量。结果:试验组患者初次主动屈曲达45°、90°的时间和NRS评分明显小于对照组(P<0.05);两组患者术后14 d的ROM、HSS评分均明显高于术前(P<0.05),试验组术后14 d的ROM、HSS评分均明显高于对照组(P<0.05);试验组患者术后康复需求、配合、依从性和遇挫折后良好情绪、家属及护理人员鼓励作用评分均明显高于对照组(P<0.05);两组患者出院时SF-12量表中生理总评分、心理总得分较术前均明显提高(P<0.05),出院时试验组两项评分均明显高于对照组(P<0.05)。结论:早期阶段式康复训练中应用虚拟现实技术可减轻TKA患者早期疼痛,提高康复速度,促进膝关节功能的恢复,可作为术后有效的辅助康复手段,应用前景广阔。     

膝关节镜术后院外功能康复训练指导效果观察

目的探讨对膝关节镜术后患者实施院外功能康复训练指导的效果。方法将60例膝关节镜术后患者随机分为观察组与对照组各30例，两组住院期间予以常规健康教育、康复指导；出院后对照组不作任何干预，观察组出院后给予功能康复训练指导，1个月内每周1次，以后每个月1次。结果观察组术后3个月、6个月膝关节HSS评分显著高于对照组（P〈0．05）。结论对膝关节镜术后患者进行院外功能康复训练指导，能使患者获得延续的护理，提高手术治疗的效果。     

膝关节镜术后患者实施医护康合作康复训练效果观察

目的 探讨基于医护康合作的康复训练模式对膝关节镜手术患者膝关节功能恢复及焦虑抑郁的影响。方法 将120例膝关节镜手术患者按照入院时间分为对照组和观察组各60例。对照组采用常规快速康复护理模式,观察组在此基础上采用医护康合作的模式对患者进行康复训练。入院时及术后1周、2周评价两组患者膝关节功能评分,同时比较两组入院时及出院时焦虑、抑郁评分。结果 术后1周、2周观察组膝关节功能评分显著优于对照组,出院时焦虑、抑郁评分显著低于对照组(P<0.05,P<0.01)。结论 医护康合作模式用于膝关节镜手术患者康复训练,可促进患者关节功能恢复,缓解其焦虑、抑郁情绪。     

膝关节置换术45例术后康复训练

目的:探究膝关节置换术后病人的康复训练,确保术后良好效果.方法:选自2008年10月～2009年12月本院45例膝关节置换术后患者.采用自行设计调查问卷的方法,收集临床资料,统计分析.结果:经科学指导术后功能训练,功能恢复明显良好.结论:人工关节置换术后,如何在做好一般护理的基础上,更进一步科学的规范术后患者的康复训练,是保障手术成功率,提高生存质量,减少并发症的重要环节.     

康复护理程序在人工单髁膝关节置换患者中的应用

目的总结探讨个体化康复训练程序对膝关节内侧间室单髁置换患者的康复效果。方法2009年03月至2012年02月,我科共收治膝关节内侧间室退变的46例52膝患者,其中男21例,女25例,均行单髁置换手术,选用Oxford Ⅲ假体植入。所有行人工单髁膝关节置换患者进行个性化、渐进性和全面性的康复训练,包括术后早期无痛训练,活动度（ROM）、肌肉力量以及膝关节本体感觉训练,预防并发症等。结果本组病例经随访结果表明,术后膝关节功能恢复良好,至术后随访膝关节功能基本恢复正常（膝关节KSS评分较术前明显改善：KSS（单）膝临床评分优良率达91％;KSS功能评分优良率87％）。结论该训练程序具有使患者康复快、关节功能恢复效果好、并发症少的特点。     

单髁置换治疗对膝关节单间室骨关节炎的临床疗效

目的探讨单髁置换治疗对膝关节单间室骨关节炎患者临床疗效和运动功能的影响。方法回顾分析2016年3月至2020年3月在本院拟行膝关节单间室骨性关节炎治疗的患者64例,分两组各32例。对照组采用全膝关节置换治疗,观察组则行单髁置换治疗。对比两组患者手术指标、运动功能指标以及术后不良反应和并发症情况。结果对照组患者术中出血量、手术时间、引流液量、住院总时间均高于观察组(P0.05),运动功能方面术后对照组与观察组的Lysholm膝关节评分量表LKSS评分以及膝关节功能评分HSS评分均升高(P0.05),且对照组低于观察组(P0.05)。结论采用单髁置换治疗治疗膝关节骨关节炎对患者运动功能恢复较好,无明显不良反应及并发症,利于患者术后康复。     

Treatment of medial ligament injuries of the knee

The anatomic structures of the knee form a complex transmission system that coordinates joint position and provides stability for knee function. Ligament injury produces abnormal kinematic states that interfere with normal knee function. Because of the unequal load-sharing between the ligaments and musculotendinous units that occurs with ligament injury, complex instability patterns can develop, compromising the functional capability of the knee. Joint damage can also develop. The surgeon must restore stability to the knee by providing the appropriate tension in the anatomic structures, thus stabilizing the tibiofemoral joint and reestablishing a more normal load-sharing function of the capsular envelope and intra-articular ligaments. Isolated, limited instability, grade III medial ligament injuries can be treated nonoperatively with bracing that allows limited motion and with a high-repetition exercise program. The examiner must be aware that complex problems also can occur with grade III injuries, adversely affecting nonoperative outcome and leading to chronic instability. For more severe acute medial ligament injuries, the surgeon can accomplish acute surgical restoration of the anatomy including the mid-third capsular ligament, tibial collateral ligament, posterior oblique ligament, semimembranosus complex, and other injured knee structures (ie, anterior cruciate ligament, meniscus, vastus medialis obliquus, and semimembranosus). A well-supervised rehabilitation program follows treatment. Reconstruction of chronic medial ligament tears produces poor results.     

Primary reconstruction of injuries of the capsular ligament of the knee joint

Whether operative or conservative treatment is indicated for acute knee ligament injuries depends on the lesions of the cruciate ligaments: complex instability with rupture of one or both cruciate ligaments and injuries to the lateral or medial ligamentous structures should be treated by operation. Surgical treatment of an isolated rupture of the anterior cruciate ligament is recommended only for the young active patient. Surgery is performed by way of a single anterolateral incision with standard medial and if necessary, lateral arthrotomies. Ruptures of the cruciate ligaments are reconstructed with absorbable sutures, which are passed through bone channels. Augmentation with an absorbable allograft is used in most reconstructions of the cruciate ligaments. A knee brace with limited range of motion is used for postoperative rehabilitation. Our long-term results after operative reconstruction of acute instabilities of the knee joint show that ligamentous stability was achieved in most cases, but the functional results were impaired by pain and limited range of motion.     

关节镜下LARS重建后交叉韧带的近期疗效

目的探讨在关节镜下应用LARS重建后交叉韧带（PCL）的近期疗效。方法7例陈旧性PCL损伤患者在伤后2～13个月使用LARS人工韧带（PPLY110）作双束双隧道PCL重建。结果7例均获随访,时间5～25个月,膝关节稳定性良好,膝活动度较术前改善,无伸直受限,后抽屉试验、反轴移试验均为阴性,Lyshlom评分由术前（47.71±5.99）分提高到术后（82.29±2.50）分。未发生并发症。结论关节镜下LARS重建PCL操作简便、创伤小,术后能早期功能锻炼,近期疗效满意,是目前临床应用效果理想的人工韧带。     

关节镜检查和镜下治疗膝关节急性损伤47例

目的 分析膝关节急性损伤早期关节镜检查和镜下治疗的价值。方法 对４７例膝关节急性损伤患者进行早期关节镜检查,其中２６例行关节镜下手术治疗。结果 ４７例关节镜检查患者,镜下除证实Ｘ线诊断外,另发现损伤２８处;２６例镜下治疗患者优良率８３．３％。结论 早期关节镜检查可全面评估损伤程度,提高诊断水平;镜下手术治疗具有创伤小、并发症少、功能恢复快以及总体疗效好等优点。     

Anatomy, function, and rehabilitation of the popliteus musculotendinous complex

We present a clinical commentary of existing evidence regarding popliteus musculotendinous complex anatomy, biomechanics, muscle activation, and kinesthesia as they relate to functional knee joint rehabilitation. The popliteus appears to act as a dynamic guidance system for monitoring and controlling subtle transverse- and frontal-plane knee joint movements, controlling anterior-posterior lateral meniscus movement, unlocking and internally rotating the knee joint (tibia) during flexion initiation, assisting with 3-dimensional dynamic lower extremity postural stability during single-leg stance, preventing forward femoral dislocation on the tibia during flexed-knee stance, and providing for postural equilibrium adjustments during standing. These functions may be most important during mid-range knee flexion when capsuloligamentous struCtures are unable to function optimally. Because the popliteus musculotendinous complex has attachments that approximate the borders of both collateral ligaments, it has the potential for providing instantaneous 3-dimensional kinesthetic feedback of both medial and lateral tibiofemoral joint compartment function. Enhanced popliteus function as a kinesthetic knee joint monitor acting in synergy with dynamic hip muscular control of femoral internal rotation and adduction, and ankle subtalar muscular control of tibial abduction-external rotation or adduction-internal rotation, may help to prevent athletic knee joint injuries and facilitate recovery during rehabilitation by assisting the primary sagittal plane dynamic knee joint stabilization provided by the quadriceps femoris, hamstrings, and gastrocnemius.     

重度屈曲畸形膝关节置换术后康复效果研究

目的评价类风湿性关节炎伴膝关节重度屈曲畸形患者行人工膝关节置换术后康复措施的临床效果。 方法回顾性分析2013年6月至2017年9月收治的21例(36膝)类风湿性关节炎伴膝关节重度屈曲畸形患者在人工膝关节置换术后进行功能康复治疗的疗效情况。纳入标准为类风湿关节炎伴膝关节屈曲挛缩角度达60°以上患者,排除标准为存在其它继发性膝骨关节炎者。对所有患者实施系统康复治疗。评估术后、康复出院时以及末次随访的疼痛视觉模拟评分(VAS评分),膝关节屈曲挛缩角度以及膝关节活动范围,进而评估术后康复措施的疗效。根据数据是否符合正态分布,多组间定量资料比较采用单因素方差分析或Friedman秩和检验。 结果在21例患者中,15例(26膝)获得随访,随访时间平均(46±15)个月。术后膝关节VAS评分中位数为7(6,8)分,康复出院时为2(2,3)分,末次随访为0(0,1.7)分,3个时间点的VAS评分组间差异有统计学意义(P<0.001)。术后膝关节屈曲挛缩角度平均为(30±13)°,康复出院时(8±5)°,末次随访为(7±10)°,3个时间点屈曲挛缩角度差异有统计学意义(F＝57.4,P<0.001)。术后膝关节活动范围为(56±21)°,康复出院时(99±11)°,末次随访(88±18)°,3个时间点膝关节活动范围差异有统计学意义(F＝53.8,P<0.001)。 结论类风湿关节炎伴膝关节重度屈曲挛缩畸形的患者行人工膝关节置换术后,经过功能康复治疗后,可实现膝关节功能的改善。     

关节镜下膝关节多发韧带损伤重建术后的康复护理

目的探讨关节镜下膝关节多发韧带损伤重建术后的康复护理方法和效果。方法对本组2010年3月～2012年9月收治的11例膝关节多发韧带损伤患者,施行关节镜下膝关节前、后交叉等多韧带重建术,根据重建材料、手术方法和患者个体差异制定系统的围手术期康复训练计划,加强出院后持续康复训练的指导,分阶段对康复效果进行随访。结果随访1周～29个月,平均随访（14．29±9．13）个月,膝关节活动度平均110°,最小的均〉95°,无关节不稳定症状。11例膝关节前抽屉试验及外侧侧方应力试验均为（-）;后抽屉试验：（＋）9例,（-）2例,手术前后比较差异均有统计学意义（Z=3．035,Z=3．066,P均小于0．01）。结论根据患者多发韧带损伤特点,制定个体化、系统的围手术期康复训练计划,加强出院后持续康复训练管理,对促进关节镜下重建多发韧带损伤术后关节功能的全面康复至关重要。     

Diagnosis and management of the multiligament-injured knee

Knee injuries involving multiple ligaments, which are often associated with tibiofemoral joint dislocations, are complex injuries that are challenging to evaluate and treat. The clinician must have a thorough understanding of knee anatomy and be capable of a detailed physical examination to determine the extent and pattern of injury. Accurate interpretation of imaging studies is crucial but cannot replace the physical examination. The magnitude of deforming forces and amount of translation and rotation of the tibia in relation to the femur determine the risk for neurovascular injury. Most patients with multiligament knee injuries undergo surgical management; however, some patients may be best served by a nonoperative approach. Successful rehabilitation consists of achieving good range of motion and strength, as well as normal gait mechanics, while respecting the stages of healing.     

Knee braces

The preceding discussion has profiled the three different types of knee braces which are available on today's market. It also has attempted to discuss the controversies surrounding these braces and to analyze the scientific data presented to date. Prophylactic braces have been shown to be ineffective in preventing knee injuries in its present day design. Evidence also has shown that their use may even lead to increased knee injuries. Rehabilitative braces, on the other hand, do serve a useful purpose in regard to the operative and non-operative treatment of ligamentous knee injuries. With their ease of application and control of joint motion, they are an important addition to the surgeon's armamentarium. One must keep in mind, however, that these braces provide little static anterior/posterior control and the hinge settings may not actually affect true joint motion. Functional knee braces may play a role in the treatment of patients with pathological laxity due to an injury of the anterior cruciate ligament. Combined with an adequate rehabilitation program and activity modification, these braces do limit excessive anterior tibial translation under low loading conditions. However, under conditions of high loading these braces provide little or no resistance to anterior translation. Therefore, in most sporting activities, their efficacy is questionable. Knee bracing continues to be a complex and controversial topic in the field of orthopedic surgery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Use of the Dynastab-K (knee) external fixator technique for functional treatment of intra- and peri-articular fractures of the knee joint]

The aim of this study was to validate the results of treatment of articular fractures using a Dynastab-K (knee) external fixator, which gives a good stabilisation, while retaining motion in the knee joint. A group of 6 patients with articular fractures of the knee joint was evaluated. Two fractures were located within the distal femur and 4 within the tibial plateau. After anatomical reposition of the bone fragments primary stabilisation was achieved by means of the Dynastab-K fixator and maintained for a period of 8-10 weeks. Passive motion of the knee was implemented in the first post-op day and active motion was implemented in the third post-op day. In all cases proper healing of the fractures, full extension and a minimally limited flexion (100 degrees) were achieved. Flexion limitation was corrected by means of an intensive rehabilitation programme. Use of the presented technique allows proper stabilisation of the bone fragments with maintenance of joint motion throughout treatment. Basing on our observations we concluded that implementation of an articulated external fixator in articular fractures of the knee leads to proper fracture healing with minimal loss of motion, which can be resolved by rehabilitation procedures.