关节镜下腘绳肌腱重建前交叉韧带术后的康复实践

目的探讨术前、术后适宜的康复训练和护理方法,对预防关节镜下腘绳肌腱重建前交叉韧带术后并发症、促进关节功能恢复的作用。方法对22例关节镜下腘绳肌腱重建前交叉韧带术患者手术前后的临床康复、护理方法进行总结。主要内容包括：术前心理准备、功能康复示范及术后五步渐进式康复训练法。结果全部病例均获随访,随访时间4～12月,平均7月。采用Lysholm膝关节功能标准评分,术前平均分61分,终末随访平均分93分,关节功能恢复良好。结论腘绳肌腱重建前交叉韧带术后行5个阶段的规范、系统、适度、个体化的康复训练,可有效的预防术后并发症和恢复关节功能,是一种安全、有效的康复训练方案。     

MR测量髌韧带和前交叉韧带的技术优化探讨

目的 探讨MR获取活体髌韧带(PL)和前交叉韧带(ACL)几何数据的技术优化,为指导前交叉韧带移植建立基础.方法 采用1.5T超导型MR扫描仪,专用膝关节线圈,快速自旋回波(FSE),经与股骨内、外侧髁后缘切线的垂直线呈10°～15°方向的斜矢状面定位线获得ACL高分辨T1WI;以髌骨下缘中心和胫骨结节中心的连线为中心定位线获取PL高分辨T1像.用Radworks 5.1工作站测量PL和ACL长度,另取3位医生分别测取的左侧PL长度行数据可信度分析.结果 本组扫描方法简单、准确、快速,能分别100%获取ACL和PL全长图像,图像质量完全满足临床测量需要.矢状位像采集时间为2 min 25 s.PL和ACL平均长度分别为:男:(42.20±4.21)cm和(36.98±4.12)cm,女:(40.15±4.00)cm和(35.80±4.67)cm;组内相关系数(ICC)大于0.997.结论 优化MR扫描技术可用于测量活体的PL和ACL长度,具有很高的稳定性和可鼋复性,能为膝关节ACL重建手术提供准确数据.     

镜下前交叉韧带重建术中止血带应用的探讨

随着人们运动意识水平的增强和社会交通的快速发展,关节损伤患者的数量也大幅增加,而前交叉韧带(ACL)损伤是关节损伤中最常见的韧带损伤.目前治疗ACL损伤的标准手术方式是在关节镜下使用止血带进行前交叉韧带重建手术(ACLR),在ACLR中使用止血带可以减少患者出血,为术者提供一个清晰的手术视野,可为手术提供极大的便利,但...     

关节镜下自体腓骨长肌腱和腘绳肌腱重建前交叉韧带的对比研究

目的 比较自体腓骨长肌腱（PLT）与腘绳肌腱（HT）重建前交叉韧带的临床疗效。方法 回顾性分析桂林市中医医院2017年8月－2019年12月收治的56例前交叉韧带损伤患者的临床资料。其中,男26例,女30例,20例行自体PLT重建前交叉韧带（PLT组）,36例行HT重建前交叉韧带（HT组）。在术前及术后6和12个月,对所有患者的手术时间、手术切口长度、合并半月板损伤、受伤时间、体重指数（BMI）等进行分析,并用国际膝关节文献委员会（IKDC）评分、Lysholm评分和Tegner评分对患者膝关节运动功能进行评估。结果 HT组手术时间和手术切口长度均较PLT组长,差异有统计学意义（P < 0.05）;两组患者术后6和12个月IKDC评分、Lysholm评分和Tegner评与术前比较,差异均有统计学意义（P < 0.05）,但术后6和12个月比较,差异均无统计学意义（P > 0.05）。结论 自体PLT重建前交叉韧带较HT重建前交叉韧带用时少、创伤小、更加美观,且操作简单、并发症少,术后疗效确切,可作为移植物替代HT行前交叉韧带断裂重建。     

关节镜下四股自体腘绳肌重建膝前交叉韧带的疗效观察

目的探讨关节镜下四股腘绳肌腱治疗膝前交叉韧带损伤的手术方法和疗效。方法对25例前交叉韧带损伤者实施关节镜下四股腘绳肌静力重建。结果随访3—38个月,24例膝关节不稳症状消失,膝活动度0°～112°,平均（107．3±1．24）°。1例术后出现膝内侧疼痛;1例术后患膝伸直型僵直,经关节镜下松解后有效改善。根据Lysholm膝关节评分法,患膝评分由术前（47．71±2．52）分提高到术后（82．35±1．01）分。结论膝前交叉韧带损伤重建应依据患者对关节功能需求和韧带损伤程度酌情选择重建术式,关节镜下自体腘绳肌重建前交叉韧带取材方便,Endo—Button“悬吊”四股胭绳肌腱的长度和强度合理,术后骨一腱愈合程度满足膝关节功能需要。     

本体感觉训练在膝前交叉韧带重建术后康复中的应用

目的探讨本体感觉训练在前交叉韧带重建术后康复中的作用。方法将前交叉韧带重建术后患者42例按病区分为本体感觉促进组(26例)和对照组(16例),对照组应用一般康复训练方法,本体感觉促进组应用一般康复训练方法和本体感觉强化训练。术后6个月进行患者位置觉测定、膝关节功能评分及关节稳定性检查。结果在被动角度重现测试中,本体感觉促进组患侧膝的总平均偏差为(4.10±1.38)°,健侧膝的总平均偏差为(3.76±1.93)°,两侧膝比较,差异无统计学意义(P>0.05)。对照组患侧膝的总平均偏差为(4.85±1.55)°,健侧膝的总平均偏差为(3.56±1.72)°,患侧膝的总平均偏差显著大于健侧(P<0.01)。本体感觉促进组的Lysholm评分显著高于对照组(P<0.05)。2组患侧膝Lanchman和Pivotshift检查均为阴性。结论前交叉韧带重建术后应用强化本体感觉训练能促进下肢功能的恢复。     

关节镜下双束重建前交叉韧带的临床研究

目的 探讨关节镜下采用自腘绳肌腱双束重建前交叉韧带的临床疗效.方法 采用自体腘绳肌双束4隧道重建前交叉韧带,利用可吸收界面螺钉和钮扣悬吊固定.KT-2000检测、2000 IKDC、Lysholm和Tegner评价表评分并分析膝关节和患肢功能.结果 术后对患者定期随访9～30个月(平均18个月),34例Iachman试验阴性.KT-2000检测:患侧、健侧胫骨前移之差由术前(6.4±2.9)mm降为随访结束时(2.1±0.6)mm.按照2000IKDC膝关节检查表,34例患者(97.1%)分级评价正常或接近正常.2000IKDC、Lysholm和Tegner评分分别从术前(42.6±5.9)、(47.8±6.2)、(3.7±0.3)分提高至随访结束时的(95.6±3.4)、(93.8±2.7)、(6.7±0.6)分(P<0.05).结论 采用自体胭绳肌双束重建前交叉韧带是修复前交叉韧带损伤的可靠方法.     

Gait retraining after anterior cruciate ligament reconstruction

OBJECTIVES: To examine the effects of 2 gait retraining protocols on the gait patterns of patients with bone-patellar tendon-bone anterior cruciate ligament (ACL) reconstruction. DESIGN: Randomized control, repeated-measures design. SETTING: Private orthopedic center and research facility. PARTICIPANTS: Sixteen patients with bone-patellar tendon-bone ACL reconstruction, randomly subdivided into 2 groups (group 1, n=8; group 2, n=8), and a healthy control group of 8 subjects. INTERVENTION: The 16 subjects with ACL reconstruction were randomly assigned to 2 different gait retraining protocols over a 6-week training interval: (1). a protocol using a predicted stride frequency calculated from the resonant frequency of a force-driven harmonic oscillator (FDHO) model or (2). a protocol using the preferred stride frequency (PSF). MAIN OUTCOME MEASURES: Gait analyses examining the lower-extremity kinematic, kinetic, and energetic gait patterns of each group. RESULTS: Gait retraining with the FDHO model showed improvements in lower-extremity positions, hip and knee extensor angular impulse, and work parameters. Gait retraining with the PSF demonstrated no statistical improvements. The FDHO training protocol facilitated a greater midstance knee range of motion (ROM) and greater rates of improvement for midstance ROM, hip extensor angular impulse, and concentric hip extensor work. CONCLUSIONS: Gait retraining with the resonant frequency of an FDHO model facilitated a greater recovery of gait function compared with training with the PSF.     

编制六股腘绳肌腱移植可吸收交叉钉固定关节镜下重建前交叉韧带临床分析

目的 总结关节镜下编制六股腘绳肌腱移植利用可吸收交叉钉固定重建前交叉韧带的方法,探讨其临床效果.方法 2005年3月至2008年6月,对39例前交叉韧带断裂患者在关节镜下采用自体腘绳肌腱六股编制移植重建前交叉韧带,移植物的股骨侧利用可吸收交叉钉固定.合并半月板损伤13例,行半月板缝合4例,部分切除8例,半月板全部切除2例;合并内侧副韧带Ⅲ度损伤4例,Ⅰ期行内侧副韧带修补或止点重建术;无合并后交叉韧带及后外侧角损伤患者.术后随访12～51个月,观察此固定方法的可靠性和术后疗效,以Lvscholm评分和KT-2000检查评价手术前后膝关节功能及稳定性.结果 32例患者获得随访,所有患者均无伸膝受限,膝关节屈膝活动度均>120°.屈膝90°时前抽屉试验均阴性;Lachman试验强阳性1例,阳性5例,阴性26例;膝关节功能Lyscholm评分为(92.6±4.2)分.KT-2000检查结果:31例为0～4.5 min,平均3.2 mm,1例患者关节不稳定,双膝差距6.5mm.结论 采用编制六股腘绳肌腱移植可吸收交叉钉固定关节镜下重建前交叉韧带,可以获得早期的初始稳定性和后期的生物稳定性,是一种可靠的手术方法,临床效果良好.     

自体富血小板血浆对前交叉韧带重建术后腱骨愈合的影响

目的 观察自体富血小板血浆(APRP)对前交叉韧带(ACL)重建术后腱骨愈合的影响.方法 回顾性分析2017年8月至2020年7月在济宁医学院附属医院接受ACL重建术治疗的86例患者的临床资料,按是否接受PRP治疗分为观察组(n=41)和对照组(n=45).观察组于术中用APRP处理移植肌腱,并在股骨隧道与移植物间注入...     

Mini-invasive technique for bone patellar tendon bone harvesting: its superiority in reducing anterior knee pain following ACL reconstruction

Arthroscopically-assisted ACL-reconstructions are currently reliable, reproducible. Residual anterior knee symptoms however, especially after patellar-BTB graft use, are not uncommon occurrences. Contributing factors are numerous and include injury to the saphenous nerve infrapatellar branches and/or histologic changes at the harvest site. The use of mini invasive harvesting technique decreases the risk of injury to the saphenous nerve infrapatellar branches while preserving the peritenon. The double-incision approach significantly reduces the mid-term incidence of anterior knee pain after ACL-reconstruction. Additionally, this technique markedly decreases the occurrence of sensory disorders and the extent of hypoesthesia. We thus advocate the use of a double-incision graft harvesting technique in ACL-reconstruction using a patellar-bone-tendon-bone transplant.     

关节镜下膝前交叉韧带重建术后的康复

探讨安全有效的前交叉韧带重建术后康复。方法:膝关节前交叉韧带(ACL)重建(BPTB)患者60例,按照我中心现行康复程序进行功能锻炼。术后1年进行关节活动度、肢体围度测量及问卷调查。使用等张肌力测试系统对术后3个月后坚持练习和未坚持练习患者各10例,评定双侧腿肌力,比较各项参数。结果:全部患者术后3个月恢复全范围AROM、正常ADL及患膝屈肌肌力,6—7个月恢复正常运动,大部分专业运动员恢复原有竞技性运动水平。术后坚持练习组与未坚持练习组肌力比较,伸肌最大输出功率、最大收缩速率、最大力量存在显著差异(P<0.05),伸肌疲劳系数及屈肌力量无显著差异(P>0.05)。术后1年,大腿及小腿围度较健侧有显著差异(P<0.01,P<0.05)。结论:ACL重建术后康复治疗程序安全有效,患者短期(3个月)可恢复正常AROM、ADL及患腿屈肌肌力,并逐步恢复正常运动。膝伸肌肌力需坚持长期练习,才可更好恢复。     

Stride-to-stride variability is altered during backward walking in anterior cruciate ligament deficient patients

Background

Recently backward walking is used by physical therapists to strengthen the hamstring muscles and thus improve the function of the knee joint of anterior cruciate ligament deficient patients. The aim of this study was to examine the stride-to-stride variability of anterior cruciate ligament deficient patients during backward walking. The variation of how a motor behavior emerges in time is best captured by tools derived from nonlinear dynamics, for which the temporal sequence in a series of values is the facet of interest.

Methods

Fifteen patients with unilateral anterior cruciate ligament deficiency and eleven healthy controls walked backwards at their self-selected speed on a treadmill while three-dimensional knee kinematics were collected (100 Hz). A nonlinear measure, the largest Lyapunov Exponent was calculated from the resulted knee joint flexion–extension data of both groups to assess the stride-to-stride variability.

Findings

Both knees of the deficient patients exhibited significantly lower Lyapunov Exponent values as compared to the healthy control group revealing more rigid movement pattern. The intact knee of the deficient patients showed significantly lower Lyapunov Exponent values as compared to the deficient knee.

Interpretation

Anterior cruciate ligament (ACL) deficiency leads to loss of optimal variability regardless of the walking direction (forwards in previous studies or backwards here) as compared to healthy individuals. This could imply diminished functional responsiveness to the environmental demands for both knees of ACL deficient patients which could result in the knees being more susceptible to injury.     

Tibial rotation in anterior cruciate ligament reconstructed knees during single limb hop and drop landings

Background

Alterations in knee joint kinematics have been suggested as a potential mechanism that influences the development of osteoarthritis of the knee after anterior cruciate ligament reconstruction. Whilst previous work has shown changes in internal–external tibial rotation during level walking, many patients aim to return to high impact activities following surgery. This study examined tibial rotation during single limb hop and drop landings in anterior cruciate ligament reconstructed knees compared to a control group, and also evaluated the influence of graft type (hamstring or patellar tendon).

Methods

In 48 participants (17 patellar tendon graft, 18 hamstring graft and 13 controls) internal–external rotation was measured during single limb hop and drop landings in a gait laboratory at mean of 10 months after surgery.

Findings

There was no difference between the two graft types and both patient groups had less internal rotation when compared to the control group. For 60% of patients, internal rotation values were at least 5°  less than the control group mean.

Interpretation

Anterior cruciate ligament reconstructed knees with both hamstring tendon and patellar tendon grafts show altered rotational kinematic patterns during high impact dynamic load activities.     

采用四股半腱肌肌腱和缝线钢板重建前十字韧带后的康复训练

FromMay１９９７toApril２００１，wereconstructedoldanteriorcruciateligament（ACL）injuryusingquadrupled－strandedsemi－tendinosustendonandsutureplateand１－yearrehabilitationexer－cise，andtherapeuticeffectwasfavorable．Hereisthereport．１Subjectandmethod１．１Subjects５１patients（２７malesand２４femalesaged１３～５７years，meanage：２４．７）enteredourstudy．Patientswithseverecompoundinjuriesofposteriorinnerandouterligamentswereex－cludedfromourstudy．AccordingtoLysholmkneescorescale犤１犦…     

A systematic review of bracing following reconstruction of the anterior cruciate ligament

Objectives

To determine whether the use of a postoperative knee brace following reconstruction of the anterior cruciate ligament (ACL) affects clinical outcomes.

Data sources

The electronic databases AMED, Cinahl, Cochrane database, Embase, Medline (via Ovid), Physiotherapy Evidence Database (PEDro) and Pubmed were searched from their inception to August 2006. A manual search of pertinent specialist journals and the reference lists of identified articles was also performed.

Review methods

All English-language, human subject, controlled clinical trials that compared the effects of wearing a knee brace with not wearing a brace for 1 day to 3 months following ACL reconstruction were included. Two reviewers extracted the data independently from the included studies, and assessed the methodological quality of the literature using the PEDro scoring system.

Results

Seven papers comprising of 390 ACL reconstructions were included. There were no significant longer-term differences in outcomes between patients who wore knee braces and those who did not. The methodological assessment of the literature revealed a number of limitations, including not blinding assessors, not performing a power calculation to determine the sample size, and not concealing subject allocation.

Conclusions

There appeared to be no significant longer-term differences in clinical outcomes between patients who wore postoperative knee braces and those who did not. Areas for further study are suggested, most notably to assess this topic using more rigorous randomised controlled trial methodologies.     

经关节镜中1/3髌韧带重建后交叉韧带

目的 介绍一种关节镜下后交叉韧带(Posterior Cruciate Ligament，简称PCL)重建术并评估其近期临床治疗效果。方法 中1／3骨—髌韧带—骨组织(Bone—Patellar Tendon—Bone Graft，简称BPB)移植重建膝关节后交又韧带，用于治疗后交叉韧带损伤后关节不稳定。手术在关节镜下经前方进路完成。结果 18例患者平均随访13．1个月。Larson评分由术前61分提高到93分。Lysholm评分由术前55分提高到91分。所有患膝术前后抽屉试验及Lachman试验均阳性，术后仅2例抽屉试验弱阳性，1例Lachman弱阳性。所有患者主观评价膝关节功能明显增进，对治疗效果满意。结论 在关节镜直视下，能准确定位后交叉韧带解剖止点，钻制骨遂道，植入移植组织。该技术具有不切开关节囊，损伤小、关节粘连率低的优点。     

前交叉韧带重建手术并发症诊断及处理的研究进展

随着医学诊疗水平的提高,因为前交叉韧带断裂而接受重建手术的患者数量在逐年增加,如何避免前交叉韧带重建术并发症的发生是运动医学领域目前关注的热点问题。目前的研究结果显示,手术中移植物的获取、骨道钻取、移植物的固定等操作以及术后的恢复过程均可能出现并发症,而术后我们更多关注关节活动度、物理治疗的进程以及恢复运动能力的情况等。因此,正确认识前交叉韧带重建手术的并发症,可以最大程度地降低前交叉韧带重建手术不良事件的发生,获得最佳的手术效果。     

Alterations in patellofemoral kinematics following vastus medialis transection in the anterior cruciate ligament deficient rabbit knee

Background

Anterior cruciate ligament deficiency and quadriceps muscle weakness are considered to be important risk factors for aberrant patellar tracking and subsequent patellofemoral osteoarthritis. However, data from in vivo experiments looking at dynamic patellar joint kinematics and muscle force are scarce. Therefore, the purpose of this study was to evaluate the effects of anterior cruciate ligament transection and loss of vastus medialis force on patellar tracking in the rabbit knee in vivo.

Methods

Eight skeletally mature New Zealand White Rabbits, weighing 6.0 kg (0.6 kg standard deviation) were used. The experimental trials consisted of active, concentric and eccentric movements of the knee joint. Measurements were performed with the intact, the anterior cruciate ligament deficient, and the vastus medialis transected knee. Patellofemoral kinematics (shift, rotation) were quantified from high speed video.

Findings

Following anterior cruciate ligament transection, patellar tracking occurred more laterally, and caused a significant lateral rotation of the patella. The addition of vastus medialis transection did not alter patellar tracking or rotation significantly for any of the force-matched experimental conditions.

Interpretation

The loss of the anterior cruciate ligament results in lateral patellar shift and rotation while the loss of vastus medialis muscle force does not affect patellar tracking or rotation in the anterior cruciate ligament deficient knee. We suggest that the current results should be considered carefully in future interpretations of knee extensor imbalance. More research is needed to describe the contribution of vastus medialis muscle strength to medial patellofemoral stability and confirm these results in the human knee.     

膝关节前交叉韧带的MRI三维成像研究

目的 探讨MRI三维成像技术(M3D/cube T2WI)在膝关节前交叉韧带(anterior cruciate ligament,ACL)正常显示和损伤诊断的价值.方法 选取30例正常自愿者(对照组)及11例ACL损伤病例(损伤组),在GE 1.5 T磁共振分别行MRI常规膝关节矢状面T1WI、FSE压脂T2WI(f...