关节镜下前交叉韧带重建术后中西医结合护理应用效果观察

目的 探讨前交叉韧带重建术后2种不同康复护理方法对患者膝关节功能恢复的影响.方法 选取60例前交叉韧带重建术后患者,随机分为实验组和对照组各30例,实验组采用西医常规护理+中药熏蒸+中药外敷,对照组采用常规西医护理.结果 实验组患者术后1、2、3、4周关节肿胀度、关节活动度的改善明显大于对照组,P＜0.05,2组护理方法有明显差异.结论 中西医结合康复护理可明显减轻前交叉韧带重建术后患者膝关节肿胀度,增加关节活动度,改善膝关节功能.     

前交叉韧带重建术后感染的早期诊断与治疗

目的 为前交叉韧带重建术后感染的早期诊断和治疗提供依据,以做到早期诊断和治疗,最大限度地保护前交叉韧带的完整性。方法 回顾性分析2016年1月-2021年12月该科室收治的40例前交叉韧带重建术后感染患者（感染组）的临床资料。其中,20例患者使用关节镜下清理术联合载抗生素硫酸钙颗粒关节腔内植入（硫酸钙组）,20例患者使用关节镜下清理术联合置管冲洗引流术（置管冲洗组）,选取同一时间段正常前交叉韧带重建术后患者40例作为对照组,检测两组患者术后不同时间炎症指标变化;比较感染后,两组（硫酸钙组和置管冲洗组）患者的临床表现和术后1、2和3周炎症指标变化情况,以及术后1、2、3和6周膝关节活动度（ROM）、膝关节Lysholm评分和视觉模拟评分（VAS）。结果 感染组术后3或4 d,C反应蛋白（CRP）、红细胞沉降率（ESR）、降钙素原和白细胞介素-6 (IL-6)均高于对照组,两组比较,差异均有统计学意义（P <0.05）,术后10～12 d,感染组CRP、ESR、降钙素原和IL-6明显高于正常情况,对照组CRP、ESR、降钙素原和IL-6均恢复正常,两组比较,差异均有统计学意义（P &...     

超声检查在前交叉韧带重建术后随访中的作用

目的：探讨前交叉韧带(ACL)重建术后超声对重建ACL近期随访中的作用。方法：31例ACL重建术患者于术后1～9个月用超声检查重建韧带，并对膝关节功能进行评定。结果：超声检查发现重建韧带厚度由1．5cm薄至0．9cm，腱纤维的条状强回声带由较稀疏变得清晰、致密，纤维间的层状低回声带由宽变窄，与周边脂肪组织的分界由不清到明显增强增厚的光带分隔；9个月时膝关节功能评定达优。结论：超声能够反映重建ACL组织学变化的大致趋势，为术后患者的康复训练提供辅助信息。     

关节镜下前交叉韧带重建术病人出院后延续护理效果观察

[目的]探讨延续护理对关节镜下前交叉韧带重建术病人出院后的功能恢复程度的影响.[方法]将84例前交叉韧带损伤病人随机分为观察组45例、对照组 39例,两组病人住院期间护理方式完全相同,观察组在出院后以定期个性化电话随访方式进行护理干预,对照组病人出院后进行自我护理.[结果]干预后两组遵医嘱功能锻炼差异有统计学意义（P＜0.05）;两组病人术后第24周膝关节Lysholm评分差异有统计学意义（P＜0.01）,出院后第12周、第24周膝关节伸屈活动度差异有统计学意义（P＜0.05或P＜0.01）.[结论]开展出院病人延续护理对关节镜下前交叉韧带重建术病人的膝关节功能恢复情况有明显的促进作用.     

关节镜下前交叉韧带重建术病人出院后延续护理效果观察

[目的]探讨延续护理对关节镜下前交叉韧带重建术病人出院后的功能恢复程度的影响。[方法]将84例前交叉韧带损伤病人随机分为观察组45例、对照组39例,两组病人住院期间护理方式完全相同,观察组在出院后以定期个性化电话随访方式进行护理干预,对照组病人出院后进行自我护理。[结果]干预后两组遵医嘱功能锻炼差异有统计学意义(P0.05);两组病人术后第24周膝关节Lysholm评分差异有统计学意义(P0.01),出院后第12周、第24周膝关节伸屈活动度差异有统计学意义(P0.05或P0.01)。[结论]开展出院病人延续护理对关节镜下前交叉韧带重建术病人的膝关节功能恢复情况有明显的促进作用。     

前交叉韧带重建术后患者早期居家康复锻炼现状的调查

目的了解前交叉韧带重建术后早期患者居家康复锻炼现状,分析患者早期关节功能恢复状况与其居家康复锻炼之间的关系。方法采用便利抽样方法选取2011年2—4月54例前交叉韧带重建术后2周门诊复查患者,采用自行设计的调查问卷了解患者一般资料、早期康复锻炼执行情况、患者对早期康复锻炼的顾虑以及膝关节功能状况。结果仅25名患者（46．3％）的关节功能恢复效果满意;早期康复锻炼中,肌肉活动的达标率为33．3％,活动度练习的达标率为29．6％;患者对早期康复锻炼存在一定的顾虑,主要顾虑包括为害怕疼痛（55．6％）,担心无人指导导致练习不当（51．9％）及康复过程枯燥无法坚持（37．0％）。患者早期膝关节功能恢复状态与康复锻炼是否达标有关。结论前交叉韧带重建术后早期患者关节功能恢复状况不够满意,居家康复锻炼状况应当受到重视,通过加强院内早期康复锻炼指导及院外随访,改善患者的康复锻炼的现状。     

关节镜下膝关节前交叉韧带重建术后康复护理

目前，关节镜技术已成为膝关节疾患诊断和治疗的重要手段，广泛应用于膝关节创伤的诊疗过程，是一种比较安全实用的新技术。我院自2001年3月-2006年12月在关节镜下行膝关节前交叉韧带重建术23例，配合正确合理的术后康复护理，取得了良好效果，现将护理体会介绍如下。[第一段]     

前交叉韧带重建术后患者早期功能锻炼依从性的影响因素分析

目的分析影响前交叉韧带重建术后患者早期功能锻炼依从性的影响因素并提出对策。方法采用自制的一般情况调查表和影响前交叉韧带重建术后患者早期功能锻炼依从性问卷调查表，对前交叉韧带重建术后患者不配合早期功能锻炼的18例患者进行调查。结果18例不配合功能锻炼的患者中，术后1～2d时，不遵医者占83％，术后3～10d时，不遵医者占38％；因中度疼痛不遵医者占55％，因轻度疼痛不遵医占38％；因担心影响术后效果不遵医者占55％；因不理解早期功能锻炼不配合所致后果的严重性不遵医者占33％。结论术后疼痛、自身症状、担心影响术后效果及知识缺乏是影响前交叉韧重建术后患者早期功能锻炼依从性的主要因素。     

关节镜下前交叉韧带重建术后不同冰敷方式 应用的效果观察

目的探究不同冰敷方式应用于关节镜下前交叉韧带重建术后的效果。方法选取2019年10月至2020年10月南通市第三人民医院收治的关节镜下前交叉韧带重建术后患者108例，按随机数表法分为两组，各54例。对照组术后创口局部给予间断冰敷，观察组给予72 h持续冰敷。比较两组患者患肢肿胀情况、疼痛程度、膝关节活动度以及舒适度。结果干预后，观察组患者患肢肿胀情况优于对照组（P＜0.05）；疼痛程度轻于对照组（P＜0.05）；膝关节活动度大于对照组（P＜0.05）；舒适度高于对照组（P＜0.05）。结论关节镜下前交叉韧带重建术后患者给予创口局部72 h持续冰敷，较间断冰敷法能够更好缓解患肢肿胀情况及疼痛程度，提高术后患者的膝关节活动度与舒适度。     

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...     

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。     

重建前交叉韧带移植物生长的MR信号改变初步研究

目的探讨术后生长良好的重建前交叉韧带(ACL)移植物MR信号改变过程。方法选取48例ACL重建患者,Lysholm平均积分由术前54分升至术后83.5分,总结其术后4～22个月重建ACL移植物的MR信号改变。扫描序列包括SE T_1WI、GE T_2WI和STIR序列。结果 4～9个月内大部分重建ACL信号增高,术后12～22个月大部分重建ACL信号降低,与正常韧带相仿。结论生长良好的重建ACL移植物,术后MR信号呈现由高到低的变化过程,1年后信号与正常韧带相仿。     

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...     

膝关节前交叉韧带损伤患者的一站式个性化单束重建术治疗策略研究

目的 探讨膝关节前交叉韧带损伤患者的一站式个性化单束重建术治疗策略.方法 前瞻性选取2019年1月至2020年6月北华大学附属医院收治的膝关节前交叉韧带损伤患者101例,按随机数字表法分为试验组(51例)和对照组(50例).2组均根据术前精确测量其股骨骨性解剖参数及半月板损伤类型制定前交叉韧带单束解剖重建术方案,其中试...     

Association between knee function and kinesiophobia 6 months after anterior cruciate ligament reconstruction

[Purpose] Kinesiophobia after anterior cruciate ligament reconstruction has been identified as an inhibitor of return to sports. This study aimed to clarify the relationship between kinesiophobia and knee function 6 months after anterior cruciate ligament reconstruction when the patient intends to return to sports. [Participants and Methods] A total of 66 patients who underwent primary anterior cruciate ligament reconstruction (mean age 17.3 ± 2.6 years, 17 males and 49 females, Tegner activity score ≥7) were included in the study. The 11-item version of Tampa scale of kinesiophobia was used to evaluate kinesiophobia 6 months postoperatively. Knee function was evaluated with knee extension muscle strength, tibial anterior displacement, heel buttock distance, heel height difference, anterior knee pain score, and single-leg hop test. The relationship between Tampa scale of kinesiophobia, patient characteristics, and knee function was investigated. [Results] A low Anterior knee pain score and low single-leg hop test, male gender, and age were significant factors associated with kinesiophobia. [Conclusion] Kinesiophobia was associated with a low anterior knee pain score and low single-leg hop test 6 months after anterior cruciate ligament reconstruction. Patients with a low single-leg hop test score or severe pain may need rehabilitation to reduce kinesiophobia.     

Functional measurement of knee joint position sense after anterior cruciate ligament reconstruction

OBJECTIVE: To examine for differences in joint position sense (JPS) between knees with reconstructed anterior cruciate ligaments (ACLs) and uninjured knees by using a functional weight-bearing measurement method. DESIGN: Two-way repeated-measures in a convenience sample. SETTING: An Australian university rehabilitation laboratory. PARTICIPANTS: Nine subjects presenting at 12 to 16 months after unilateral ACL reconstruction using the semitendinosus/gracilis graft who were recruited from 2 orthopedic surgeons. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: JPS of the reconstructed and uninjured knees was examined by using the Peak Motus motion measurement system to record target joint angles and to calculate reproduced angles after limb movement into flexion and extension, performed in a weight-bearing position. RESULTS: There were no significant differences in JPS between reconstructed and uninjured knees (P=.68) or between the flexion and extension tasks (P=.47). CONCLUSION: There was no deficit in knee JPS 12 to 16 months after ACL reconstruction, as measured by a functional weight-bearing method. Further studies should examine the clinical utility of the method as a way to evaluate functional aspects of knee joint proprioception.     

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.     

Functional recovery after anterior cruciate ligament reconstruction: a longitudinal perspective

Hopper DM, Strauss GR, Boyle JJ, Bell J. Functional recovery after anterior cruciate ligament reconstruction: a longitudinal perspective.

Objective

To evaluate functional hop performance in subjects with an anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone graft during 12, 18, 26, 39, and 52 weeks.

Design

A longitudinal comparative study.

Setting

University research laboratory.

Participants

Patients (N=19) were evaluated at 12, 18, 26, 39, and 52 weeks after ACL reconstruction surgery.

Intervention

Testing on 5 separate occasions.

Main Outcome Measures

The Cincinnati Knee Rating System and analog scales, the 6-meter timed hop, crossover hop, stair hop, and vertical hop, and limb symmetry indices.

Results

The uninjured and injured legs and test order were randomized. There was a significant test occasion main effect for both the Cincinnati and analog scores (P=.001). Subjective rating scores improved over the 5 testing occasions. For all 4 hop tests, test occasion and limb main effects were significant (P=.001). Paired t test comparisons at each testing occasion indicated a significant difference between the reconstructed and uninjured limb (P<.05). Furthermore, significant test occasion main effects were noted for limb symmetry indices for the 4 hop tests (P=.001). Using a score of greater than or equal to 85% as a criterion for normative limb symmetry, normative scores were recorded in the 6-m timed hop at the week 18 test occasion, the stair hop and vertical hop at the week 26 test occasion, and the crossover hop at the week 39 test occasion.

Conclusions

These hop tests showed different levels of imposed demands on the knee that could be used to assess functional recovery and readiness to resume sport.     

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.