膝关节前交叉韧带损伤患者自我效能水平对术后膝关节功能恢复的影响

目的了解膝关节前交叉韧带损伤患者自我效能水平、术后进行功能锻炼的情况,以及术后1个月时膝关节活动度的恢复情况,并探讨其相关性。方法采用便利取样方法,选取北京市某三级甲等综合医院关节损伤门诊复查患者57例,采用中文版一般自我效能感量表调查其自我效能,采用自设问卷调查其锻炼情况,并记录其膝关节活动度。结果患者一般自我效能量表得分为(2.89±0.49)分,不同文化程度患者自我效能得分的差异有统计学意义(P<0.05);患者锻炼情况得分为(3.02±0.65)分;患者自我效能与锻炼情况呈正相关(r=0.335,P<0.05);患者膝关节活动度与锻炼情况呈正相关(r=0.230,P<0.05)。结论膝关节前交叉韧带重建术后,应有针对性地加强康复锻炼指导,提高患者自我效能水平,从而促进其膝关节功能的恢复。     

系统性康复锻炼对膝关节前交叉韧带并半月板损伤患者术后疼痛程度改善及膝关节功能的影响

目的探讨系统性康复锻炼对膝关节前交叉韧带并半月板损伤患者术后疼痛程度改善及膝关节功能的影响。方法选取2015年1月至2018年5月某院膝关节前交叉韧带并半月板损伤患者153例,按康复方案不同分实验组51例、延迟组51例、对照组51例。实验组予以系统性康复锻炼、延迟组延迟2周转康复医学科实施系统性康复锻炼、对照组建议适当自行锻炼。对比3组术前、术后1个月、6个月、12个月疼痛程度(VAS评分)及膝关节功能(HSS评分)。结果术后1个月至12个月HSS评分呈升高趋势,且实验组高于延迟组、对照组(P<0.05);术后1个月至12个月VAS评分呈降低趋势,且实验组低于延迟组、对照组(P<0.05)。结论予以膝关节前交叉韧带并半月板损伤患者系统性康复锻炼能促进膝关节功能恢复,缓解疼痛。     

膝关节前交叉韧带损伤

膝关节前交叉韧带损伤后的康复治疗过程中有一些问题需要注意和探讨。①康复训练介入的时机选择问题：何时开始进行何种训练，目前只能是采用时间来判定，缺乏比较明确的量化指标，基本上依靠经验。②具体实施的康复训练内容缺乏统一性，容易造成康复训练的片面性，哪些因素的训练对ACL的恢复是有用的，哪些是没有意义的。③对采用不同ACL重建手术方法的患者应采用不同康复训练程序，目前的研究基本上是不区分手术类型都采用同一套康复治疗手段。④缺乏统一的康复疗效评价指标：基本上停留在关节活动度和肌力的评价上，缺乏患者残疾、残障方面的评价。     

膝关节前交叉韧带损伤与康复

前交叉韧带(anterior cruciate ligament，ACL)是膝关节韧带中最易受损伤的部分，受损伤者绝大多数是喜爱体育活动的年轻人。国外运动性ACL损伤多见于足球、滑雪、橄榄球、篮球、排球等项目。而女性损伤多在足球、篮球、排球项目，女性在这些体育运动中ACL损伤的几率高于男性。国内运动专项研究结果表明，运动员组中，ACL损伤多见于足球、     

保留残端重建术对前交叉韧带损伤患者膝关节功能恢复及本体感觉恢复情况的影响

目的 探究保留残端重建术对前交叉韧带(anterior cruciate ligament,ACL)损伤患者的应用价值.方法 选取焦作市人民医院2017年4月至2019年4月105例ACL损伤患者为研究对象,依据手术保留或不保留残端分为对照组和观察组.对照组予ACL不保留残端重建术,观察组予ACL保留残端重建术,对比两...     

关节镜下保留残端重建前交叉韧带对前交叉韧带损伤患者膝关节功能恢复的影响

目的：探讨关节镜下保留残端重建前交叉韧带（ACL）对ACL损伤患者膝关节功能恢复的影响。方法：选择2018年3月~2020年5月收治的90例ACL损伤患者,根据随机数字表法分为干预组（45例）和对照组（45例）。两组患者均行ACL重建,干预组术中保留胫骨端ACL残端,对照组术中不保留胫骨端ACL残端。比较两组术前及术后3、6、12个月本体感觉和膝关节功能。结果：干预组术后3、6个月膝关节Lysholm评分高于对照组,被动角度再生试验结果、被动活动察觉阈值低于对照组,差异有统计学意义（P＜0.05）;两组术前、术后12个月被动角度再生试验结果、膝关节Lysholm评分、被动活动察觉阈值比较,差异无统计学意义（P＞0.05）。结论：关节镜下保留残端重建ACL治疗ACL损伤患者能够加快本体感觉恢复速度,促进膝关节功能恢复。     

自体材料重建前交叉韧带术后康复训练

目的：分析近年来关于自体材料重建前交叉韧带术后康复训练的文献资料，了解该领域的发展趋势。 资料来源：通过计算机检索Medline1990-01／2005-03的文章，检索词为“anterior cruciate ligament，reconstruction，rehabilitation”，限定文章语言种类为English；另外检索中文期刊全文数据库2000-04／2005-04的文章，检索词为“前交叉韧带、重建术、康复”，文章语言为中文。 资料选择：选取有关膝关节前交叉韧带重建术后康复训练的文章，纳入标准：①随机或自身前后对照的临床研究。②观点明确。③采用自体材料重建。排除标准：①综述。②重复性研究。③异体或异种材料重建。 资料提炼：共检索到49篇关于膝关节前交叉韧带重建术后康复训练的文章，选择其中符合标准的25篇进行综述。 资料综合：观察并比较保守、激进两种不同性质的康复训练方法对术后膝关节功能恢复的影响。一般来说，用骨-髌腱-骨重建后的康复训练应早于用膪绳肌重建，股四头肌肌力训练对术后膝关节功能恢复相当重要，闭链训练适用于康复早期，开链训练适用于康复晚期。由于前交叉韧带中存在着本体感受器，而重建材料中不舍有本体感受器，故术后本体感觉促进训练对膝关节功能的完善至关重要。 结论：前交叉韧带重建术后的康复训练变得越来越激进。康复训练方案应该按照重建材料的不同及个体差异分别制定。     

自我效能对手术后膝关节功能恢复的影响

目的 研究护理中自我效能对膝关节前交叉韧带损伤患者康复训练以及康复效果的影响。 方法 选取2011年10月-2013年10月到我院就诊的关节损伤患者共114例,在护理中对其进行基本情况的问卷调查、康复训练评分、自我效能评分以及康复结果调查,并采用统计学方法研究其间的相关性。结果 不同学历的患者自我效能评分差异具有统计学意义(P<0.05);自我效能越好,康复训练的得分越高,得分良好所占的人数也越高(P<0.05);患者的康复训练得分和康复效果均与自我效能评分呈正相关(P<0.05)。 结论 护理中自我效能可以提高患者康复的信心,使患者战胜康复训练中的种种困难,达到较好的康复效果,临床上应积极提高患者的自我效能。     

透视辅助韧带重建术对前交叉韧带损伤患者膝关节功能及稳定性的影响

目的 探讨透视辅助前交叉韧带(ACL)重建术对ACL损伤患者膝关节功能及稳定性的影响。方法 回顾性分析收治的175例ACL损伤患者的临床资料。根据不同手术方式分为对照组95例(常规关节镜下ACL重建术)和透视组80例(透视辅助关节镜下ACL重建术)。比较2组手术相关指标、膝关节功能恢复情况、骨髓道定位参数、膝关节稳定性和活动度以及并发症发生情况。结果 透视组患者手术时间长于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05)。术后12个月,透视组膝关节Lyshlom评分及国际膝关节文献委员会(IKDC)评分均高于对照组,差异有统计学意义(P<0.05)。透视组患者术后Blumensaat延长线与胫骨水平交点位置至胫骨隧道前边缘间距(a)与胫骨平台前后径宽度(c)比值(a/c)、Blumensaat线与胫骨隧道中轴线夹角(α角)小于对照组,Blumensaat线上垂直位点到Blumensaat线与股骨外侧髁前皮质交点间距(A)与Blumensaat线到股骨外侧髁前皮质交点间距(B)比值(A/B)大于对照组,差异有统计学意义(P<0.05)。术后12个月,透视组...     

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.     

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...     

关节镜下双股半腱肌移植前交叉韧带重建术后的康复

目的　探讨关节镜下双股半腱肌移植重建术前交叉韧带 (anteriorcruciateligament ,ACL)手术后配套的康复治疗计划及其在临床康复中的可行性。方法　研究设康复组患者 3 4例 ,对照组 2 1例。术后康复计划实施程序分 3个周期。Ⅰ期 :保护性康复期 ;Ⅱ期 :康复训练准备期 ;Ⅲ期 :抗阻力肌力强化训练期。结果　康复组除 2名 5 0岁以上女性患者关节活动度 (ROM )屈曲受限约 2 0°外 ,其余全部恢复正常。ROM达正常平均 8周 ,全部患者关节稳定性好。同期对比对照组显示 :ROM恢复迟缓 ,肌肉萎缩明显 ,关节达到正常ROM平均为 16周 ,8名患者屈曲受限 2 0° ,χ2 检验二组资料P <0 .0 1。结论　康复计划的实施可有效地防止术后并发症 ,是保证膝关节功能康复的重要措施。该项技术的应用与普及 ,有助于ACL术后康复水平的提高     

前交叉韧带损伤:MRI多征象分析

目的明确MRI对各种前交叉韧带(ACL)损伤征象的诊断价值.方法回顾分析139个经关节镜证实的膝关节MR图像,包括52个损伤的ACL和87个完好的ACL.在不告知关节镜结果的条件下,2名放射医生共同对5个ACL损伤直接征象和13个间接征象进行评价.结果在评价的5个直接征象中,ACL不连续和ACL走行异常均具有相对高的诊断敏感性、特异性以及阳性试验似然比(LR );在评价的13个间接征象中,大多数具有相对高的特异性和低的敏感性,其中"对吻性"骨挫伤、Notch征、胫骨前移位、以及外侧半月板后角裸露等4个征象具有相对高的LR .结论 ACL损伤的直接征象为诊断主要依据,以ACL不连续和ACL走行异常最具诊断价值;ACL损伤的间接征象具有辅助诊断意义,其中"对吻性"骨挫伤、Notch征、胫骨前移位、以及外侧半月板后角裸露等4个征象最有价值.     

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.     

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.     

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。     

Effect of suspension training on neuromuscular function,postural control,and knee kinematics in anterior cruciate ligament reconstruction patients

BACKGROUNDSuspension training (SET) is a method of neuromuscular training that enables the body to carry out active training under unstable support through a suspension therapy system. However, there have been few reports in the literature on the application of SET to anterior cruciate ligament reconstruction (ACLR) patients. It is not clear what aspects of the patient''s function are improved after SET.AIMTo investigate the effect of SET on the neuromuscular function, postural control, and knee kinematics of patients after ACLR surgery. METHODSForty participants were randomized to an SET group or a control group. The SET group subjects participated in a SET protocol over 6 wk. The control group subjects participated in a traditional training protocol over 6 wk. Isokinetic muscle strength of the quadriceps and hamstrings, static and dynamic posture stability test, and relative translation of the injured knee were assessed before and after training. RESULTSThe relative peak torque of the quadriceps and hamstrings in both groups increased significantly (P < 0.001), and the SET group increased by a higher percentage than those in the control group (quadriceps: P = 0.004; hamstrings: P = 0.011). After training, both groups showed significant improvements in static and dynamic posture stability (P < 0.01), and the SET group had a greater change than the control group (P < 0.05). No significant improvement on the relative translation of the injured knee was observed after training in either group (P > 0.05). CONCLUSIONOur findings show that SET promotes great responses in quadriceps and hamstring muscle strength and balance function in ACLR patients.