持续被动活动对兔重建前交叉韧带生物力学特性的影响

目的:采用半腱肌腱重建兔前交叉韧带(ACL),探讨持续被动活动(CPM)对移植物生物力学特性的影响。方法:对30只8月龄雄性新西兰大白兔右侧后肢膝关节行自体双股半腱肌腱移植重建前交叉韧带手术。术后随机分为CPM组和非CPM组两组:CPM组术后第2天开始采用自制兔膝关节CPM器进行持续被动活动,共6周;非CPM组仅笼养。分别于术后第6、12、24周取材,每组每次取5只行生物力学观察。结果:与非CPM组相比,CPM组大部分标本两束融合成一体。从术后6周到24周,所有移植物的最大载荷、最大应力、弹性模量以及这些指标和其对照侧ACL的比值逐渐增加。在术后6、12、24周时,CPM组移植物最大载荷分别为22.72N、79.56N、122.20N,最大应力分别为4.58MPa、13.62MPa、21.79MPa;非CPM组移植物最大载荷分别为16.00N、70.68N、96.20N,最大应力分别为3.07MPa、11.58MPa、17.89MPa。3个时间点两组间上述指标差异均具有统计学意义(P<0.05)。结论:半腱肌腱重建兔前交叉韧带术后早期进行持续被动活动可明显提高移植物的生物力学性能。     

跑台运动对兔前交叉韧带断裂后膝关节软骨的影响

目的:建立一种可有效用于研究兔前交叉韧带(ACL)断裂后运动对软骨影响的实验运动模型,进而研究早期运动对兔ACL断裂后关节软骨的影响。方法:45只成年新西兰大白兔(4~5月龄,体重2.5~3kg),随机平均分为:I组,假手术自由活动组(Sham组);II组,前交叉韧带切断(ACL transection)自由活动组(ACLT组);III组,前交叉韧带切断跑台运动组(ACLT with exercise,ACLT+Ex组)。运动组在实验跑台上定期运动,运动始于术后第5天,运动强度为5天/周,10分钟/天,跑台速度为0.3英里/小时(约8米/分钟)。分别于术后第2、3、4周每组处死5只兔子,对兔膝关节股骨髁软骨进行印度墨汁染色大体观评分、组织学和二型胶原免疫组化染色并使用国际骨关节炎研究会(OARSI)软骨损伤评分系统进行软骨损伤评估。结果:术后2周,Sham组、ACLT组和ACLT+Ex组未见明显软骨损伤;术后3周、4周,Sham组软骨未见明显损伤退变;ACLT组和ACLT+Ex组均出现软骨损伤,在大体观评分和OARSI分级、分期、总分上分别与Sham组存在显著统计学差异;ACLT组与ACLT+Ex组在大体观评分和OARSI软骨损伤评分上无统计学差异。结论:跑台运动是可用于研究兔ACL断裂后对关节软骨损伤研究的有效实验运动模型;兔ACL断裂后早期出现关节软骨损伤,但与笼养自由活动相比,实验跑台运动对关节软骨损伤进程无影响,表明ACL断裂后早期进行合理运动与康复不会加重膝关节软骨损害。     

CPM机锻炼在人工全膝关节置换术后早期康复训练中的效果评价

目的探讨CPM机持续被动锻炼在人工膝关节置换术后早期康复训练中的应用及效果评价。方法对92例人工膝关节置换进行早期CPM康复训练指导并进行随访。结果本组所有病例在术后7～14 d在步行器的帮助下步行,膝关节自主屈曲活动均达到90°以上,伸直0°,出院2～3个月后生活完全自理。结论对膝关节置换术后患者应用CPM机进行功能康复训练指导,可以有效防止关节粘连,使膝关节早日恢复良好状态。     

半导体激光局部照射在全膝关节置换术后康复训练中的应用

目的 探讨810 nm半导体激光局部照射对全膝关节置换术后疼痛及关节活动度的治疗效果.方法 将60例全膝关节置换术后患者随机分为治疗组及对照组,每组30例.治疗组于置换手术后第2天开始在手术部位以波长810 nm、输出功率50～100 mW、光斑直径8～10 cm半导体激光局部照射,照射距离5 cm,照射时间10 min,每日1次,10次为一疗程.同时开始使用持续被动运动(continuous passive motion,CPM)训练仪进行训练.对照组单纯使用CPM训练仪进行训练.疗程结束后两组采用视觉模拟评分法(visual analogue scale,VAS)对疗效进行比较,并分别于术后3、5和10 d以量角器测量关节活动度,比较两组患者的膝关节活动度.结果 总有效率治疗组为96.7%,对照组为83.3%.差异有显著意义(P<0.05).康复治疗后3、5和10 d膝关节活动度治疗组皆好于对照组,差异有显著意义(P<0.05).结论 膝关节置换术后使用810 nm半导体激光局部照射,可缓解局部疼痛,消除肿胀,松解粘连,改善关节活动度,是提高术后疗效的有效治疗方法.     

全膝关节置换术后早期康复对膝关节功能和日常生活活动能力的影响

目的:探讨全膝关节置换术(Total Knee Arthroplasty,TKA)后早期康复对患者功能改善的效果.方法:单侧全膝关节置换术患者60例,随机分为康复治疗组30例和对照组30例,康复治疗组按我科制定的康复训练程序进行早期康复治疗,对照组采用常规CPM机进行持续被动运动,在入院后和出院前分别对两组患者的患膝进行主动关节活动度(AROM),WOMAC量表以及FIM量表的评定,对结果进行比较.结果:出院时两组患者膝关节活动度、WOMAC及FIM评分均比入院时有明显改善(P<0.01),其中康复治疗组AROM显著高于对照组(P<0.01),康复治疗组WOMAC量表每项积分均低于对照组(P<0.05,P<0.01),康复治疗组的FIM评估在生活自理、转移、行进三项内容积分高于对照组(P<0.05).结论:全膝关节置换术后早期康复能明显改善患者膝关节功能水平,对生活自理、转移、行进三方面能力亦有改善和提高.     

前交叉韧带重建术后应用玻璃酸钠减少髌股摩擦感的临床研究

目的:评价前交叉韧带重建术后关节内注射玻璃酸钠对减少术后髌股摩擦感、改善膝关节活动度的作用。方法:将我院2012年1月至2013年4月收治的单纯膝关节前交叉韧带断裂患者80例随机分为治疗组和对照组,每组40例,两组均采用同一术者、手术方式和康复计划。治疗组术后4周开始注射玻璃酸钠25mg,1次/周,连续注射5周。分别在术后4周(注射前)、8周、12周、半年、1年对患者进行随访,随访内容包括髌股摩擦感、关节活动度。结果:术后4周及8周时两组髌股摩擦感人数比较差异无统计学意义,术后12周、6月及1年时两组差异有统计学意义(P<0.05)。术后4周时两组关节活动度比较差异无统计学意义,术后8周及12周两组间差异有统计学意义(P<0.05),而术后6个月及1年时差异有显著的统计学意义(P<0.01)。结论:前交叉韧带重建术后关节内注射玻璃酸钠可以明显减少髌股摩擦感,改善关节活动度。     

膝关节韧带联合损伤的关节镜治疗后康复护理效果分析

目的探讨关节镜下膝关节前交叉韧带、后交叉韧带、内侧副韧带、外侧副韧带、后外侧结构联合损伤的康复护理效果。方法2003年10月—2005年11月,采用关节镜下重建交叉韧带,修复或重建侧副韧带和后外侧结构治疗急性膝联合韧带损伤12例。术后早期等长肌力练习、早期完全负重、早期本体感觉练习、早期被动练习。出院后随诊并功能评分。结果12例均获得随访,随访时间6~24个月,平均14个月。Lysholm评分:优2例,良8例,可2例。关节稳定性良好,有2例腘绳肌腱重建者抽屉试验Ⅰ度阳性。膝关节屈曲超过120°者9例,90~120°者3例。结论膝关节联合韧带损伤关节镜手术治疗配合正确的康复护理可取得良好效果。     

关节持续被动活动联合中药熏洗在手外伤术后康复中的效果观察

目的:观察关节持续被动活动(CPM)联合中药熏洗在手外伤术后康复中的效果。方法:选择手外伤术后100例,随机分为观察组和对照组各50例。对照组仅采用常规康复练习;观察组在此基础上采用CPM配合中药熏洗。疗程均为4周。6个月后随访,比较两组总主动活动度(TAM)评分及手部遗留症状。结果:观察组TAM评分优良率78.0%,非常显著高于对照组的48.0%(P<0.01);观察组手部遗留症状明显及不能耐受者共占18.0%,非常显著低于对照组的44.0%(P<0.01)。结论:CPM配合中药熏洗可有效促进手外伤术后手部功能恢复,减少遗留症状。     

患侧腘绳肌腱移植重建膝关节前交叉韧带治疗膝关节三联征

目的比较采用患侧与健侧自体腘绳肌腱移植重建前交叉韧带损伤伴侧副韧带损伤的临床疗效。方法选择膝关节三联征患者28例,随机分为两组:A组(取患侧腘绳肌腱重建前交叉韧带+侧副韧带修复)和B组(取健侧腘绳肌腱重建前交叉韧带+侧副韧带修复)。比较两组患者手术时间,术前后关节活动度、Lysholm评分。结果两组的术后关节活动度恢复、Lysholm评分比较无统计学差异(P>0.05),两组手术时间比较,差异有统计学意义(P<0.05)。结论采用患侧自体腘绳肌腱移植重建前交叉韧带治疗膝关节三联征可获得良好疗效。     

持续被动活动在膝关节外科中的应用

膝关节外伤或手术后常发生膝关节的僵硬。本文报告对54例膝关节伤病在术后进行持续被动活动治疗的结果,术后10个月的随访效果满意。持续被动活动有助于防止关节内粘连和关书僵直,促进关节软骨和关节周围组织的愈合,从而加速手术后的康复进程。     

Nutrition of the anterior cruciate ligament. Effects of continuous passive motion

Twelve freshly killed mature male rabbits were used to study the effects of continuous passive motion (CPM) on regional and overall nonvascular nutritional pathways of the anterior cruciate ligament (ACL). One hundred fifty microcuries of 35sulphate was injected intraarticularly into each knee joint. The right knee underwent CPM for 1 hour, while the left knee remained immobilized. Both knee joints were then isolated and immediately frozen. The ACLs were removed while still mostly frozen, and sectioned into anterior, middle, and posterior thirds for the six rabbits in Group 1, and proximal, middle, and distal thirds for the six rabbits in Group 2. In addition, quadriceps tendon samples were harvested from each limb of three rabbits. After appropriate processing, all samples were counted in a scintillation counter, and counts per minute per milligram of tissue were calculated. There was significantly higher uptake in rest extremity ACLs compared to CPM extremity ACLs (P = 0.0001). No significant difference was demonstrated in regional uptake comparing respective thirds of the ACL in either Group 1 or Group 2. Quadriceps tendon uptake trended higher in the limbs exposed to CPM compared to those maintained at rest (P = 0.14). The ACL uses diffusion as a primary nutrient pathway. CPM does not increase nutrient uptake by the ACL in this avascular model, but CPM may facilitate transport of metabolites out of the joint. No regional differences in uptake within the ACL occurred in either group.     

Early knee motion after open and arthroscopic anterior cruciate ligament reconstruction

The hypothesis proposed in this study was that the initiation of active and passive knee motion within 48 hours of major intraarticular knee ligament surgery would not have the deleterious effects of increasing knee effusion, hemarthrosis, periarticular soft tissue edema, and swelling. We conducted a prospective study with randomized assignment of 18 patients into two groups: 9 patients in the "motion" group began 10 hours of daily continuous passive motion (CPM) on the 2nd postoperative day, while the remaining 9 in the "delayed motion" group used a soft hinged knee brace with knee hinges locked at 10 degrees of flexion and entered into the motion program on the 7th postoperative day. All knees were allowed full 0 degrees to 90 degrees of motion except for a total of seven knees with concomitant mensicus repairs and extraarticular reconstructions where 20 degrees to 90 degrees of motion was allowed, limiting the last 20 degrees of knee extension for the first 4 postoperative weeks to protect the repair. In all other respects, the rehabilitation program after surgery was the same for the two groups, including postoperative compression dressings, exercises, and weight-bearing status. Ten of the eighteen patients had acute ACL disruptions and 8 had chronic ACL insufficiencies. There was an even distribution of acute and chronic knee cases and of open and arthroscopic ligament procedures in the early and delayed motion groups. Associated surgery included four meniscus repairs, three medial collateral ligament repairs, and one lateral collateral ligament repair. Special suturing and fixation techniques were used at surgery to maintain the integrity of ligament and meniscus structures, allowing the surgeon to feel safe in subjecting the joint to early postoperative motion. The objective parameters measured were KT-1000 arthrometer measurements, Cybex isokinetic testing, girth measurements at four lower limb locations, range of motion goniometer measurements, postoperative pain medications, and days of hospitalization. Starting intermittent passive motion on the 2nd postoperative day did not increase joint effusion, hemarthrosis, or soft tissue swelling. In both motion groups, postoperative joint effusions were absent after the 14th postoperative day. There was no statistically significant difference in knee extension or flexion limits, pain medication used, or hospital stay in comparing the two knee motion programs. An important finding of this study was the significant decreases in thigh circumference that occurred within the first few weeks of surgery, which progressed despite a closely supervised inpatient and outpatient rehabilitation program.(ABSTRACT TRUNCATED AT 400 WORDS)     

Benefits of active motion for joint position sense

Anterior cruciate ligament (ACL) ruptures lead to a proprioceptive deficit and therefore joint position sense. This study examined whether active motion is better suited than passive motion to address this deficit. Sixty patients with ACL rupture were prospectively randomised into two groups [continuous active motion (CAM)/continuous passive motion (CPM)]. All patients had an ACL reconstruction. An angle reproduction test was used to assess the proprioceptive deficit. The relevant examinations were performed before surgery (pre-op evaluation) and after the seventh postoperative day. No preoperative difference was found between the two groups. After postoperative treatment, the deficit was reduced in both groups. Significantly better results were, however, obtained in the CAM group (CPM, 4.2±1.6°; CAM, 1.9±1.2°; P<0.001). During the first postoperative week, a CAM device produced a significantly greater reduction in the proprioceptive deficit and should be the first choice in immediately postoperative rehabilitation after ACL replacement.     

Treatment of limited motion after anterior cruciate ligament reconstruction

Limited motion or arthrofibrosis after anterior cruciate ligament (ACL) reconstruction causes significant pain and functional impairment. Based on physical findings and loss of motion compared with the opposite normal knee, classification systems for the diagnosis and treatment of arthrofibrosis have been developed. The operative techniques and preoperative and postoperative rehabilitation and management are discussed. Range of motion (ROM) problems after ACL reconstruction have been minimized by improved surgical techniques and perioperative rehabilitation programs. The most effective treatment for arthrofibrosis is prevention by delaying ACL reconstruction until the patient has a normal gait and full ROM and minimal swelling in the injured knee and by appropriate ROM exercises after surgery. Received: 13 October 1997 Accepted: 23 June 1998     

The effect of continuous passive motion on anterior cruciate ligament reconstruction stability

This study was undertaken to examine the immediate effect of continuous passive motion (CPM) on anterior cruciate ligament (ACL) reconstruction stability. Cadaver knees were tested with a knee arthrometer with the anterior cruciate intact and then with the anterior cruciate sectioned. One of three anterior cruciate reconstructions was then performed and stability was restored to the knee and it was again tested with the knee arthrometer. Stability was defined as being within 2 mm of the intact measurement. The three operations selected were the Marshall-MacIntosh "over-the-top," (OTT) a patellar bone-patellar tendon-tubercle bone (BTB) graft, and a semitendinosis reconstruction. The specimens were placed on a CPM device in a cooler at 38 degrees F and put through a range of motion of 20 to 70 degrees at 10 cycles per minute for 3 days. A success was less than a 2 mm increase in the post-CPM measurement compared to pre-CPM. All three bone-tendon-bone operations failed. The semitendinosis operation was successful in only three out of eight specimens. The OTT operation was successful in eight out of nine specimens. The possible reasons for success and failure are discussed. Because of the potential problems with failure of an ACL with CPM it is suggested that the particular technique being used for an anterior cruciate reconstruction be tested prior to it being used with CPM clinically.     

Rehabilitation of the multiple-ligament-injured knee

Rehabilitation for a patient with a multiple-ligament knee injury should be designed to reduce pain and swelling, restore range of motion, strength, and endurance, and to enhance proprioception, and dynamic stability of the knee, with the goals of restoring function and minimizing disability. The biomechanics of the knee must be considered when designing a rehabilitation program. General guidelines for rehabilitation of the multiple-ligament-injured knee include considerations for promoting tissue healing, decreasing pain and swelling, restoring full motion, increasing muscular strength and endurance, improving proprioception, enhancing dynamic stability of the knee, and reducing functional limitations and disability. A patient's progression through this sequence must be individualized and depends on the pattern of ligament injury or surgical procedure that was performed, and the principles of tissue healing. Specific guidelines for rehabilitation following ACL reconstruction combined with MCL repair, PCL reconstruction, combined ACL-PCL reconstruction, and reconstruction of the LCL and posterolateral corner have been provided.     

前交叉韧带重建军人患者快速康复与传统康复对术后功能恢复的影响

目的 比较快速康复训练与传统康复训练对军人患者前交叉韧带重建术后膝关节功能及运动恢复的影响.方法 回顾性分析2018-06至2019-06在东部战区总医院骨科行关节镜下前交叉韧带重建术的102例军人患者资料,分为快速康复组(51例)和传统康复组(51例).分别记录两组患者术前、术后疼痛视觉模拟量表(VAS)评分、Lys...     

前交叉韧带重建术后移植物的韧带化过程及其影响因素

目的:探讨前交叉韧带(ACL)重建术后移植物的韧带化过程及其影响因素。方法:选取2013年1月至12月期间的膝关节镜下ACL重建手术患者,记录患者的性别、年龄、体重、身高、体重指数(BMI)、关节松弛度评分(Beighton评分)、ACL断裂病程时长和半月板处理情况。术后6月、1年、2年和4年随访时进行膝关节稳定性检查,并通过核磁检查测量韧带移植物近端、中部和远端的信号强度,分别计算信噪比(SNQ),用以评估重建韧带的韧带化情况。对全部数据进行统计分析,探讨韧带移植物的韧带化情况及其影响因素,以及与膝关节稳定性的相关性。结果:共计71例ACL重建患者入选研究,结果显示韧带移植物近端、中部和远端的SNQ值均随时间延长逐渐减小,韧带中部的SNQ值在术后2年、韧带近端和远端的SNQ值在术后4年呈现显著性降低(P<0.05)。性别、年龄、体重、身高、BMI、Beighton评分、ACL断裂时长和半月板处理情况等因素对韧带移植物的SNQ数值均无显著性影响(P>0.05),SNQ数值与随访时膝关节稳定性无显著相关性(P>0.05)。结论:ACL重建术后韧带移植物的韧带化情况随时间...