前十字韧带缺损膝本体感觉的变化与重建

前十字韧带(anterior cruciate ligament,ACL)断裂引起的膝关节不稳(即ACL缺损膝)为当前运动医学、矫形外科和康复医学的治疗难题〔1〕,过去对这一问题常倾向于外科手术进行解剖结构的重建,但不少随访资料表明〔1,2〕,尽管ACL缺损膝经矫形外科术后,关节稳定性有改善,但关节运动功能的恢复并不令人满意。不少研究认为〔1,3〕,ACL损伤常导致关节本体感觉的缺失,由此引起的关节神经肌肉控制能力减弱可能是功能性关节不稳的重要原因之一。因此提出ACL缺损膝关节稳定性的重建,不仅应包括关节生物力学稳定性的重建,而且还应有健全…     

胫腓骨折合并膝关节后十字韧带损伤18例分析

胫腓骨骨折合并同侧膝关节后十字韧带损伤早期常易忽视造成漏诊 ,错过最佳治疗时机 ,难取得满意疗效 ,我院自1996 - 0 7至今共收治 18例 ,经中西医结合治疗效果良好 ,报告如下。1　临床资料本组男 13例 ,女 5例。胫腓骨粉碎骨折 12例 ,横断骨折 6例 ,其中开放骨折 6例 ,本组 18例均为车祸伤。后十字韧带损伤早期确诊 11例 ,漏诊 5例 ,伤后至就诊最长时间 98d,最短 5 d,平均 2 4.4d。急性期诊断明确的 11例中 ,2例采用外固定治疗 ,余 9例均手术治疗 ,胫腓骨骨折钢板内固定 ,后交叉韧带损伤行探查修补术。早期漏诊后十字韧带损伤 5例 ,采用半…     

系统化康复训练路径在前交叉韧带重建后膝关节本体感觉功能训练中的应用效果

目的探讨系统化康复训练路径在前交叉韧带重建后膝关节本体感觉功能训练中的应用效果。方法选取我院2015年2月至2016年2月我院收治的82例进行膝前交叉韧带重建术后的患者为研究对象,随机将其等分为研究组和对照组,对照组患者术后给予一般的康复训练,研究组患者在对照组的基础上加入本体感觉强化训练。在术后6个月比较两组患者患膝和健膝关节位置重现偏差与本体感觉恢复效果。结果两组患者健侧膝比较,差异无统计学意义(P> 0. 05),研究组患侧膝的总平均偏差明显好于对照组(P <0. 05);在患者的本体感觉恢复程度上研究组同样好于对照组(P <0. 05)。结论前交叉韧带重建术后运用强化本体感觉训练能尽快使患者的下肢功能恢复,可以加快患者自主行走这一目标的实现,值得临床推广应用。     

前十字韧带损伤的诊断评价

一、解剖、功能及损伤机制 膝关节前十字韧带(anterior cruciate ligament;A-CL)断裂是发生率较高且严重的损伤,常由运动不当或暴力伤引起,治疗不当会导致膝关节不稳,并可继发关节内主要结构损伤,严重影响膝关节功能。 ACL起于胫骨髁间前突内侧部,内侧髁间结节的     

自体与同种异体组织移植重建膝关节前十字韧带

背景：关节镜辅助下重建前十字韧带的移植物主要有自体组织移植物、同种异体组织移植物,各具优势,对于如何选择移植物存在较多争议。目的：评价关节镜辅助下自体与同种异体组织重建膝关节前十字韧带的疗效。方法：回顾性分析2010年6月至2013年6月于阿克苏地区第一人民医院骨科行关节镜辅助下膝关节十字韧带重建52例患者的临床资料,其中自体组织移植组27例,同种异体组织移植组25例。结果与结论：与同种异体组织移植组相比,自体组织移植组重建后住院天数和发热天数均减少（P〈0.05）。两组重建后物理学检查、功能试验、国际膝关节文献编制委员会分级评估标准与Lysholm-Tegner膝关节综合功能评定结果比较差异无显著性意义（P〉0.05）。结果证实,关节镜辅助下自体与同种异体组织重建膝关节前十字韧带均是安全可行的手术方案;自体组织移植与同种异体组织移植重建前十字韧带重建后膝关节功能恢复疗效相同,但两组间住院天数和发热天数之间的差异将影响人们对移植物的选择。     

磁共振技术在膝关节内外侧副韧带及十字韧带损伤中的临床诊断效果

目的：观察磁共振技术在膝关节内外侧副韧带及十字韧带损伤中的临床诊断效果。方法：选取2020年1月—2021年1月间内蒙古科技大学包头医学院第一附属医院收治的200例内外侧副韧带及十字韧带损伤患者作为研究对象,采用随机数字表法将所有患者分为观察组和对照组,各100例,分别实施关节镜检查诊断和磁共振检查诊断,对比两组患者诊断准确率、韧带损伤检出例数、韧带损伤情况、生活质量评分以及患者满意度。结果：观察组患者诊断准确率（98.00%）、韧带损伤检出例数（98例）、生活质量评分以及患者满意度（96.00%）均高于对照组,观察组患者韧带损伤率高于对照组,差异均有统计学意义（P <0.05）。结论：磁共振技术在膝关节内外侧副韧带及十字韧带损伤中的临床诊断效果显著,可以快速确定患者韧带损伤情况,诊断准确率高,患者满意度高,建议临床应用。     

转移腓骨长肌腱治疗膝关节交叉韧带及内侧副韧带损伤

外伤所致膝关节的前后交叉韧带、内侧副韧带断裂损伤在临床上较多见,治疗方法亦多种多样,但疗效并不满意。1991年7月～1994年8月我们应用转移胖骨长肌胜静力修复膝关节炎稳症12例,效果较好,报道如下。1临床资料1．1一般资料本组12例,男7例,女5例;年龄27～51岁,平均40岁。左膝关节7例,右膝关节5例。10例为新鲜损伤,2例是陈旧性损伤。2例伴有髌骨折,3例伴有髁间撕脱骨折,7例伴有半月板损伤,卫例伴滚韧带断裂。12例均为闭合性损伤。1．2手术方法选用持续硬膜外腔麻醉。取仰卧位,应用止血带。选用膝关节前侧切口,下端止于胫骨结…     

本体感觉强化训练对前交叉韧带重建后功能恢复的影响

目的探讨本体感觉强化训练对前交叉韧带重建后膝关节功能恢复的影响。 方法选取30例前交叉韧带重建后患者按随机数字表法分为干预组和对照组,每组15例。2组患者均接受常规康复训练,干预组在此基础上给予本体感觉强化训练。分别于入组时（治疗前）和治疗8周后（治疗后）,采用再成角试验对2组患者本体感觉进行评定;采用PH-A平衡功能检测系统评定患者平衡功能,在双足站立位（睁眼和闭眼状态下）进行,取摆幅指数（SI）、摆动的轨迹长和外周面积三个指标进行分析;下肢运动协调性采用表面肌电时序分析;膝关节功能采用Lysholm膝关节功能评分。 结果2组在入组时再成角试验、平衡检测指标及Lysholm膝关节功能评分差异均无统计学意义（P&rt;0.05）,具有可比性。治疗后,2组患者再成角试验结果显示,干预组膝关节的平均偏差为（7.62±3.21）mm,明显低于对照组的（12.96±4.63）mm,且组间差异有统计学意义（P<0.05）;2组患者治疗后平衡检测中闭眼状态下各指标均较组内治疗前有显著改善（P<0.05）,且干预组治疗后评分较对照组明显改善,组间治疗后差异亦有统计学意义（P<0.05）。表面肌电分析在最大等长收缩过程中,干预组患膝治疗后的拮抗肌协同收缩率较组内治疗前明显降低（P<0.05）。2组患者治疗前Lysholm膝关节功能评分差异无统计学意义（P&rt;0.05）,而治疗后干预组的Lysholm膝关节功能评分较对照组治疗后明显改善（P<0.05）。 结论本体感觉强化训练不仅对ACL重建后患者的本体感觉恢复有肯定疗效,还能促进患者平衡功能、下肢运动协调性及膝关节功能的全面恢复。     

前交叉韧带重建术后膝关节功能康复的阶段性本体感觉训练

总结前交叉韧带重建术后通过阶段性本体感觉训练恢复患者膝关节功能的方法。术后早期：炎症反应期（术后第1周）采取踝泵运动、股四头肌和胭绳肌等长收缩、主动和被动关节活动度锻炼、直抬腿及侧抬腿练习、行走训练;初期：部分负重期（术后第2一第5周）进行关节活动度训练、肌力强化训练、增加平衡板和同定自行车练习;中期：完全负重期（术后第6周至第3个月）增加半蹲训练、步行灵活性和慢跑训练;后期：恢复活动期（术后第4－第12个月）行绕环练习、侧踏台阶训练,并可选择游泳、跳绳、慢跑或户外自行车等。本组48例患者术前Lysholm膝关节评分（56．7&#177;3．7）分,术后2个月为（91．8&#177;3．5）分,术后6个月评分为（94．7&#177;3．1）分,关节功能明显改善,治疗和康复效果满意。     

平衡促进训练对膝关节前交叉韧带损伤重建术后患膝本体感觉的影响

目的:研究平衡促进训练对膝关节前交叉韧带(ACL)损伤重建术后患膝本体感觉的影响。方法:选取124例ACL损伤重建术后患者,全部进行常规康复训练12周,术后第12周采用随机数字法分成两组(对照组62例,训练组62例),训练组在第12周开始进行平衡促进训练,持续至第16周;对照组继续进行患肢肌力和步态训练,持续至第16周。采用专业平衡功能评定系统,分别在术后第12周和第16周对两组进行平衡功能测定。结果:术后第16周测定结果:①睁眼状态下,训练组与对照组在指标LFS指数和覆盖90%椭圆区域面积指数无显著差异(P>0.05)。②闭眼状态下,训练组与对照组在指标LFS指数和覆盖90%椭圆区域面积指数差异具有显著性意义(P<0.05)。结论:平衡促进训练对ACL损伤重建术后患者膝关节本体感觉能力恢复具有显著提高作用。     

Effects of 4 weeks preoperative exercise on knee extensor strength after anterior cruciate ligament reconstruction

[Purpose] After an anterior cruciate ligament injury and subsequent reconstruction, quadriceps muscle weakness and disruption of proprioceptive function are common. The purpose of this study was to examine the effects of a 4 weeks preoperative exercise intervention on knee strength power and function post-surgery. [Subjects and Methods] Eighty male patients (27.8±5.7 age), scheduled for reconstruction surgery, were randomly assigned to two groups, the preoperative exercise group (n=40) and a no preoperative exercise group (n=40). The preoperative exercise group participated in a 4-week preoperative and 12-week post-operative programs, while the no preoperative exercise group participated only in the 12-week postoperative exercise program. Isokinetic measured of quadriceps strength were obtained at 4 weeks before and 3 months after surgery. [Results] The knee extensor strength deficits measured at 60°/s and 180°/s was significantly lower in the preoperative exercise group compared with the no preoperative exercise group. At 3 months after surgery, the extensor strength deficit was 28.5±9.0% at 60°/sec and 23.3±9.0% at 180°/sec in the preoperative exercise group, whereas the no preoperative exercise group showed extensor strength deficits of 36.5±10.7% and 27.9±12.6% at 60°/sec and 180°/sec, respectively. The preoperative exercise group demonstrated significant improvement the single-leg hop distance. [Conclusion] Four week preoperative exercise may produce many positive effects post reconstruction surgery, including faster recovery of knee extensor strength and function, as measured by single-leg hop ability.Key words: Anterior cruciate ligament, Preoperative exercise, Knee extensor strength     

Effect of a functional knee brace on knee flexion and extension strength after anterior cruciate ligament reconstruction

OBJECTIVES: To investigate the effect of a knee brace on knee flexion and extension muscular strength of patients after anterior cruciate ligament (ACL) reconstruction and to evaluate whether the effect of the brace depends on patient symptoms and muscular strength. DESIGN: Repeated measures. SETTING: A university-based outpatient orthopedic clinic and musculoskeletal assessment laboratory. PARTICIPANTS: Twenty-seven patients (14 women, 13 men; mean age, 28+/-11 y) having undergone arthroscopically assisted ACL reconstruction by using a semitendinosus and gracilis autograft. INTERVENTION: A custom-fit ACL functional knee brace. MAIN OUTCOME MEASURES: The brace effect was calculated as the change in peak torque observed with the brace, expressed as a percentage of peak torque observed without the brace, during isokinetic concentric knee flexion and extension movements performed at 90 degrees /s. Patient symptoms were quantified by using a disease-specific health-related quality of life questionnaire. RESULTS: Knee flexion strength decreased significantly with the brace (mean brace effect=-7.3%, P<.05). The brace effect during knee flexion varied considerably (-52% to 47%) and was significantly related to peak torque observed without the brace (r=-.50, P<.01). All other comparisons and correlations were not significant. CONCLUSIONS: These findings suggest that brace effects depend on patient strength. A brace may inhibit knee flexion strength of stronger patients, yet result in no change or even improvements in strength of weaker patients. Future research is required to further elucidate which patients may derive most benefit or detriment from bracing.     

前交叉韧带重建后膝关节本体感觉功能的康复训练与护理

膝关节前交叉韧带重建后,本体感觉功能的恢复与否是衡量膝关节功能恢复的重要标志.总结了对53例前交叉韧带重建术后病人的康复训练与护理,重点包括股四头肌等长收缩锻炼,直腿抬高训练,终末伸膝锻炼,视知觉下的膝关节角度、位置训练,以及功能协调性训练和心理护理等.经8～24个月随访,本组有49例(占92.5%)本体感觉恢复良好,病人满意.认为在前交叉韧带重建后进行系统、正规的康复训练和护理,有利于促进膝关节本体感觉功能的恢复.     

保留残端重建对膝关节本体感觉恢复的影响

前交叉韧带对维持膝关节的稳定具有重要的作用,临床上治疗前交叉韧带损伤的标准是关节镜下重建损伤的韧带。据报道,解剖重建术已经能很好地恢复术后膝关节的前后向及旋转向稳定性。但相当部分患者术后诉关节不稳和肌无力,有学者研究认为这可能与术后膝关节本体感觉恢复有关。     

Muscular isokinetic strength recovery after knee anterior cruciate ligament reconstruction revision: Preliminary study

MethodThirty-nine revision of ACL reconstructions were evaluated: 23 primary ACL reconstructions with bone-patellar tendon-bone graft (BPTB) revised with hamstring tendon (HT) grafts, 10 primary ACL reconstructions with HT grafts revised with ipsilateral BPTB graft (iBPTB) and finally 6 primary ACL reconstructions with BPTB grafts revised with contralateral BPTB (cBPTB) grafts were compared with 78 primary ACL reconstructions (46 HT grafts and 32 BPTB grafts). Recovery of isokinetic muscle strength was evaluated at 4, 6 and 12 months post-revision surgery.ResultsDeficits in muscle strength at 12 months post-revision ACL surgery were comparable to the one observed for primary ACL reconstruction with the same technique. At 4 and 6 months post-surgery, strength deficits for the knee extensors were less pronounced after revision ACL reconstruction with HT grafts (25% ± 16 vs. 37% ± 16; P < 0.001) and iBPTB grafts (41% ± 11 vs. 17% ± 17; P < 0.001).DiscussionLower strength deficits for the knee extensors after revision ACL reconstruction with HT grafts can be explained by a less intensive rehabilitation program due to lower stakes in resuming sport activities. With cBPTB, donor-site morbidity could explain the decreased strength deficits for knee extensors.ConclusionDeficits in isokinetic muscle strength after ACL revision seem similar to the ones observed after primary ACL reconstruction with the same surgical technique.     

人工韧带重建与膝关节前交叉韧带的运动损伤

目的:总结膝关节前交叉韧带的结构、功能,损伤的力学机制和特点及其缺损后的人工韧带重建研究现状,为人工韧带的临床应用提供依据.方法:以"膝关节,前交叉韧带,人工韧带,重建"为关键词,用计算机检索维普数据库和Medline数据库,按纳入和排除标准,对文献进行筛选,共纳入31篇文章.重点对以下3个方面进行了探讨:①前交叉韧带的结构和功能?②前交叉韧带运动损伤机制和特点?③前交叉韧带运动缺损后人工韧带的重建?结果:前交叉韧带由胶原纤维组成,对膝关节的内旋和胫骨的伸直活动起稳定性作用,限制胫骨前移及过度伸展,对膝内侧的稳定、膝伸直位时胫骨旋转活动限制作用.在一些扭转、斜切、急停等动作较多的运动中容易发生损伤,诸多研究表明LARS人工韧带重建前交叉韧带效果与其他移植物相比具有显著优势.结论:前交叉韧带在膝关节的稳定当中起着重要作用,但也是极易发生损伤的部位.当前对于前交叉韧带缺损的治疗比较认可的方法是LARS人工交叉韧带重建.它具有创伤小、早期即可从事运动等优势,同时也存在医疗费用高等不足.     

Knee extensor muscle function before and after reconstruction of anterior cruciate ligament tear

Knee extensor performance, in 17 subjects with chronic anterior cruciate ligament (ACL) tear, was investigated preoperatively and on four different occasions postoperatively, using isokinetic measurements and electromyography of single maximum and repetitive manoeuvres. Preoperatively maximum mechanical output was comparatively low (injured leg), deteriorating further by 50% at fourteen weeks postoperatively. Endurance also falls markedly. Thereafter knee-extensor performance improved successively, mostly during intensive training (14-20 weeks postoperatively) irrespective of the training programme used. After one year, maximum performance was still unequal but the injured leg had achieved the "normal" preoperative noninjured value. Fatiguability/endurance level improved over preoperative values. Muscular work/integrated EMG was stable while EMG/t increased. Twenty weeks postoperatively quadriceps area was decreased to 69%, cf. noninjured control. The early postoperative loss of performance was evidently caused by loss of muscle mass. Neuromuscular relearning appears to be a sizable factor in later recovery. Isokinetic training does not offer any specific advantage in the early muscular rehabilitation after ACL reconstruction.     

Anterior cruciate ligament reconstruction of the knee

Anterior cruciate ligament (ACL) injuries affect more than 175,000 patients annually. Located in the center of the knee joint, the ACL is the major stabilizing ligament of the knee. If the ACL is injured, then the knee becomes unstable and can buckle when the person pivots. Surgeons can use autograft or allograft tissue to accomplish ACL reconstruction by using a single-bundle or double-bundle type of repair. The surgeon performs the reconstruction arthroscopically, using two ports and a small incision over the anteromedial surface of the tibia to facilitate passage of the graft and for distal fixation of the graft. Correct placement of the tibial and femoral tunnels is the most important technical aspect of the procedure. After reconstruction, the patient must undergo intense physical therapy starting one or two days after surgery. If diligent with physical therapy, then the patient can return to full activity as soon as four months after surgery.     

关节镜下前交叉韧带重建术后膝关节感染的诊断和治疗

目的 探讨膝关节镜下前交叉韧带(ACL)重建术后膝关节感染的诊断和治疗方法.方法 收集2015年1月-2019年12月6例行关节镜ACL重建术后膝关节感染患者的临床资料.其中,4例采用抗感染药物治保守疗,2例经二次膝关节镜关节腔清理术治疗.结果 所有患者均得到治愈,体温恢复正常,膝关节局部症状消失,血液学指标恢复正常....