COA: Effect of anterior cruciate ligament reconstruction on biomechanical features of knee in level walking: a meta-analysis

Background The anterior cruciate ligament (ACL) is one of the most commonly injured knee ligaments. Even following ACL reconstruction, significant articular cartilage degeneration can be observed and most patients suffer from premature osteoarthritis. Articular cartilage degeneration and osteoarthritis development after ACL injury are regarded as progressive process that are affected by cyclic loading during frequently performed low-intensity daily activities. The purpose of this study was to perform a meta-analysis on studies assessing the effects of ACL reconstruction on kinematics, kinetics and proprioception of knee during level walking. Methods This meta-analysis was conducted according to the methodological guidelines outlined by the Cochrane Collaboration. An electronic search of the literature was performed and all trials published between January 1966 and July 2010 comparing gait and proprioception of a reconstructed-ACL group with an intact-ACL group were pooled for this review. Thirteen studies were included in the final meta-analysis. Results There was no significant difference in step length, walking speed, maximum knee flexion angle during loading response, joint position sense and threshold to detect passive motion between the reconstructed-ACL group and the intact-ACL group (P>0.05). However, there was a significant difference in peak knee flexion angle, maximum angular knee flexion excursion during stance, peak knee flexion moment during walking and maximum external tibial rotation angle throughout the gait cycle between the reconstructed-ACL group and the intact-ACL group (P<0.05). Conclusions Step length, walking speed, maximum knee flexion angle during loading response, joint position sense and threshold to detect passive motion usually observed with ACL deficiency were restored after the ACL reconstruction and rehabilitation, but no significant improvements were observed for peak knee flexion angle, maximum angular knee flexion excursion during stance, peak knee flexion moment during walking and maximum external tibial rotation angle throughout the gait cycle. Methods This meta-analysis was conducted according to the methodological guidelines outlined by the Cochrane Collaboration. An electronic search of the literature was performed and all trials between January 1966 and September 2010 comparing ACL reconstruction group with ACL intact group in gait and proprioception were pooled for this review. Thirteen studies were finally recruited in the meta-analysis. Results There was no significant difference in step length,step speed,maximum knee flexion during loading response,joint position sense and threshold to detect passive motion between ACL reconstruction group and ACL intact group(p>0.05).However,there was a significant difference in peak knee flexion,maximum knee flexion angular joint during stance,knee moment peak knee flexion during walking and maximum tibial rotation during gait cycle between ACL reconstruction group and ACL intact group(p<0.05). Conclusions The step length,step speed,maximum knee flexion during loading response,joint position sense and threshold to detect passive motion for ACL deficiency were restored after the ACL reconstruction and rehabilitation,but no significant improvements were observed in terms of peak knee flexion,maximum knee flexion angular joint during stance,knee moment peak knee flexion during walking and maximum tibial rotation during gait cycle.     

自体髌腱与腘绳肌腱重建前交叉韧带后的步态分析

目的 观察膝关节前交叉韧带(ACL)损伤不同重建方式术后步态运动学变化规律.方法 应用三维运动捕捉步态分析系统(东方新锐DVMC-8801三维运动分析系统),对2006年3月至2007年3月因单侧前交叉韧带损伤应用自体中1/3骨-髌腱-骨(髌腱组)或四股胴绳肌腱(胭绳肌腱组)进行重建的各19例患者进行步态分析,分别于术前、术后3、6、9、12个月采集步态数据,同期采集19名健康人的步态数据并与之比较.受试对象按恒定速度(1.9 km/h)在运动平板上行走120 s,测量0°和15°时的步态数据,测量时空参数包括:步长、步宽;运动学数据包括:膝关节运动角度、膝关节角加速度.结果 两组38例前交叉韧带损伤患者术前及术后3个月均出现股四头肌逃避步态,术后6个月15°倾斜运动平板的时空参数与正常比较差异无统计学意义,术后9个月15°倾斜运动平板的运动学指标与正常比较差异无统计学意义;髌腱组术后6个月15°运动平板伸膝角加速度明显小于腘绳肌腱组,屈膝角加速度明显大于腘绳肌腱组.结论 腘绳肌腱或髌腱移植前交叉韧带重建,膝关节正常的步态模式表现与术后时间有相关性;两种重建方式术后早期存在的膝关节生物力学差异与移植物取材部位相关.     

运用三维步态分析评价下肢机器人训练对偏瘫患者步行能力的影响

正脑血管疾病是导致老年人慢性动作功能受损的主因之一,影响日常生活功能~([1])。机器人辅助疗法是近年来出现的脑卒中康复疗法,具有重复性、专一性、可定量评价等优点~([2-3])。既往评价偏瘫患者下肢机器人训练效果多采用量表评定,结果较主观,三维步态分析具有数据客观、定量、可信度高等优点~([4])。本研究利用三维步态分析系统对比观察脑卒中偏瘫患者经下肢机器人结合本体感觉训练或仅采用本体感觉训练后其三维步态参数的变化情况,评价下肢机器人训练对脑卒中偏瘫患者步行能力的改善效果。     

膝骨关节炎患者的三维运动解析

背景　膝骨关节炎（KOA）患者发生膝关节变形、活动受限、步态异常等改变,预示KOA是与运动学、动力学等生物力学因素关系密切的一种疾病。而目前临床上缺乏对这些运动学、动力学指标的客观定量评定指标。目的　应用VICON三维运动捕捉系统解析KOA患者的病情,为临床医生治疗、康复计划的制定和实施提供新的重要参考依据。方法　2010年10月-2017年6月,选择上海交通大学医学院附属瑞金医院门诊及住院的双KOA患者10例作为KOA组,另外招募无膝关节疼痛的健康中老年人10例作为对照组。采用英国VICON三维运动捕捉系统对两组受试者进行行走测试,并分析受试者的步行情况和膝关节的生物力学（运动学、动力学）特征。结果　与正常人比较,KOA患者存在明显的步态和生物力学特征：步频、跛行指数、步长、步幅、步速均缩短,双足支撑期、单足支撑期、一步时间、步行周期均延长（P<0.05）;膝关节屈曲角峰值,冠状面最初角度,矢状面、冠状面、水平面膝关节最大活动范围均减小（P<0.05）;膝关节角速度、膝关节角加速度峰值和平均值均减小（P<0.05）;膝关节伸展力矩峰值减小（P<0.05）;Y轴和Z轴方向地板反作用力峰值减小（P<0.05）。结论　KOA患者关节内及其周围生物力学环境发生了明显变化,同时下肢运动出现了异常。而采用VICON运动捕捉系统对KOA患者和正常人进行三维步态分析,有助于更好地了解膝关节运动学和动力学等指标,为KOA诊断、治疗及研究提供重要的参考依据。     

前交叉韧带重建手术前后的步态分析

目的 研究膝关节前交叉韧带(ACL)损伤及重建手术后步态特点及变化.方法 应用三维运动捕捉步态分析系统,对单侧前交叉韧带损伤应用四股胴绳肌腱进行重建的29例患者进行步态分析,前交叉韧带损伤患者自受伤到手术的平均时间为2.6个月(2周～16个月),分别于术前、术后3、6、9、12个月采集步态数据,同期采集58名健康人的步态数据并与之比较.受试对象按恒定速度(1.9 km/h)在运动平板上行走120 s,测量0°和15°时的步态数据,时空参数包括:步长、步宽;运动学数据包括:膝关节运动角度、膝关节角加速度、前交叉韧带移动数据(以胫骨沿前交叉韧带方向的位移表示).结果 本组29例前交叉韧带损伤患者术前及术后3个月均出现股四头肌逃避步态,术后3个月0°运动平板的时空参数与正常比较无明显差别,术后6个月15°倾斜运动平板的时空参数与正常比较无明显差别,术后9个月15°倾斜运动平板的运动学指标与正常比较差异无统计学意义.结论 应用四股腘绳肌腱进行前交叉韧带重建能够恢复膝关节正常的步态模式并表现出与时间相关趋势.运用步态分析的运动学数据对膝关节ACL损伤进行功能量化评价,可以更为准确的了解膝关节前交叉韧带损伤及重建术后的生物力学变化,为评定术后疗效、制定康复方案及评定疗效提供客观依据.     

自体腘绳肌腱与异体胫前肌腱重建前交叉韧带短期疗效比较

目的:探讨关节镜下应用自体腘绳肌腱与异体胫前肌腱重建前交叉韧带术后的短期疗效。方法:选择2009年8月-2011年2月在本院行前交叉韧带重建术并具有完整随访资料的患者50例,其中应用自体腘绳肌腱患者24例,应用异体胫前肌腱患者26例,术后随访指标包括前抽屉试验、轴移试验、髌上10cm大腿周径、主动屈膝角度、有无膝前痛、局部压痛、感觉减退;同时,采用Lysholm评分表、Tegner评分表、IKDC膝关节主观评价表评价患者主观运动功能。结果:两组患者在前抽屉试验、轴移试验、髌上10cm大腿周径、有无膝前痛、局部压痛、感觉减退、Lysholm评分、Tegner评分、IKDC膝关节主观功能评分各方面均无明显差别(P<0.05),而异体胫前肌腱组在主动屈膝角度上大于自体腘绳肌腱组(P<0.05),受伤前后患者Tegner评分有明显差别(P<0.05)。结论:应用自体腘绳肌腱和异体肌腱重建前交叉韧带均可获得满意的短期疗效。     

Ankle rotation changes and its influences in knee osteoarthritis

Background

Biomechanical factors are known to be important in knee osteoarthritis (OA) development and progression. This study was designed to determine changes of hamstrings muscle activation, knee adduction moment and ankle rotation angle in two knee osteoarthritis (mild and moderate) and a healthy control group.

Methods

16 females (10 with mild and 6 with moderate medial knee osteoarthritis) and 10 control matched females were recruited. A 3D gait analysis was performed on the subjects while they walked along the walkway. Electromyography data was also collected during gait from lateral and medial hamstrings. Post Hoc Tukey HSD (multi comparison) was performed to compare knee adduction moment, ankle rotation angle and medial and lateral hamstrings activity at early and late stance, between three groups.

Results

Ankle rotation angle, knee adduction moment and lateral hamstrings activation showed no significant difference between three groups. Interestingly, medial hamstrings activity was significantly higher at late stance in moderate group compared with asymptomatic and mild groups (p=0.03, 0.02 respectively). Also knee adduction moment at late stance was significantly and directly correlated with ankle rotation angle, and lateral hamstrings activity at early stance was significantly and inversely correlated with this angle.

Conclusions

It can be concluded that, increased lateral hamstrings activity can increase external ankle rotation and consequently decrease knee adduction moment.     

原发性骨关节病中半月板MRI信号的研究

目的探讨原发性骨关节病半月板的异常MR]信号与关节软骨和交叉韧带之间的关系。方法半月板MRI信号分级与关节镜下关节软骨分级进行相关分析;比较关节镜下前交叉韧带正、异常组间半月板MRI信号有无差异。结果半月板异常MRI信号分级和同侧股骨髁、胫骨髁软骨关节镜下分级之间具有相关性（P〈0．0001）。正、异常组间交叉韧带分组间半月板异常信号显示率不同（P〈0．01）。结论半月板与关节软骨和交叉韧带之间关系密切,在退变过程中相互影响。     

膝骨性关节炎患者膝关节疼痛指数与足底压力变化的相关性研究

目的：探讨膝骨性关节炎患者足底压力改变及疼痛对足底压力的影响。方法运用足底压力测试系统对28例单侧膝骨性关节炎疼痛患者自然行走时的步态进行测试,观察受试者单足支撑分期时段参数、足角及膝关节疼痛指数,对健、患侧足底压力各指标进行统计学分析并分析膝关节疼痛指数与各指标相关性。结果膝骨性关节炎患者患侧前足着地阶段时间百分比为（57.90±32.93）、全足支撑阶段时间百分比为（57.93±2.93）低于健侧对应百分比（60.26±2.66,P =0.007;51.53±3.84,P <0.001）;患侧足角（16.24±4.50）明显高于健侧足角（14.67±4.09）,差异有统计学意义（P =0.014）;膝关节疼痛指数与患侧前足着地阶段时间百分比（r =-0.53,P =0.004）、全足支撑阶段时间百分比（r =-0.56,P =0.002）呈负相关;与患侧足角无明显相关性（r =0.245,P =0.193）。结论膝骨性关节炎患者足底压力具有特征性,前足着地时段、全足支撑时段明显缩短、足角变大,疼痛严重影响膝骨性关节炎患者步态。     

Factors affecting proprioceptive recovery after anterior cruciate ligament reconstruction

Background Proprioception plays an important role in knee movements. Since there are controversies surrounding the overall recovery time of proprioception following surgery, it is necessary to define the factors affecting proprioceptive recovery after anterior cruciate ligament （ACL） reconstruction and to investigate the relationship between proprioception and muscle strength. Methods A total of 36 patients who had their ACL reconstructed with a semitendinosus/gracilis graft （reconstructed group： 6 months post-surgery） and 13 healthy adults without any knee injury （control group） were included in the study. Knee proprioception was evaluated with a passive reproduction test. Isokinetic strength was measured using the Biodex System. Statistical analysis was used to compare proprioception of the reconstructed group versus the control group, and to define causal factors, including sex, hamstring/quadriceps ratio, and the course of injury before reconstruction, We also investigated the correlation between the passive reproduction error and quadriceps index. Results There was a significant difference in proprioception between the reconstructed and control groups （P 〈0.05）. When the course of injury before reconstruction was less than 4 months, there was a linear correlation with proprioception 6 months after the operation （r=0.713, P 〈0.05）. There was a positive correlation between post-surgery proprioception and the quadriceps index at 6 months post-surgery. Conclusions Impaired knee proprioception is observed 6 months after ACL reconstruction. Within 4 months of injury, early undertaking of reconstruction is associated with better proprioception outcome. Patients with enhanced proprioception have a better quadriceps index.     

关节镜下胫骨端保残重建治疗前交叉韧带损伤的疗效分析

目的 探讨关节镜下胫骨端保残重建治疗前交叉韧带（ACL）损伤的疗效。方法 选取2015年1月至2016年5月安徽医科大学第一附属医院收治的56例ACL损伤患者,按照随机数字表法分为胫骨端保残重建ACL组（保残组）和清除胫骨端韧带组（对照组）,术前及术后第12个月进行一次随访,分析比较两组患者国际膝关节评分委员会评分（IKDC）及本体感觉评分的差异。结果 保残组患者术前IKDC评分为（49.54±5.17）分,本体感觉评分为（16.14±1.04）分,术后第12个月IKDC评分为（89.61±5.21）分;本体感觉评分为（7.04±0.79）分。对照组患者术前IKDC评分为（48.64±5.26）分,本体感觉评分为（16.28±0.98）分,术后第12个月随访IKDC评分为（88.15±4.98）分,本体感觉评分（10.43±0.84）分。两组患者术后的IKDC和本体感觉评分均高于术前差异有统计学意义（P<0.05）。保残组术后的本体感觉评分高于对照组差异有统计学意义（P<0.05）。结论 关节镜下胫骨端保残单束重建ACL对膝关节本体感觉功能的恢复有积极作用。     

膝关节镜下保留与未保留残端单束重建治疗前交叉韧带损伤的临床对比

目的对比膝关节镜下保留与未保留残端单束重建治疗前交叉韧带（ACL）的临床疗效。方法选择行关节镜下ACL重建的病人30例,随机分为2组,其中采用保留残端单束重建ACL的病人15例（保留组）,未保留残端单束重建ACL的病人15例（未保留组）。对比2组术前和术后6个月的Lysholm评分、主观膝部评估表（IKDC）评分和Tegner评分,以及术后膝关节活动度和稳定性,同时比较2组术后6个月的本体感觉指标。结果2组病人术前的Lysholm评分、IKDC评分和Tegner评分差异均无统计学意义（P>0.05）,而保留组术后6个月的Lysholm评分、IKDC评分和Tegner评分均明显高于未保留组（P < 0.05）。2组术前和术后6个月的KT-1000侧-侧差值和ROM角度差异均无统计学意义（P>0.05）,术后6个月保留组其被动角度再生试验角度和被动活动察觉阈值均低于未保留组（P < 0.01）。结论保留残端单束重建ACL能更好地促进膝关节术后功能和本体感觉的恢复,其临床效果优于未保留残端的ACL重建。     

止痛健骨方对兔膝骨关节炎模型滑膜及软骨修复的影响

目的：观察止痛健骨方对兔膝骨关节炎模型滑膜及软骨修复的影响。方法建立兔膝骨关节模型,将兔随机分为正常对照组,模型对照组,骨刺宁组,止痛健骨低、中、高组共6组,每组6只,止痛健骨低、中、高剂量组分别给予4.48、8.96、17.92 g/kg止痛健骨方灌胃,骨刺宁组给予0.504 g/kg骨刺宁胶囊灌胃,正常对照组、模型对照组给予蒸馏水灌胃,每次10 mL/kg,每日1次,连续给药4周,检测各组兔右膝关节屈曲活动度、关节滑膜厚度及软骨未钙化厚度/钙化厚度,以及膝关节滑膜液炎性细胞,并进行比较。结果实验4周后,模型对照组较正常对照组膝关节屈曲活动度、软骨未钙化厚度/钙化厚度明显减少,关节滑膜厚度、滑膜液炎性细胞明显增加（P＜0.05）。与模型对照组比较,止痛健骨低、中、高剂量组膝关节屈曲活动度、软骨未钙化厚度/钙化厚度均明显增加,关节滑膜厚度、滑膜液炎性细胞减少,差异有统计学意义（P＜0.05）。结论止痛健骨方能抑制滑膜增生,增加非钙化软骨厚度,延缓软骨退变,增加关节屈曲活动度,这可能是其治疗膝骨关节炎的作用机制。     

Second-look arthroscopic evaluation of the articular cartilage after primary single-bundle and double-bundle anterior cruciate ligament reconstructions

Background  Several reports have shown the progression of articular cartilage degeneration after anterior cruciate ligament (ACL) reconstruction. No report has been published about the cartilage comparing changes after single-bundle (SB) and double-bundle (DB) ACL reconstructions. The purpose of this study was to evaluate the articular cartilage changes after SB and DB ACL reconstructions by second-look arthroscopy.

Methods  Ninety-nine patients who received arthroscopic ACL reconstruction were retrospectively reviewed at an average of 14 months after reconstruction, 58 patients underwent SB ACL reconstruction and 41 patients underwent DB ACL reconstruction. Hamstring tendon autografts were used in all patients. Second-look arthroscopy was done in conjunction with the tibial staple fixation removal at least one year after the initial ACL reconstruction. Arthroscopic evaluation and grading of the articular cartilage degeneration for all patients were performed at the initial ACL reconstruction, and at the second-look arthroscopy.

Results  The average cartilage degeneration at the patellofemoral joint (PFJ) was found significantly worsened after both SB and DB ACL reconstructions. This worsening were not seen at medial tibiofemoral joint (TFJ) and lateral TFJ. Grade II cartilage damage was the most common. At second-look arthroscopy, the average patellar cartilage degeneration was 1.14±0.14 (at first look 0.52±0.11) for the SB group, and 1.22±0.15 (at first look 0.56±0.12) for the DB group. The average trochlear cartilage degeneration was 1.05±0.16 (at fist look 0.10±0.06) and 0.66±0.17 (at fist look 0.17±0.09), respectively. The average patellar cartilage degeneration showed no significant difference in both groups. However, the average trochlea cartilage degeneration in DB group was significantly less than in SB group.

Conclusions  Patellofemoral cartilage degeneration continued to aggravate after ACL reconstruction. DB ACL reconstruction could significantly decrease the trochlea cartilage degeneration compared with SB ACL reconstruction.

     

前交叉韧带重建位置需个体化

目的　探讨模拟生理负荷条件下前交叉韧带的等距重建位置是否适用于每一个体。方法　 7具新鲜冷冻尸体膝关节标本 ,在前交叉韧带股骨与胫骨附着区各取 5点分别钻骨隧道 ,通过钢丝和等距测量器施加初负荷 ,检测膝关节屈曲过程中胫骨和股骨隧道间的距离变化。结果　股骨韧带附着区中点、后点和下点与胫骨附着区 5点间的距离变化保持在等距范围内。膝关节自 0°屈曲至 90°位点间距离变化在各个标本间的差异无显著性。股骨韧带附着区中点、前点、上点和下点随膝关节屈曲分别在各膝关节间出现的差异有显著性。结论　股骨韧带附着区内重建位置变化影响重建疗效 ,股骨韧带附着区后点和下点是前交叉韧带重建的理想等距位点 ,前交叉韧带重建时应个体化调整重建位置。     

关节镜下保留与清除断裂前交叉韧带残端重建术后疗效比较

目的:对比关节镜下保留与清除断裂前交叉韧带（ACL）残端重建术后临床疗效。方法:回顾性分析70例获得12个月以上随访的ACL断裂患者临床资料,其中对照组35例采用传统清除残端重建ACL,观察组35例采用保留残端重建ACL,比较2组患者术后关节稳定性、关节功能及本体感觉恢复情况。结果:所有患者均获得随访,随访时间为12～27个月。2组患者术后关节稳定性差异无统计学意义（P>0.05）;末次随访时观察组患者术后关节功能均优于对照组（P<0.01）;观察组患者术后本体感觉优于对照组（P<0.01）。结论:关节镜下保留与清除残端重建ACL均能取得较好的临床疗效,恢复关节稳定性;但保留残端手术更有利于术后膝关节功能及本体感觉的恢复。     

Application of modified TransFix-II technique in arthroscopic reconstruction of the anterior cruciate ligament using double tibial tunnel

OBJECTIVE: To describe a modified TransFix- 11 technique for arthroscopic reconstruction of anterior cruciate ligament (ACL) using double tibial tunnel. METHODS: Twelve cases of ACL ruptures were reconstructed anatomically using modified TransFix- 11 technique. The double-looped semitendinosus and gracilis (DLSTG) tendon autograft was placed in a single femoral tunnel and double tibial tunnels to replace the anteromedial (AM) and posterolateral (PL) bundles of the original ACL. All the 12 patients underwent the same postoperative accelerated rehabilitation program. RESULTS: Lachman test, anterior drawer test and pivot shift sign, and mcmurray test showed negative results in all cases. All patients regained normal range of motion of the knee and gait 4-6 weeks after operation, and 8 patients returned to the low risk sports at 10-12 weeks. One year after operation, 9 patients were followed: the International Knee Document Committee (IKDC) analysis revealed normal or near normal knees in 9 patients. The Tegner score revealed that 6 patients regained their pre-injury activity level. No patient had a significant femoral or tibial tunnels enlargement, as shown by follow-up CT scan. CONCLUSION: Arthroscopic ACL reconstruction with double tibial tunnel using DLSTG and the technique of modified TransFix-II is reliable for replacement of the AM and PL bundles of the original ACL. The postoperative accelerated rehabilitation and the rapid restoration of the injured knee function can be expected.     

痉挛性脑瘫患儿步态的运动学参数分析

目的:对痉挛性脑瘫患儿与正常儿童步态的运动学参数进行分析,为临床痉挛性脑瘫患儿步行能力的评价提供参考。方法:采用三维运动捕捉系统,运用分析软件对观察组28例痉挛性脑瘫患儿和对照组24例正常儿童进行运动学数据的采集;利用独立样本均数T检验对数据进行分析。结果:①两组膝关节最大角和最小角、踝关节最大角和最小角各参数均有显著差异(P<0.05);②两组膝关节和踝关节的活动范围均有显著性差异(P<0.01)。结论:①痉挛性脑瘫患儿膝关节最大角和踝关节最小角低于正常儿童;膝关节最小角和踝关节最大角高于正常儿童。②痉挛性脑瘫患儿膝、踝关节的活动范围明显低于正常儿童。③步态运动学各参数可作为痉挛性脑瘫患儿步行能力的评价指标。     

Relationship between tunnel widening and different rehabilitation procedures after anterior cruciate ligament reconstruction with quadrupled hamstring tendons

Background It has been demonstrated that bone tunnel widening could appear after knee anterior cruciate ligament (ACL) reconstruction, especially for those patients whose ruptured ACL were reconstructed with semitendinosus and gracilis tendons. Many factors can influence the extent of tunnel widening. Few studies have investigated the relationship between bone tunnel widening and rehabilitation procedures. This research was carried out to find the rehabilitation procedures’ influence on the tibial bone tunnel widening after ACL reconstruction. Methods Sixty-five cases, whose ACL reconstructions were done using quadrupled semitendinosus and gracilis tendons, were divided into two groups. Group A had 33 cases, 19 men, 14 women, averaged (31.2±12.4) years old, only ACL reconstruction was done using Paessler’s technique, and aggressive rehabilitation procedure was used for function recovery post operation. Group B had 32 cases, 20 men, 12 women, averaged (30.3±10.3) years old. Except for ACL reconstruction, every patient in group B accepted meniscus repair using re-fixation methods or cartilage repair using microfracture technique, conservative rehabilitation procedure was used post operation. Six months post operation, standard posterior-anterior radiographic plates were taken for each case, CorelDRAW 8.0 software was used to digitize all X-ray plates and measure the upper, middle and lower parts of the tibial tunnel. Magnification effect of X-ray plates was taken out after measurement. Results Six months after ACL reconstruction the tibial tunnel widening of the upper, middle and lower parts on both the posterior-anterior and lateral X-ray plates in Group A with aggressive rehabilitation procedure was much more serious than in Group B with conservative rehabilitation. KT-1000 knee stability measurement and clinical manifestation showed no difference between the two groups. Conclusions Rehabilitation procedure after ACL reconstruction is one of the reasons for tunnel widening. It not only can directly influence the function recovery of ACL reconstructed knee, but also perhaps indirectly influence the function recovery and long-term clinical result of the operated knee by influencing the tunnel widening.     

应用PNF技术改善本体感觉治疗原发性膝骨性关节炎的临床研究

目的通过应用神经肌肉本体促进技术(proprioceptive neuromuscular facilitation,PNF)治疗膝骨性关节炎,探讨患者本体感觉的改善对膝骨性关节炎症状的治疗作用。方法自2017年4月～2018年4月,以60例原发性KOA患者为研究对象,设计单一肌力训练(对照组)和PNF训练(试验组)两种运动处方,观察训练前后Lysholm膝关节功能评分标准(Lysholm knee score scale,LKSS)、疼痛VAS评分(Visual analogue scale,VAS)、股四头肌和腘绳肌肌肉功能(峰力矩、相对峰力矩)和膝关节本体感觉评定的变化,观察本体感觉及肌肉功能的变化对膝关节功能改善的影响。结果两组间治疗前关节功能、疼痛程度、股四头肌峰力矩及相对峰力矩、腘绳肌峰力矩及相对峰力矩、本体感觉均未见显著性差异(P0.05),治疗后试验组关节功能优于对照组,差异具有统计学意义(P0.05);治疗后试验组疼痛程度低于对照组,差异具有统计学意义(P0.05);治疗后试验组股四头肌峰力矩、相对峰力矩高于对照组,差异具有统计学意义(P0.05);治疗前及治疗后腘绳肌相对峰力矩未见显著性差异(P0.05);治疗后试验组本体感觉优于对照组,差异具有统计学意义(P0.05)。经过spearman相关分析,关节功能变化与本体感觉变化呈正相关,随着本体感觉变化越大,关节功能变化越大(P0.05)。试验组通过PNF训练,不仅本体感觉增强,关节功能评分也随之增高。结论 PNF训练可以有效刺激膝关节本体信息向中枢部位的传导。这些神经肌肉反馈的信息在大脑皮层储存加工后,下行反馈增强本体感受器的灵敏度,对KOA患者进行PNF训练很有必要,而且本试验采用的训练方法不受场地和器材的限制,方便实施。