急性前交叉韧带损伤合并内侧副韧带损伤治疗后的康复训练

目的比较急性前交叉韧带（ACL）损伤合并内侧副韧带（MCL）损伤治疗后激进康复训练与保守康复训练的康复效果。方法北京军区总医院2006年11月～2010年10月急性ACL损伤合并MCL损伤患者32例,采取关节镜下前交叉韧带重建术和内侧副韧带保守治疗,术后行康复治疗,随机分为激进训练组（16例）和保守训练组（16例）,分别用保守和激进康复训练法进行术后康复,术后1年检测膝关节肌力、稳定性、活动度及Lysholm功能评分,评价其疗效。结果与保守训练组比较,激进训练组术后早期肿胀明显、渗液较多。激进训练组15例和保守训练组8例需要关节穿刺抽液,激进训练组关节穿刺抽液量平均为（49.87±18.96）mL;保守训练组关节穿刺抽液量平均为（18.13±5.72）mL,两组关节穿刺抽液量间差异有统计学意义（P〈0.05）。1年后随访,两训练组患者都有患肢的肌肉萎缩,程度不同,激进训练组程度轻,激进训练组大腿围度差平均为（1.41±0.61）cm,保守训练组大腿围度差平均为（3.28±0.79）cm,两组肌肉萎缩程度之间的差异有统计学意义（P〈0.05）。激进训练组和保守训练组膝关节稳定性体格检查均阴性。两组膝关节活动度及Lysholm功能评分比较,差异无统计学意义（P〉0.05）。恢复正常运动训练所需时间激进训练组8个月,保守训练组1年。结论与保守训练组相比,激进训练组能更早恢复膝关节功能,明显缩短康复时间,获得更好的肌力,增加了患者的治疗依存性,促进医患关系和谐。

Rehabilitation after treatment of acute anterior cruciate and medial collateral ligament injuries of knee

Objective To compare the effects of accelerated rehabilitation and conservative rehabilitation after treat ment of acute anterior cruciate and medial collateral ligament injuries of knee.Methods 32 patients with acute anterior cruciate and medial collateral ligament injuries of knee in Beijing Army General Hospital from November 2006 to October 2010 were treated under arthroscope for anterior cruciate ligament reconstruction and medial collateral liga ment conservative treatment.These patients were done rehabilitation after operation,and randomly divided into accel erated rehabilitation training group（n=16） and conservative rehabilitation training group（n=16）.One year after operation,the knee muscle strength,stability,scope of activites and Lysholm function score were detected,and the thera peutic effect was assessed.Results Comparing with conservative rehabilitation training group and accelerated rehabili tation training group,more joint swelling and effusion were found early after operation.15 cases of the accelerated re habilitation training group and 8 cases of conservative rehabilitation training group needed to puncture and aspirate effusion.The average volume of effusion was detected（49.87 ±18.96） mL in the accelerated rehabilitation training group and（18.13±5.72） mL in the conservative rehabilitation training group,and there were significant differences in the average volume of effusion between the two groups（P 0.05）.One year after operation,the average difference value of leg circumference was detected（1.41±0.61） cm in the accelerated rehabilitation training group and（3.28 ±0.79） cm in the conservative rehabilitation training group,and there were significant differences in muscle strength between the two groups（P 0.05）.There was negative in the physical examination of stability in the two groups.There were no significant differences in the knee scope of activites and Lysholm function score between the two groups（P 0.05）.The training time for normal knee joint movement was eight months for the accelerated rehabilitation training group,and one year for the conservative rehabilitation training group.Conclusion Comparing with the conservative rehabilitation training group,the accelerated rehabilitation training group is earlier to recover knee joint function,can obviously shorten the time for rehabilitation,obtains better muscle strength,increases the patient＇s treatment dependence and promotes the physician-patient rela tionship harmony.