手法加中药熏蒸对前交叉韧带断裂重建术后膝关节功能康复的病例对照研究

目的 :研究手法加中药熏蒸对前交叉韧带断裂重建术后关节功能康复的治疗作用和对腱-骨愈合的影响。方法:选择膝关节前交叉韧带断裂重建术后患者50例,分为治疗组(手法加中药熏蒸组)和对照组(康复治疗组)。其中对照组男16例,女9例,采用等长肌力锻炼、逐渐加大屈曲幅度和渐进性负重等常规康复治疗手段;治疗组男15例,女10例,在康复治疗基础上加用中药熏蒸和手法,中药熏药采用海桐皮汤方由熏药机加热雾化后局部熏蒸,手法治疗根据韧带愈合生物力学规律,把握屈膝程度、松解手术后粘连。采用Lysholm膝关节评分系统作为疗效评价标准,以随访中MRI上测量的骨隧道宽度变化作为腱-骨愈合情况的观察指标。结果:Lysholm膝关节评分:两组患者术前、术后1个月、术后3个月组内比较,总分均随时间推移改善(治疗组F=36.54,P0.05;对照组F=28.12,P0.05);组间比较,术后治疗组评分优于对照组(术后1个月t=0.105,P0.05;术后3个月t=5.361,P0.01)。治疗组和对照组腱-骨愈合情况在术后3个月和1年随访时胫骨和股骨侧差异均无统计学意义(P0.05)。结论:手法加中药熏蒸治疗有利于膝关节前交叉韧带断裂重建术后早期功能恢复,且不会影响腱-骨愈合。

Case-control study on Chinese medicine fumigation and massage therapy for the treatment of knee stability and functional recovery after anterior cruciate ligament reconstruction operation

Objective: To study clinical outcomes of Chinese medicine fumigation and massage therapy for the treatment of knee stability and functional recovery after anterior cruciate ligament reconstruction operation,and to explore the effect on tendon-bone healing. Methods: Total 50 patients were divided into two groups:the control group(normal rehabilitation therapy group),the treatment group(Chinese medicine fumigation and manipulation group). There were 25 patients in the control group,including 16 males and 9 females,who were treated with isometric muscle training,with the gradually enlarging amplitude of flexion and progressive loading of bearing training for knee recovery. There were 25 patients in the treatment group,including 15 males and 10 females,who were treated with the conventional rehabilitation therapy combined with Chinese medicine fumigation and massage therapy. The Chinese herbs named as Haitongpi decoction was steamed by a special equipment to fumigate the knee after operation;Based on the biomechanical parameters of the ligament reconstruction,the massage therapy was designed to control the degree of the knee flexion and release the adhesion for early recovery of knee functions. The Lysholm knee function evaluation system was used,and MRI examination was performed to measure the change in width of ligament tunnel in femur and tibia to evaluate the safety and stability of the treatment. Results: Lysholm system showed that two groups both had improving results from the 1st month after operation to the 3rd month (treatment group,F=36.54,P<0.05;the control group,F=28.12,P<0.05),and the results of the treatment group was better than that of the control group at the observation point (the 1st month,t=0.105,P<0.05;the 3rd month,t=5.361,P<0.01). There was no difference between the two groups when evaluating the bone and tendon healing 3 and 12 months after operation(P>0.05),indicating that Chinese rehabilitation therapy was a safety treatment without the influence on the loosing of tendon. Conclusion: Chinese medicine fumigation and massage therapy can early improve the knee function after the anterior cruciate ligament reconstruction operation without the disturbance of the knee stability.