足球运动中单纯性膝关节后十字韧带断裂损伤非手术性康复疗效的跟踪分析

Follow-up of curative effect of non-operative rehabilitation on pure knee joint posterior cruciate ligament injury in soccer training

目的:报道1例足球训练比赛中发生单纯性膝关节后十字韧带断裂损伤病例非手术性康复过程和效果。方法:患者2001-08-27在一次足球训练比赛中进行倒地铲球动作时左膝胫骨结节部受到来自前方的撞击,撞击后膝关节变形,经X射线片,MRI检查及临床病理试验诊断为单纯性膝关节后十字韧带断裂损伤。运用负荷逐步增加非手术性5阶段康复方案进行治疗:①第1阶段(伤后1～5d):伤者连续5d使用拐杖和膝关节固定装置,膝关节不负重。在此期间使用冰敷,局部压迫,下肢抬高,休息。②第2阶段(伤后6～19d):交替冷热敷,被动无痛全范围活动,直腿上抬,旁腱牵伸,蹲推练习,股四头肌练习,在不影响愈合的情况下西贝斯奥托托隆KT2(美国产)上进行的力量训练。③第3阶段(伤后20～25d):着重功能活动,活动以半速进行,包括蹲推练习,旁腱牵伸,股四头肌练习,无负荷游泳动作和滑雪动作练习,奥托托隆上进行耐力训练等。④第4阶段(伤后26～29d):继续加强股四头肌和旁腱的训练,增加功能训练。⑤第5阶段:从患者伤后第4周开始,允许患者参加球队训练,但要逐渐增加活动量,专注其体力维持。伤后38,77d进行两次随访西贝斯奥托托隆KT2测试,测试其左右腿股四头肌的应力水平。结果:患者重新参加足球运动训练的时候(伤后38d),他的损伤腿股四头肌力量已经增加到另一侧的102%,第1次测验(伤后11d)损伤膝关节和对侧膝力量的比率为0.51,两周之后比率增加到0.95。患者回队后参加训练比赛,取得了满意的效果,至今没有显著的膝关节症状。结论:用负荷逐步增加的非手术性康复治疗方案治疗单纯性膝关节后十字韧带断裂损伤,膝关节功能恢复满意,没有显著的膝关节症状。

AIM： To report the recovered process and effect of one case with pure knee joint posterior cruciate ligament （PKJPCL） in soccer training and competition by using non-operation method. METHODS： The tibial tubercle of left knee of the patient was struck by the front when doing the sliding tackle in one competition of soccer training. The knee joint was deformity, and diagnosed as PKJPCL by X-ray, MRI examination and clinical pathological experiment. The graded load 5- stage non-operation therapy was adopted to treat the patient： ①The first stage （1 to 5 days after injury.）： The patient was employing the walking stick and nut-blocking device of knee joint for 5 days to prevent the weight. Meanwhile, the ice .compress was used with local pressing; and the leg was put straight upside.②The second stage （6 to 19 days after injury）： The hot and ice compress was adopted, and the patient did the passive painless activities： the leg was stretched and raised to stretch the ham leader, squat and push exercise, quadriceps exercise, which were done on the KT2 made in America. ③The third stage （20 to 25 days after injury）： Mainly the functional exercise with slow frequency included squat and push exercise, quadriceps exercise, swimming without load and ski movement and endurance exercise on machine. ④The fourth stage （26 to 29 days after injury）： The quadriceps exercise and functional exercise were strengthened. ⑤The fifth stage： From the 4^th week after injury, the patient was allowed to take part in team training, but the amount of activity should be increased gradually to maintain their physical strength. The KT2 test was performed twice at the 38^th and 77^th days after injury to detect the strength level of quadriceps of right leg. RESULTS： The strength of the quadriceps of injured leg had increased to 102% of the other leg when the patient took part in the training again （38 days after injury）, the ratio of the first detection （11 days after injury） of the strength of the injured knee joint to that of the other leg was 0.51, which increased to 0.95 two weeks later. The training the patient return to got a satisfaction and by now, there were no obvious knee joint symptoms. CONCLUSION： The non-operation therapy for PKJPCL is satisfactory without obvious knee joint symptoms.