早期康复锻炼对ACL重建术后胫骨隧道的影响

Effect of early rehabilitation on bone tunnel widening after anterior cruciate ligament reconstruction with bone-patellar-bone

目的探讨早期不同康复训练方案对膝关节前交叉韧带(ACL)重建术后胫骨骨道增宽的影响。方法将34例用同种异体骨-髌腱-骨(B-PT-B)重建ACL的患者分为2组,A组16例。男8例,女8例;平均年龄(32.7±15.6)岁。手术采用同种异体B-PT-B重建ACL进行ACL单束重建,术后采用普通的康复方案进行功能康复;B组18例,男8例,女10例;平均年龄(33.1±14.8)岁。手术采用同种异体B-PT-B重建ACL进行ACL单束重建,同时接受半月板缝合修复手术,术后采用保守的康复训练方案进行康复治疗。2组患者均在术后12个月采用CorelDRAW8.0软件对测量X线片上胫骨骨隧道关节面内口的直径;同时采用lysholm评分评价ACL重建术后临床疗效。结果34例同种异体B-PT-B重建ACL患者中有29%(10例)出现胫骨骨隧道的增宽;与术后采用普通的康复方案的A组相比,术后采用保守的康复训练方案进行康复治疗的B组患者骨隧道的增宽程度明显减小。术后12个月A和B组的临床lysholm疗效评分分别为(92.5±4.5)和(94.5±5.5),两组之间的临床疗效差异无显著性,P>0.05。结论早期不同的康复训练方案将影响同种异体B-PT-B重建ACL术后胫骨骨隧道的愈合,但对膝关节的功能恢复影响不大。

[Objective] To study the effects of different early rehabilitation training projects on the tibial tunnel widening after anterior cruciate ligament （ACL） reconstruction. [Methods] 34 patients undergone ACL reconstruction with bone-patellar-bone （B-PT-B） from allograft were divided into two groups. Group A （16 patients）, which used B-PT-B from allograft for single beam ACL reconstruction, received common rehabilitation project for recovery. Group B （18 patients）, which used ACL reconstruction and menisci suturation at the same time, received conservative rehabilitation project. Standard X-ray examination and CorelDRAW 8.0 software were used to measure inner diameter of the tibial tunnel on twelfth month after operation. The clinical effect of early rehabilitation training project after ACL reconstruction was evaluated with lysholm score. [Results] There were 10 patients （29%） with tibial tunnel widening after operation in this study. Tibial tunnel widening in Group B was significantly diminished than in Group A. The mark of lysholm evaluation for clinical effect of A and B were （92.5±4.5） and （94.5±5.5）, respectively. There were no obvious difference between two groups in clinical effect, P 〉0.05. [Conclusion] Different early rehabilitation training projects have effect on the tibial tunnel healing after ACL reconstruction with B-PT-B from allograft, but have no effect on the functional recovery of the knee joint.