前十字韧带重建术后开链与闭链康复运动的选择

Open- or closed-kinetic chain exercises after anterior cruciate ligament reconstruction

目的 比较前十字韧带重建术后康复中开链运动与闭链运动的效果,为前十字韧带重建术后康复方案的选择提供依据.方法 2009年2月至2010年6月符合纳入标准的接受异体肌腱单束解剖重建前十字韧带手术的患者60例,随机分为两组,分别采用开链运动康复方案（30例）和闭链运动康复方案（30例）.两组术前Lysholm膝关节评分、国际膝关节评分委员会（International KneeDocumentation Committee,IKDC）评分、KT-1000值的差异均无统计学意义.比较术后3个月及6个月时两组患者的主动、被动关节活动度差值、Lysholm膝关节评分、IKDC评分、单足跳测试及KT-1000值.结果 术后3个月两组被动关节活动度差值、Lysholm膝关节评分、IKDC评分的差异均无统计学意义；主动关节活动度差值、单足跳测试、KT-1000值的差异有统计学意义,闭链运动组优于开链运动组.术后6个月两组主动关节活动度差值、被动关节活动度差值、Lysholm膝关节评分、IKDC评分、单足跳测试的差异均无统计学意义；KT-1000值的差异有统计学意义,闭链运动组优于开链运动组.结论 闭链运动较开链运动能更好地保护重建韧带,更有利于本体感觉及肌肉力量的恢复.

Objective To observe the clinical effects of open kinetic chain and closed kinetic chain exercise in the early period of anterior cruciate ligament reconstruction rehabilitation,provide the theoretical and clinical experiences for the early rehabilitation of the anterior cruciate ligament reconstructed knee.Methods From February 2009 to June 2010,60 patients undergoing single-bundle anterior cruciate ligament reconstructions by using hamstring tendon allograft were enrolled in the study,and were divided into two groups：open kinetic chain group（30 cases,30 knees）and closed kinetic chain group（30 cases,30 knees）.In accordance with the rehabilitation procedures for six months,no statistically significant differences were found between the two groups in Lysholm scores,International Knee Documentation Committee（IKDC）scores and one-leg hop test preoperative.The active and passive range of notion,Lysholm scores,IKDC scores,one-leg hop test and KT-1000 were evaluated three and six months after surgery.Results Three months after surgery,no significant differences were found in passive range of motion,Lysholm scores,IKDC scores,but significant differences were found in active range of motion,one-leg hop test and KT-1000,and the closed kinetic chain group was significantly better than the open kinetic chain group.Six months after surgery,no significant differences were found in active range of motion,passive range of motion,one-leg hop test,Lysholm scores,IKDC scores,but significant difference in KT-1000,and the closed kinetic chain group was significantly better than the open kinetic chain group.Conclusion Closed kinetic chain exercise is benefit for recovery of muscles strength,proprioception and protect the graft in the early rehabilitation period after anterior cruciate liganent reconstruction.