关节镜微创手术结合术后功能锻炼对膝关节脱位失稳性的疗效价值分析

Value Analysis of Arthroscopic Minimally Invasive Surgery Combined with Postoperative Functional Exercise for Instability of Knee Joint Dislocation

目的:探讨一期行关节镜下前后交叉韧带重建手术后结合临床专业膝关节功能锻炼对膝关节脱位(knee joint dislocation,KD)失稳性患者的临床疗效与价值。方法:回顾性分析2012年6月-2015年6月在东莞石碣医院及广州市第一人民医院就诊的KD失稳性患者60例的临床资料,均行一期关节镜前后交叉韧带重建+有限切开修复/重建侧副韧带手术治疗,其中30例采取术后常规恢复为对照组;另外30例在对照组基础上采取术后专业膝关节功能锻炼恢复为研究组。比较两组术后恢复情况,术前及术后的膝关节活动度,术后IKDC2000膝关节主观功能评级及生活质量评分。结果:两组术后切口愈合良好且均无术后感染、并发症发生;术后12个月随访中,对照组出现间歇膝关节疼痛现象8例(26.7%),但不影响日常生活,多于研究组的2例(6.7%),比较差异有统计学意义(x^2=4.320,P=0.038);术后1、3、6、12个月,研究组膝关节活动度均大于对照组,比较差异均有统计学意义(P<0.05);术后3、6、12个月,研究组IKDC2000优良率均高于对照组,比较差异均有统计学意义(P<0.05);术后12个月,研究组各项生活质量评分均高于对照组,比较差异均有统计学意义(P<0.05)。结论:一期关节镜下前后交叉韧带重建+有限切开修复/重建侧副韧带手术具有创伤小、恢复快、并发症少的临床优点,能够减轻患者手术痛苦、快速恢复出院。同时,术后及时给予专业膝关节功能锻炼可明显改善患者膝关节功能的恢复,有效保证患者关节稳定性,为患者带来长久的手术预后效果,值得临床推广。

Objective：To explore the clinical effect and value of one stage arthroscopic anterior cruciate ligament reconstruction combined with clinical professional knee function exercise for instability of knee joint dislocation（KD）.Method：The clinical data of 60 cases of KD instability in Dongguan Shijie Hospital and Guangzhou No.1 People＇s Hospital from June 2012 to June 2015 were retrospectively analyzed.They were treated with one stage arthroscopic anterior and posterior cruciate ligament reconstruction＋limited incision repair/reconstruction of collateral ligament surgery,30 of them were taken routine postoperative recovery as control group and the other 30 patients received postoperative functional rehabilitation of professional knee joint on basis of control group as research group.The postoperative recovery,preoperative and postoperative knee motion,postoperative IKDC2000 knee subjective function rating and quality of life score in two groups were compared.Result：They healed well after operation,and no postoperative infection or complications occurred,during the 12 month followup,8 cases（26.7%） had intermittent knee pain in control group,but it did not affect the daily life,which was more than 2 cases（6.7%） of study group,the difference was statistically significant（ x^2=4.320,P=0.038）.After operation 1,3,6 and 12 months,the range of motion of knee joint in study group were larger than those of control group,the differences were statistically significant（P〈0.05）.After operation 3,6 and 12 months,the excellent and good rate of IKDC2000 in study group were higher than those of control group,the differences were statistically significant（P〈0.05）.After operation 12 months,the each score of life quality in study group were all higher than those of control group,the differences were statistically significant（P〈0.05）.Conclusion：One stage arthroscopic anterior and posterior cruciate ligament reconstruction＋limited incision repair/reconstruction of collateral ligament surgery has the advantages of less trauma,quicker recovery and fewer complications,can relieve pain and recover quickly.At the same time,timely postoperative professional knee joint functional exercise can significantly improve the recovery of knee function,effectively ensure the stability of patients＇ joints,bring long-term surgical prognosis for patients,and is worthy of clinical promotion.