早期手法松解与延期关节镜下松解治疗交叉韧带重建术后膝关节屈曲受限患者的疗效对比

Comparison of the effects of early stage manipulation and delayed arthroscopic releasing for flexion constraint knees after cruciate ligaments reconstruction

目的比较交叉韧带重建术后膝关节屈曲受限早期手法松解与延期关节镜下松解效果。方法随访2013年5月至2016年5月因关节镜下交叉韧带重建手术术后出现关节屈曲受限的患者共22例。一组10例患者再次住院进行关节镜下关节松解手术,男7例,女3例,左侧6例,右侧4例,手术时年龄19~71岁,平均年龄(32.9±16.1)岁,两次手术间隔2~10个月,平均(5.4±2.5)个月,入院时屈膝角度40~90°,平均(66.5±19.7)°,所有患者膝关节抽屉试验(-),在交叉韧带重建术前Lysholm评分40~81分,平均(63.8±13.1)分,IKDC评分52.9~82.3分,平均(69.29±11.34)分。二组共12例患者,10例在门诊进行手法松解,2例再次住院进行手法松解。其中男6例,女6例,左侧7例,右侧5例,年龄25~52岁,平均(39.7±8.0)岁,松解时距前次手术时间间隔3~6周,平均(4.3±0.8)周,屈膝角度30~70°,平均(51.3±11.3)°,所有患者膝关节抽屉试验(-),在交叉韧带重建术前Lysholm评分51~81分,平均(68.8±10.4)分,IKDC评分55.7~83.6分,平均(71.79±9.49)分。结果一组患者术后随访9~20个月,平均(11.3±2.7)个月,术后9个月时屈膝角度90~140°,平均(130.5±5.5)°。稳定性检查:抽屉实验无阳性病例。膝关节Lyshlom评分83~100分,平均(93.4±5.0)分,膝关节IKDC评分85.1~98.8分,平均(92.75±4.73)分。二组患者随访9~20个月,平均(11.1±2.3)个月,术后9个月时屈膝角度120~140°,平均(136.3±5.7)°。稳定性检查:前抽屉试验1例一度阳性。膝关节Lyshlom评分90~100分,平均(96.2±3.3)分,膝关节IKDC评分93.2~99.3分,平均(96.77±1.82)分。两组患者经关节松解,膝关节活动度均得到显著改善,膝关节功能评分较交叉韧带重建前显著提高。最终两组患者之间膝关节稳定性和膝关节Lysholm评分差异无统计学意义,但手法松解治疗的患者比手术松解的患者术后IKDC评分和屈膝角度改善情况更好。结论综合评估患者康复所需时间、所需费用、膝关节活动度及功能恢复情况,手法松解治疗交叉韧带重建术后膝关节屈曲受限临床性价比更高,效果更好,值得推广。

Objective To evaluate and compare the effects of early stage manipulation and delayed arthroscopic releasing for flexion constraint of knees after cruciate ligaments reconstruction.Methods There were 22 patients with flexion constraint knee after cruciate ligaments reconstruction from May 2013 to May 2016.Group 1 contained 10 patients,who were treated by arthroscopic releasing,including 7 males and 3 females,6 left and 4 right,aging from 19 to 71 years(average 32.9±16.1 years).The average time from previous operation was(5.4±2.5)months(2-10 months),the average flexion angle of the operation knee was 66.5±19.7°(40-90°).None of the patients′drawer test was positive.The average Lysholm score before cruciate ligaments reconstruction was 63.8±13.1(40-81),average international knee documentation committee(IKDC)score was 69.29±11.34(52.9-82.3).Group 2 contained 12 patients,who were treated by manipulation,10 of them treated in the clinic,and 2 of them treated in the in-patient department,including 6 males and 6 females,7 left and 5 right,aging from 25 to 52 years(average 39.7±8.0 years).The average time from previous operation was 4.3±0.8 weeks(3-6 weeks),the average flexion angle of the operation knee was 51.3±11.3°(30-70°).None of the patients′drawer test was positive.The average Lysholm score before cruciate ligaments reconstruction was 68.8±10.4(51-81),average IKDC score was 71.79±9.49(55.7-83.6).Results The average follow-up period in group 1 was 11.3±2.7 months(9-20 months).The average flexion angle at 9-month post-operation was 130.5±5.5°(90-140°).No patient′s drawer test was positive.Average Lyshlom score was 93.4±5.0(83-100),average IKDC score was 92.75±4.73(85.1-98.8).The average follow-up period in group 2 was 11.1±2.3 months(9-20 months).The average flexion angle at 9-month post-operation was 136.3±5.7°(120-140°).One patient′s anterior drawer test was positive(Grade 1),while other patientswere negative.Average Lyshlom score was 96.2±3.3(90-100),average IKDC score was 96.77±1.82(93.2-99.3).The flexion angel of operated knees of patients in both groups was improved significantly,and the functional scores were increased visibly compared with the time before cruciate ligaments reconstruction.The differences in the stability of the knee and the average Lysholm score between two groups were not significant,but the average flexion angel and IKDC score in group 2 were better than those in group 1.Conclusions Based on comprehensive evaluation of the cost of time from cruciate ligaments reconstruction to recovery,costs,flexion angels,functional scores and other factors,early stage manipulation is more appropriate for patients with flexion constraint knees after cruciate ligaments reconstruction than delayed arthroscopic releasing,which is worth popularizing.