基于循证构建前交叉韧带重建术患者的康复锻炼方案及实证研究

Evidence-based study on rehabilitation program and empirical study of patients with anterior cruciate ligament reconstruction

目的基于循证方法构建前交叉韧带重建术康复锻炼方案,实证研究评价前交叉韧带重建术康复锻炼方案在临床中的应用效果。方法循证确定前交叉韧带重建术后康复锻炼方案,选择2019年1—8月南京大学医学院附属鼓楼医院运动医学与成人重建外科收治的行前交叉韧带重建术患者80例,采用随机数字表法分为干预组40例和对照组40例。干预组给予循证建立的前交叉韧带重建术康复锻炼方案,对照组给予常规康复训练,分别记录术后疼痛评分、手术前后膝关节活动度以及术后膝关节Lysholm评分。结果对检索的1535条文献进行筛选和排除,基于循证方法最终确定6篇符合纳入标准的文献,制订了前交叉韧带重建术的康复锻炼方案。干预组术后12、24 h疼痛评分分别为1(0~2)、1(1~3)分,对照组分别为2(1~3)、3(1~3)分,2组比较差异均有统计学意义(Z值为4.955、6.489,均P<0.001)。干预组患者术后2、4、6、12周膝关节活动度分别为(61.6±5.1)°、(85.3±6.6)°、(114.6±5.2)°、(127.6±3.4)°,对照组分别为(54.9±4.6)°、(71.0±8.8)°、(105.1±5.9)°、(115.8±4.0)°,2组比较差异有统计学意义(t值为6.209~14.138,均P<0.001)。干预组患者术后6、8、12周膝关节Lysholm评分分别为(58.8±3.7)、(71.1±3.1)、(84.3±3.7)分,对照组分别为(56.0±3.4)、(65.4±4.3)、(75.6±3.0)分,2组比较差异有统计学意义(t值为3.511、6.867、11.439,均P<0.001)。结论本研究基于循证构建了前交叉韧带重建术康复锻炼方案,能够减轻前交叉韧带重建术后患者疼痛;改善膝关节活动度和术后膝关节恢复情况。

Objective To construct the rehabilitation strategy of anterior cruciate ligament reconstruction based on the evidenced method and evaluate the effectiveness in clinic.Methods The rehabilitation strategy was firstly built based on evidenced method.And then 80 patients from Department of Sports Medicine and Adult Reconstructive Surgery,Nanjing University Medical School Affiliated Drum Tower Hospital from January to August,2019 were randomly and equably sent to experiment group and control group.Patients in experiment group or control group were accepted the evidenced method or regular method as treatment strategy,respectively.The visual analogue scale(VAS),thigh circumference,motion range of knee joint and Lysholm score were recorded before and after surgery.Results Six papers met the inclusion criterion and were been screen out from 1535 papers,and then the evidenced rehabilitation strategy of anterior cruciate ligament reconstruction was made.The VAS scores in 12 and 24 h were 1(0-2),1(1-3)in experiment group and 2(1-3),3(1-3)in control group,the differences were significant between two groups(Z values were 4.955,6.489,P<0.001).The motion ranges of knee joint in 2,4,6,12 weeks after operation were(61.6±5.1)°,(85.3±6.6)°,(114.6±5.2)°,(127.6±3.4)°in experiment group and(54.9±4.6)°,(71.0±8.8)°,(105.1±5.9)°,(115.8±4.0)°in control group,the differences were significant between two groups(t values were 6.209-14.138,P<0.001).The Lysholm scores at 6,8,12 weeks after operation were 58.8±3.7,71.1±3.1,84.3±3.7 in experiment group and 56.0±3.4,65.4±4.3,75.6±3.0 in control group,the differences were significant between two groups(t values were 3.511,6.867,11.439,P<0.001).Conclusions This evidenced rehabilitation strategy of anterior cruciate ligament reconstruction in this study was helpful to alleviating the pain,improving motion range of knee joint after anterior cruciate ligament reconstruction.