前交叉韧带重建术后康复不同屈膝时间节点对骨隧道孔径大小的影响

Effect of different knee flexion time nodes on bone tunnel aperture after anterior cruciate ligament reconstruction

目的评估前交叉韧带重建术后康复不同时间屈膝对骨隧道孔径大小的影响。方法分析2016年1月至2018年5月广州中医药大学第一附属医院行前交叉韧带重建手术的患者共35例。根据随机数字表法将其分成2周屈膝组(术后2周开展屈膝训练,17例)和4周屈膝组(术后4周开展屈膝训练,18例)。测量术后膝关节磁共振上骨隧道的孔径大小,用Lysholm膝关节评分(LKS)、国际膝关节文献委员会主观膝部评估表(IKDC)、Tenger膝关节运动评分表评价膝关节功能恢复情况。结果随访时间为28~56个月,中位随访时间为44个月。在骨隧道孔径方面,2周屈膝组在胫骨矢状位内口、胫骨冠状位内口、股骨水平位内口、股骨冠状位内口4个测量方位上的扩大百分数均高于4周屈膝组(P<0.05)。临床评分上,末次随访时两组LKS、IKDC评分、Tenger膝关节运动评分均较术前提高,差异有统计学意义(P<0.05)。末次随访时两组LKS、IKDC评分、Tenger膝关节运动评分比较,差异无统计学意义(P>0.05)。结论不同屈膝时间节点对前交叉韧带重建术后功能恢复影响不大,但早期(2周)行屈膝锻炼会明显扩大骨隧道,因此,建议前交叉韧带重建术后开始屈膝功能锻炼的时间不早于2周。

Objective To evaluate the effect of different knee flexion time nodes on bone tunnel aperture after anterior cruciate ligament reconstruction.Methods A total of 35 patients who underwent anterior cruciate ligament reconstruction in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2016 to May 2018 were analyzed.According to the method of random number table,the patients were divided into two-week knee flexion group(17 cases were given knee flexion training two weeks after surgery)and four-week knee flexion group(18 cases were given knee flexion training four weeks after surgery).The pore size of bone tunnel on postoperative knee magnetic resonance imaging was measured,and Lysholm knee score(LKS),the International Knee Documentation Committee subjective knee form(IKDC)and Tenger activity scale were used to evaluate the recovery of knee function.Results The follow-up time was 28 to 56 months,with a median follow-up time of 44 months.In terms of bone tunnel aperture,the percentage of enlargement in the four measuring directions of the sagittal,coronal,horizontal and coronal internal mouth of the tibia in the the two-week knee flexion group was higher than that in four-week knee flexion group(P<0.05).In terms of clinical scores,at the last follow-up,LKS,IKDC score and Tenger activity scores of the two groups were improved compared with those before surgery,and the differences were statistically significant(P<0.05).At the last follow-up,there were no significant differences in LKS,IKDC score and Tenger activity score between the two groups(P>0.05).Conclusion Different knee flexion time nodes have little effect on functional recovery after anterior cruciate ligament reconstruction,but early knee flexion exercise(two weeks)will significantly expand the bone tunnel,therefore,it is recommended to start knee flexion exercise no earlier than two weeks after anterior cruciate ligament reconstruction.