加速康复在关节镜下膝关节前交叉韧带重建术后的应用和临床疗效研究

Application and clinical effect of accelerated rehabilitation after arthroscopic anterior cruciate ligament reconstruction of knee joint

目的探讨根据加速康复外科理念(ERAS)制定的加速康复计划对于膝关节镜下前交叉韧带重建术术后恢复的临床效果。方法前瞻性分析了2019年1月至2020年9月本院60例单纯前交叉韧带断裂患者的术后康复情况,住院期间均采用膝关节镜下单束前交叉韧带重建术。术后30例患者采用目前国内大多数医院使用的传统康复计划,另外30例采用本团队制定的加速康复计划,均随访6个月以上。期间采用Lysholm和IKDC评分评价患者术前1周内、术后1月、术后3月和术后6月的患肢膝关节功能;并测量患者术前和术后6月的髌骨上方10 cm处大腿的周径,评价股四头肌的萎缩程度。结果本研究中无死亡病例,传统康复组随访丢失1例,比较术后同一时间段,加速康复组的膝关节功能评分比传统康复组的功能评分高(P<0.05);术后6月髌骨上方10cm处大腿的周径差值(cm)提示患肢股四头肌均有不同程度的萎缩,但加速康复组较传统康复组的萎缩程度要轻(P<0.05)。结论笔者团队制定的加速康复计划能有效改善膝关节功能,并防止股四头肌过度萎缩,从而达到较理想的临床治疗效果。

Objective To explore the clinical effect of accelerated rehabilitation on the recovery of arthroscopic anterior cruciate ligament reconstruction based on the concept of enhanced recovery after surgery(ERAS).Methods We prospectively analyzed postoperative recovery condition data of 60 patients after arthroscopic anterior cruciate ligament reconstruction of knee joint due to simple rupture of anterior cruciate ligament in our hospital from January 2019 to September 2020.All patients were treated with single bundle anterior cruciate ligament reconstruction under knee arthroscopy.After operation,30 patients adopted the traditional rehabilitation plan currently used by most hospitals in China,and the other 30 patients adopted the accelerated rehabilitation plan developed by our team.All patients were followed up for more than 6 months.During this period,Lysholm and IKDC scores were used to evaluate the knee joint function of the injured leg at the time within 1 week before operation,1 month,3 months and 6 months after operation.And we measured the circumference of the leg at the 10 cm above the patella before operation and 6 months later,and evaluated atrophy degree of quadriceps.Results There was no death in this study,and just 1 patient was lost in follow-up from the traditional rehabilitation group.After operation,the knee joint function score of the accelerated rehabilitation group was higher than that of the traditional rehabilitation group(P<0.05).Six months after operation,the circumference difference(cm)of the thigh at the 10 cm above the patella indicated that the quadriceps of the injured limb had atrophy in different degrees,but the average degree of atrophy in the accelerated rehabilitation group was lower than that in the traditional rehabilitation group(P<0.05).Conclusion The accelerated rehabilitation plan developed by our team can effectively improve the function of knee joint and prevent excessive atrophy of quadriceps femoris,and achieve ideal effect for treatment.