步态训练联合关节松动术对膝关节前交叉韧带损伤重建术后功能恢复及骨隧道改变的影响

Effect of Gait Training Combined with Joint Mobilization on Functional Recovery and Bone Tunnel Changes after Reconstruction of Knee Anterior Cruciate Ligament Injury

目的探究步态训练联合关节松动术对膝关节前交叉韧带(ACL)损伤重建术后功能恢复及骨隧道改变的影响。方法回顾性分析2019年6月至2020年6月在广州市红十字会医院就诊的66例行膝关节ACL损伤重建术患者,按照术后康复训练方式的不同分为对照组(使用减重步态训练器训练,34例)和试验组(在对照组基础上联合关节松动术,32例)。比较两组术后康复训练4周、12周腱骨结点T2、信号强度、骨髓道宽度、术后视觉模拟评分法(VAS)评分、Lysholm量表评分、Berg平衡量表(BBS)评分、10 m步行时间、小腿周径、Holden步行功能分级以及治疗后并发症发生情况。结果康复训练前后腱骨结点T2、信号强度、骨髓道宽度以及VAS评分、Lysholm量表、BBS评分、10 m步行时间、小腿周径及Holden步行功能分级的主效应差异有统计学意义(P<0.01);不考虑测量时间,两组间腱骨结点T2、信号强度、骨髓道宽度、VAS评分、Lysholm量表、BBS评分、10 m步行时间、小腿周径及Holden步行功能分级的主效应差异有统计学意义(P<0.01);腱骨结点T2、信号强度、骨髓道宽度、VAS评分、Lysholm量表、BBS评分、10 m步行时间、小腿周径及Holden步行功能分级的组间与时点间存在交互作用(P<0.01),但两组康复训练前后腱骨结点T2、信号强度、骨髓道宽度、VAS评分、Lysholm量表、BBS评分、10 m步行时间、小腿周径及Holden步行功能分级的变化幅度不同,试验组变化更明显(P<0.05)。康复训练12周时,对照组发生韧带松弛、拉长2例,试验组无康复训练相关并发症发生,两组康复训练并发症发生率比较差异无统计学意义(P>0.05)。结论步态训练联合关节松动术不仅能提高膝关节ACL重建术后患者的步行能力及平衡能力,降低患者术后疼痛,还能促进腱骨恢复,减轻膝关节骨髓道的扩大。

Objective To explore the effect of gait training combined with joint mobilization on functional recovery and bone tunnel changes after reconstruction of knee anterior cruciate ligament(ACL)injury.Methods A retrospective analysis was made of 66 patients with knee ACL injury treated in Guangzhou Red Cross Hospital from Jun.2019 to Jun.2020.According to the different ways of postoperative rehabilitation training,they were divided into a control group(34 cases trained with weight reduction gait trainer)and a test group(32 cases combined with joint mobilization on the basis of the control group).The tendon bone node T2,signal intensity,bone tunnel width,postoperative visual analogue scale(VAS)score,Lysholm scale score,Berg balance scale(BBS)score,10 m walking time,calf circumference,Holden walking function classification and complications after treatment were compared between the two groups after 4 and 12 weeks of postoperative rehabilitation training.Results Before and after rehabilitation training,there were significant differences in the main effects of tendon bone node T2,signal intensity,bone tunnel width,VAS score,Lysholm scale,BBS score,10 m walking time,calf circumference and Holden walking function grading(P<0.01);regardless of the measurement time,there were significant differences in the main effects of tendon bone node T2,signal intensity,bone tunnel width,VAS score,Lysholm scale,BBS score,10 m walking time,calf circumference and Holden walking function classification between the two groups(P<0.01);There were interactions in tendon bone node T2,signal intensity,bone tunnel width,VAS score,Lysholm scale,BBS score,10 m walking time,calf circumference and Holden walking function classification between time points and the groups(P<0.01),but the changing amplitudes before and after rehabilitation training,tendon bone node T2,signal intensity,bone tunnel width,VAS score,Lysholm scale,BBS score,10 m walking time,calf leg circumference and Holden walking function classification of the two groups were different,and the changes were more obvious in the test group(P<0.05).At 12 weeks of rehabilitation training,2 cases of ligament relaxation and lengthening occurred in the control group,while there was no rehabilitation training related complications occurred in the test group.There was no significant difference in the incidence of rehabilitation training complications between the two groups(P>0.05).Conclusion Gait training combined with joint mobilization can not only improve the walking ability and balance ability of patients after ACL reconstruction of the knee,reduce postoperative pain,but also promote tendon bone recovery and reduce the expansion of bone tunnel of the knee.