飞行员前交叉韧带重建术后4例康复治疗经验及医学鉴定结论并文献复习

Rehabilitation treatment experience and medical identification of 4 pilots undergoing ACL reconstruction and its literature review

背景膝关节损伤是空军飞行员最常见的军事训练伤之一,其中又以前交叉韧带(anterior cruciate ligament,ACL)损伤较为常见。前交叉韧带重建(anterior cruciate ligament reconstruction,ACLR)是常规治疗方法且技术成熟,术后康复介入时机对飞行员患者的功能恢复、重返训练、返岗复飞至关重要。目的分析飞行员患者ACLR术后康复介入时机对康复治疗周期、功能恢复情况和返岗复飞时间的影响。方法回顾性分析2019年3月-2021年12月空军军医大学第一附属医院康复理疗科收治的4例ACLR术后飞行员患者的一般资料、康复介入时间、康复评定[膝关节主动关节活动度(active range of motion,AROM)、双侧大腿周径差、视觉模拟评分(visual analogue scale,VAS)、Lysholm评分]、康复治疗(冷疗、神经肌肉电刺激等物理因子治疗,关节松动术,神经肌肉控制训练,减重步行训练等)、康复转归以及空军医学鉴定等。结果病例1,术后第6天康复介入,仅关节轻微肿胀和疼痛,无关节僵硬,康复治疗3周患侧AROM达到0°~125°,双侧大腿周径差0.5 cm,VAS评分1分,Lysholm评分85分,术后6个月医学鉴定结论合格返岗复飞;病例2,术后第14天康复介入,仅关节肿胀和疼痛,无关节僵硬,康复治疗6周患侧AROM达到-2°~135°,双侧大腿周径差1.5 cm,VAS评分0分,Lysholm评分90分,术后6个月医学鉴定结论合格返岗复飞;病例3,术后第57天康复介入,关节僵硬,屈曲明显受限,康复治疗13周患侧AROM达到-2°~130°,双侧大腿周径差1.5 cm,VAS评分0分,Lysholm评分91分,术后8个月医学鉴定结论合格返岗复飞;病例4,术后第89天康复介入,膝关节僵硬,屈曲伸直明显受限,跛行步态,康复治疗17周患侧AROM达到0°~125°,双侧大腿周径差2 cm,VAS评分1分,Lysholm评分86分,术后9个月医学鉴定结论合格返岗复飞。结论飞行员患者ACLR术后开始康复治疗时间越早,其恢复到膝关节全范围所需要的康复治疗时间越短,医学鉴定结论合格返岗复飞所需时间越短。因此应尽早(术后1周内)介入康复治疗,通过早期、规范的康复治疗,可以在较短时间内(3~6周)获得良好的康复效果,避免关节僵硬,早日返岗复飞。

Background Knee injuries are prevalent among air force pilots during military training,with anterior cruciate ligament(ACL)injuries being particularly common.ACL reconstruction(ACLR)is a well-established treatment for these injuries,but the timing of postoperative rehabilitation interventions is crucial for achieving functional recovery,returning to training and flight.Objective To analyze the impact of the timing of postoperative rehabilitation interventions on the rehabilitation cycle,functional recovery,and the time taken returning to training and flight in pilots who underwent ACLR.Methods Clinical data,rehabilitation treatment,general information,rehabilitation intervention time,rehabilitation evaluation(AROM,bilateral thigh circumference difference,VAS,Lysholm),rehabilitation therapies(cold therapy,neuromuscular electrical stimulation therapy,joint release surgery,neuromuscular control training,weight loss walking training,etc.),rehabilitation regression and air force medical evaluation of 4 military pilots who underwent rehabilitation at different time points after ACLR at the Department of Rehabilitation and Physiotherapy,Xijing Hospital,the Fourth Military Medical University,from March 2019 to December 2021 were retrospectively analyzed.Results Case 1:On the 6th day of postoperative rehabilitation intervention,the patient experienced slight swelling and pain in the joints,without joint stiffness.With 3 weeks of rehabilitation,the patient achieved a knee AROM of 0°-125°on the affected side,with a bilateral difference in thigh circumference of 0.5 cm.The VAS score was 1,and the Lysholm score was 85.The medical evaluation deemed the patient fit to return to duty and resume flying at 6 months after surgery.Case 2:On the 14th day of postoperative rehabilitation intervention,the patient experienced joint swelling and pain,without joint stiffness.With 6 weeks of rehabilitation,the patient achieved a knee AROM of-2°-135°on the affected side,with a bilateral difference in thigh circumference of 1.5 cm.The VAS score was 0,and the Lysholm score was 90.The patient returned to work and resumed flying at 6 months after surgery.Case 3:On the 57th day after surgery,the patient started rehabilitation intervention.The patient experienced joint stiffness and limited flexion.With 13 weeks of rehabilitation,the patient achieved a knee AROM of-2°-130°on the affected side,with a bilateral difference in thigh circumference of 1.5 cm.The VAS score was 0,and the medical evaluation concluded that the patient was fit to return to work and resume flying with a Lysholm score of 91 at 8 months after surgery.Case 4:On the 89th day after surgery,the patient started postoperative rehabilitation intervention.The patient experienced knee stiffness and significant limitation in flexion and extension,resulting in a limp gait.After 17 weeks of rehabilitation treatment,the patient achieved a knee AROM of 0°-125°on the affected side,with a bilateral difference in thigh circumference of 2 cm.The VAS score was 1,and the Lysholm score was 86.The medical evaluation concluded that the patient was fit to return to work and resume flying at 9 months after surgery.Conclusion Initiating rehabilitation as early as possible(within one week after surgery)leads to a shorter rehabilitation time needed to achieve a full knee range of motion and return to work and flying with a qualified medical evaluation.Early and standardized rehabilitation therapy can result in favorable rehabilitation outcomes and preventing joint stiffness,thus facilitating a quicker return to work and flying(within 3-6 weeks).