早期负重训练对前交叉韧带重建术后关节功能的影响

Early weightbearing improves joint function after anterior cruciate ligament

目的观察早期负重训练对前交叉韧带重建术后患者下肢运动功能、膝周肌群激活水平及膝关节稳定性的影响。方法选取前交叉韧带重建术后患者44例,按照随机数字表法将其分为对照组和试验组,每组22例。2组患者术后均给予常规康复治疗,对照组从术后第8天开始进行负重训练,试验组从术后第3天开始进行负重训练。术后3 d、6周、12周,采用国际膝关节评分委员会(IKDC)膝关节主观评价表、视觉模拟评分法(VAS)、量角器分别评定2组患者的运动功能、疼痛程度、膝关节主动活动度(AROM)。记录2组患者股四头肌内侧头、股直肌的平均肌电值(AEMG)。采用KT-1000关节动度仪评估膝关节的稳定性。结果2组患者术后的IKDC膝关节主观功能评分、VAS评分、伸膝AROM、屈膝AROM、股四头肌内侧头AEMG比值、股直肌AEMG比值均有不同程度的改善。与对照组同时间点比较,试验组术后6周的VAS评分[3.00(2.00,3.25)分]、伸膝AROM[-0.15(-1.43,0.93)°]、屈膝AROM[118.80(117.38,120.23)°]、股四头肌内侧头AEMG比值[1.42(1.39,1.48)]、股直肌AEMG比值[1.45(1.39,1.48)]较为优异,术后12周的IKDC膝关节主观功能评分[84.40(81.40,85.55)分]、屈膝AROM[129.70(128.30,131.25)°]、股四头肌内侧头AEMG比值[1.17(1.15,1.18)]、股直肌AEMG比值[1.15(1.15,1.18)]较为优异(P<0.05)。结论在常规康复治疗的基础上增加早期负重训练,能明显改善前交叉韧带重建术后患者的下肢运动功能、减轻疼痛、增加关节活动范围、提升肌力,其中术后3 d介入的疗效较好。

Objective To observe the effect of early weightbearing after anterior cruciate ligament reconstruction(ACLR)on lower limb motor function,activation of the knee muscles and the stability of the knee joint.Methods Forty-four persons who had received ACLR were divided at random into a control group and an experiment group,each of 22.In addition to conventional rehabilitation treatment after surgery,the control group underwent weightbearing training from the 8th day after the surgery,while the experimental group began weight-bearing training from the 3rd postoperative day.Both groups had their motor functioning evaluated using the International Knee Scoring Committee(IKDC)knee subjective evaluation form 3 days after the operation,and then 6 and 12 weeks later.Their pain perceptions were quantified on the same schedule using visual analogue scoring(VAS),and protractor measurements documented active range of motion(AROM).Electromyography(AEMG)of the medial head and rectus femoris muscle was also performed,and the stability of the knee joint was assessed using the KT-1000 test.Results After the intervention,the average IKDC score,VAS score,knee extension and flexion AROMs,medial quadriceps head AEMG ratio,and rectus femoris muscle AEMG ratio improved to different degrees in the two groups.At 6 weeks the average pain score,knee extension and flexion ranges of motion,quadriceps medial head AEMG ratio,and rectus femoris AEMG ratio of the experimental group were all better than the control group′s averages.At 12 weeks the average IKDC subjective knee function score in the experimental group was also superior.Conclusions Supplementing conventional rehabilitation with early weight-bearing can significantly improve the recovery from anterior cruciate ligament reconstruction.Beginning on day 3 after the operation gives the best results.