前交叉韧带重建术后关节粘连患者的综合物理治疗30例报告  

Comprehensive physical therapy on arthrofibrosis following anterior cruciate ligament reconstruction:report of 30 cases

作　　者：刘丽琨[1] 蔡斌[1,2] 岳冰[2] 姜鑫[1] 范帅[1] 陆沈吉[1] LIU Li-kun CAI Bin YUE Bing JIANG Xin FAN Shuai LU Shen-ji(Department of Rehabilitation Medicine, Shanghai Ninth People＇s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, PRC)

机构地区：[1]上海交通大学医学院附属第九人民医院康复医学科,200011 [2]上海交通大学医学院附属第九人民医院骨科,200011

出　　处：《中国骨与关节杂志》2016年第10期743-746,共4页Chinese Journal of Bone and Joint

基　　金：上海市重要薄弱学科建设项目(2015ZB0404)

摘　　要：目的：探讨综合物理治疗前交叉韧带（ anterior cruciate ligament，ACL ）重建术后关节粘连的可行性和临床疗效。方法选取2014年2月至2015年6月，在我院康复科门诊就诊的 ACL 术后关节粘连患者30例，对患膝施以 Kaltenborn 流派的关节松动技术的手法治疗为主，固定股骨远端，沿着胫骨干水平方向做持续的分离牵伸，并在胫骨粗隆处做胫骨相对股骨向后的滑动，同时辅以干扰电、超声波治疗、蜡疗、软组织松动。手法治疗后指导患者进行下肢肌力训练、平衡稳定性训练。最后予冰敷结束治疗。每周3次，隔日1次，连续治疗12周。治疗前、治疗4周和12周评估：膝关节最大主动活动角度（ ROM ）、视觉模拟疼痛指数（ visual analogue pain score，VAS ）（0～10分）、膝关节 HSS 功能评分。治疗结束后随访1年。采用 SPSS 19.0软件包，用单因素重复测量方差分析、卡方检验分析治疗前、后差异。结果 ROM：治疗前（69.8±15.1）°，治疗后4周（88.3±13.9）°，治疗后12周（103.0±10.1）°，差异有统计学意义（P＜0.01）。随访12个月 ROM 为（117.3±11.6）°。VAS 评分：治疗前（2.0±1.3）分，治疗后4周（0.9±0.8）分，差异有统计学意义（P＜0.01）。治疗后12周 VAS 评分为0分。HSS 评分优良率：治疗后4周6.7%，治疗后12周33.3%，随访12个月93.3%，差异有统计学意义（P＜0.01）。结论综合物理治疗膝关节镜 ACL 重建术后关节粘连有一定的疗效，可以改善活动度，减轻疼痛，恢复膝关节功能，并且远期疗效良好。Objective To evaluate the clinical possibility and results of the comprehensive physical therapy on arthroifbrosis following anterior cruciate ligament （ ACL ） reconstruction.Methods The 30 patients with arthroifbrosis following ACL reconstruction in the outpatient clinic from Feb. 2014 to Jun. 2015 were included in the study. They were treated by Kaltenborn manual mobilization of the joints. The distal femur was ifxed on the treatment table, continuous traction was performed along the longitudinal axis of the tibial diaphysis, and the tibia was pushed backward from the femur on the tibial tuberosity, which were aided by interferential current therapy, ultrasound, wax therapy and mobilization of soft tissues. After the manual therapy, the patients did some exercises under the guidance, including lower limb strength and stability and balance training. The knee was treated with ice compress in the end. The treatment was continued for 12 weeks, 3 times a week and once every 2 days. Before the treatment and 4 and 12 weeks after the treatment, the maximum active range of motion （ ROM ） scale, visual analogue scale （ VAS ） （ 0 - 10 points ） and hospital for special surgery （ HSS ） score were used to evaluate the function of the knee. All the patients were followed up for 1 year. SPSS 19.0 statistical software package was used for data processing. The data were compared before and after the treatment with repeated-measures single factor analysis of variance and chi-square test.Results The ROM scores were （ 69.8 ± 15.1 ） °, （ 88.3 ± 13.9 ） ° and （ 103.0 ± 10.1 ） ° before the treatment and at 4 and 12 weeks after the treatment. The differences were statistically signiifcant （P 〈 0.01 ）. And at 12 months afterthe treatment, the ROM score was increased to （ 117.3 ± 11.6 ） °. The VAS scores were （ 2.0 ± 1.3 ） points and （ 0.9 ± 0.8 ） points before the treatment and at 4 weeks after the treatment. The differences were statistically significant （P 〈 0.01 ）. And

关 键 词：前交叉韧带重建 膝关节 物理治疗方法 韧带 关节 

分 类 号：R687.4[医药卫生—骨科学]