前交叉韧带重建后膝关节周围屈伸肌力与运动功能的变化  

Changes in the flexion and extension muscle strength and motor function of the knee joint after anterior cruciate ligament reconstruction

作　　者：刘志成[1] 李雁 张其亮 Liu Zhi-cheng;Li Yan;Zhang Qi-liang(Department of Bone Joint and Sports Medicine,Qingdao Municipal Hospital,Qingdao University,Qingdao 266000,Shandong Province,Chin)

机构地区：[1]青岛大学附属青岛市市立医院骨关节与运动医学科,山东省青岛市266000

出　　处：《中国组织工程研究》2018年第27期4393-4399,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:虽然前交叉韧带重建后康复效果良好,但目前重建后患肢肌力仍存在缺失,且运动功能不能完全恢复。目的:观察应用半腱肌、股薄肌肌腱为移植物行前交叉韧带重建后患肢肌力及运动功能的恢复过程,从而更好地指导前交叉韧带重建后患者的康复锻炼。方法:选择150例单纯前交叉韧带损伤患者为研究对象,所有患者均选用自体半腱、股薄肌肌腱为移植物进行重建,重建后进行康复锻炼。分别在重建后3,6,9和12个月对患者进行患侧及健侧等速肌力测试,并计算股四头肌肌力对称指数、屈肌肌力/伸肌肌力比值;在重建后第6及12个月进行单脚跳、6 m计时单脚跳、侧边单脚跳及交叉单脚跳4项运动功能测试。分析并评估重建后肌力及运动功能随时间变化的情况。结果与结论:(1)150例研究对象中只有118例完成全部测试,32例由于各种原因失访,失访率21.3%;(2)研究结果显示:在3,6,9和12个月时前交叉韧带重建后患者的患侧股四头肌肌力分别为对侧的(64.01±4.45)%,(77.97±5.04)%,(84.25±5.14)%,(86.98±5.28)%;腘绳肌肌力分别为对侧的(81.58±3.12)%,(91.06±3.72)%,(96.48±3.87)%,(97.59±3.77)%。经重复测量检验证实,随时间延长,屈、伸肌肌力逐步恢复(F=27.23,P=0.00);(3)对不同时间段肌力恢复情况的分析证实,3-6个月期间肌力恢复最快(P<0.05);重建后12个月时患侧肢体的股四头肌肌力仍显著低于健侧肢体(P<0.05),腘绳肌肌力与健侧无显著差异(P>0.05);(4)重建后3,6,9和12个月时屈肌肌力/伸肌肌力比值均显著高于健侧肢体(P<0.05);(5)前交叉韧带重建后6个月时单脚跳、6 m计时单脚跳、侧边单脚跳及交叉单脚跳等四项运动功能测试均低于健侧肢体的90%;重建后12个月时,患侧单腿跳及6 m计时单腿跳超过健侧肢体的90%,侧边单脚跳及交叉单脚跳仍低于健侧肢体的90%;(6)结果提示,前交叉韧带重建后患肢屈、伸肌肌力恢复�BACKGROUND： Although the effect of anterior cruciate ligament （ACL） reconstruction is good, the postoperative muscle strength is still absent and the motor function cannot be fully recovered. OBJECTIVE： To observe the muscle strength and functional performance of the affected limbs after ACL reconstruction using semitendonosus and gracilis as a autograft, so as to guide the rehabilitation of patients with ACL reconstruction. METHODS： Totally 150 patients with ACL injuries participated in this study. All patients underwent ACL reconstruction using semitendonosus and gracilis as an autograft and rehabilitation. Extension and flexion torques were measured for the injured and healthy limbs at postoperative 3, 6, 9 and 12 months, and the quadriceps strength symmetry index, hamstring/quadriceps ratio were measured. The single hop test, the 6-m timed hop test, crossover hop test and the side-to-side hop test were conducted at 6 and 12 months postoperatively. The changes of muscle strength and motor function with time were analyzed and evaluated. RESULTS AND CONCLUSION： （1） Of the 150 patients, only 118 patients completed all tests, and 32 patients （21.3 %） lost to follow up. （2） The average quadriceps strength of the affected side at 3, 6, 9, and 12 months postoperatively was （64.01±4.45）%, （77.97±5.04）%, （84.25±5.14）% and （86.98±5.28）% of the healthy side, respectively. The average hamstring strength of the affected side at 3, 6, 9, and 12 months postoperatively was （81.58±3.12）%, （91.06±3.72）%, （96.48±3.87）% and （97.59±3.77）% of the healthy side, respectively. Repeated measurement test confirmed that the flexor/extensor strength gradually recovered with time （F=27.23, P=0.00）. （3） Muscle strength recovered quickly between 3 and 6 months （P 〈 0.05）. The quadriceps strength of involved limb was still significantly lower than the uninvolved limb after 12 months （P 〈 0.05）. The hamstring muscle was not significantly different from the un

关 键 词：前交叉韧带重建 膝关节 肌力 等速 自体半腱 股薄肌肌腱 单脚跳测试 

分 类 号：R318[医药卫生—生物医学工程]