早期负重对距骨骨软骨病损关节镜下修复术后关节功能恢复影响的前瞻性研究  

A prospective study of the effect of early weight-bearing on joint function recovery after arthroscopic repair of osteochondral lesions of the talus

作　　者：史长安 刘丽[1] 王建伟[1] SHI Chang-an;LIU Li;WANG Jian-wei(Department of Orthopaedics,Yan'an People's Hospital,Yan'an,Shaanxi,716000,China)

机构地区：[1]延安市人民医院骨科,陕西716000

出　　处：《中国骨与关节杂志》2020年第9期703-707,共5页Chinese Journal of Bone and Joint

摘　　要：目的探讨早期负重锻炼对距骨骨软骨病损 (osteochondral lesions of the talus,OLT) 经关节镜微骨折术后康复的影响。方法前瞻性纳入 80 例接受关节镜微骨折术治疗的 OLT 患者,根据随机数表将患者分为早期负重组 (40 例) 和延迟负重组 (40 例),其中早期负重组在术后第 1 天即开始部分负重锻炼、并于术后 4 周达到完全负重锻炼,而延迟负重组在术后第 5 周开始部分负重锻炼、于术后第 8 周达到完全负重锻炼。比较两组患者术后 1 年的 Berndt-Harty 分型、Mintz 分期情况,并比较两组患者术后 6 个月、12 个月和24 个月疼痛视觉模型评分 (visual analogue scale,VAS) 和 Tegner 活动指数差异。结果早期负重组和延迟负重组的术后 Berndt-Harty 分型和 Mintz 分期差异无统计学意义 (P>0.05)。两组术后 6 个月、12 个月和 24 个月的 AOFAS 评分分别为 (82.1±11.3) vs.(82.9±12.4)、(85.8±9.9) vs.(85.3±11.7)、(87.5±8.8) vs.(87.4±9.2),差异无统计学意义 (P>0.05);两组术后 6 个月、12 个月和 24 个月的 VAS 评分分别为 (2.6±0.4) vs.(2.4±0.8)、(2.4±0.5) vs.(2.4±0.4)、(1.5±0.5) vs.(1.5±0.3),差异无统计学意义 (P>0.05)。早期负重组患者术后 6 个月、12 个月和 24 个月的 Tegner 活动指数均显著高于延迟负重组,分别为 (4.5±1.0) vs.(2.6±0.8)、(4.7±1.2) vs.(3.7±0.9)、(4.7±1.0) vs.(3.9±1.1),差异有统计学意义 (P<0.05)。结论早期负重锻炼并不影响 OLT 患者术后踝关节的功能恢复,并且能够促进术后活动能力改善。Objective To investigate the effect of early weight-bearing exercises on postoperative rehabilitation after arthroscopic microfracture of osteochondral lesions of the talus (OLT).Methods Eighty OLT patients after arthroscopic microfracture were prospectively enrolled and divided into the early weight-bearing group(40 cases) and delayed weight-bearing group (40 cases) according to a random number table.The early group began partial weight-bearing exercises on the first day after surgery,and achieved full weight-bearing exercises 4 weeks after surgery.The delayed group began partial weight-bearing exercises at the 5th week after surgery,and achieved full weight-bearing exercises at the 8th week after surgery.The Berndt-Harty and Mintz staging were compared between the two groups at 1 year after operation,and the visual analogue scale (VAS) and Tegner activity index were compared between the two groups at 6 months,12 months,and 24 months after surgery.Results There were no significant differences in Berndt-Harty classification and Mintz staging between the early group and delayed group (P > 0.05).The AOFAS scores at 6 months,12 months,and 24 months after surgery were (82.1±11.3) vs.(82.9±12.4),(85.8±9.9) vs.(85.3±11.7),and (87.5±8.8) vs.(87.4±9.2) in the early group and delayed group,respectively,but there were no statistically significantly differences (P > 0.05).The VAS scores at 6 months,12 months,and 24 months after surgery were (2.6±0.4) vs.(2.4±0.8),(2.4±0.5) vs.(2.4±0.4),and (1.5±0.5) vs.(1.5±0.3) in the early group and delayed group,respectively,but there were no statistically significantly differences (P > 0.05).The Tegner activity indexes of the early group were significantly higher than that of the delayed group at 6 months,12 months and 24 months after surgery,which were (4.5±1.0) vs.(2.6±0.8),(4.7±1.2) vs.(3.7±0.9),and (4.7±1.0) vs.(3.9±1.1),respectively (P < 0.05).Conclusions Early weight-bearing exercises benefit the postoperative function recovery of patients with OLT.

关 键 词：距骨 骨软骨病 骨折 应力性 负重 抗阻训练 

分 类 号：R687.4[医药卫生—骨科学]