镜下微骨折术后早期持续被动活动治疗膝软骨损伤  

Early continuous passive motion after arthroscopic microfracture for knee cartilage injury

作　　者：罗立立[1] 魏康[1] 刘均 周明[1] 戴文昊 张曦[1] 高俊[1] LUO Li-li;WEI Kang;LIU Jun;ZHOU Ming;DAI Wen-hao;ZHANG Xi;GAO Jun(Changzhou Hospital of Traditional Chinese Medicine,Nanjing University of Chinese Medicine,Changzhou 213000,China)

机构地区：[1]南京中医药大学附属常州市中医医院,江苏常州213000

出　　处：《中国矫形外科杂志》2024年第6期512-518,共7页Orthopedic Journal of China

基　　金：第四批省名老中医药专家传承工作室建设项目(编号:苏中医科教[2021]7号);第七批全国老中医药专家学术经验继承工作指导老师及继承人项目(编号:国中医药人教函[2022]76号)。

摘　　要：[目的]探讨关节镜下微骨折术后早期持续被动活动(continuous passive motion,CPM)对膝关节软骨损伤修复的作用。[方法]回顾性分析2017年1月—2021年5月79例因膝关节软骨损伤在本院接受关节镜微骨折术治疗患者的临床资料,根据医患沟通结果,40例接受早期CPM治疗,39例接受常规康复治疗。比较两组围手术期、随访、影像学指标。[结果]两组患者软骨损伤部位、主要病变面积、手术时间、切口愈合、住院时间、术前及术后1 d的VAS评分的比较差异均无统计学意义(P>0.05),但CPM组术后3、7 d VAS评分均显著优于常规组[(5.4±0.9)vs(5.9±0.8),P=0.007;(4.6±1.0)vs(5.2±1.2),P=0.010]。随时间推移,两组VAS评分、OKS评分、WOMAC评分、AKS评分、膝ROM均显著改善(P<0.05),治疗后18周、末次随访时,CPM组VAS评分[(3.9±0.9)vs(4.4±0.6),P=0.004;(2.8±1.0)vs(3.4±0.9),P=0.003]、OKS评分[(33.8±4.2)vs(40.1±3.7),P<0.001;(25.5±3.4)vs(30.3±3.8),P<0.001]、WOMAC评分[(16.5±2.9)vs(20.1±3.1),P<0.001;(13.7±3.0)vs(18.2±3.9),P<0.001]、AKS评分[(96.3±10.5)vs(80.4±9.9),P<0.001;(113.5±13.3)vs(103.8±10.4),P<0.001]、膝ROM[(107.1±9.3)°vs(99.0±7.8)°,P<0.001;(111.9±9.0)°vs(105.0±9.1)°,P<0.001]均显著优于常规组。影像方面,与术前相比,末次随访时,CPM组患者软骨损伤MRI分级显著改善(P<0.05),但常规组软骨损伤MRI分级无显著变化(P>0.05),末次随访时,CPM组的软骨损伤MRI分级[膝,0/I/II/III/IV,(1/7/11/13/8)vs(0/2/8/15/14),P<0.001]显著优于常规组。[结论]膝关节软骨损伤患者在行关节镜下微骨折术后实施早期持续被动活动能够很大程度的改善患者的临床症状,优化膝关节功能,软骨修复效果显著,且并发症较少。[Objective]To investigate the clinical consequences of early continuous passive motion(CPM)on the repair of knee carti-lage injury after arthroscopic microfracture.[Methods]A retrospective study was conducted on 79 patients who received arthroscopic mi-crofracture for knee cartilage injury in our hospital from January 2017 to May 2021.According to the results of doctor-patient communica-tion,40 patients received early CPM treatment,while other 39 cases received routine rehabilitation.The perioperative period,follow-upand imaging documents were compared between the two groups.[Results]There were no significant differences in cartilage injury site,ma-jor lesion area,operation time,incision healing,hospital stay,preoperative and postoperative VAS scores 1 day after surgery between thetwo groups(P>0.05).However,the CPM group were significantly better than the conventional group in term of VAS scores 3 and 7 days af-ter surgery[(5.4±0.9)vs(5.9±0.8),P=0.007;(4.6±1.0)vs(5.2±1.2),P=0.010].The VAS,OKS,WOMAC,AKS scores and knee ROM signifi-cantly improved in both groups over time(P<0.05).The CPM group proved significantly superior to the routine group in terms of VAS score[(3.9±0.9)vs(4.4±0.6),P=0.004;(2.8±1.0)vs(3.4±0.9),P=0.003],OKS score[(33.8±4.2)vs(40.1±3.7),P<0.001;(25.5±3.4)vs(30.3±3.8),P<0.001],WOMAC score[(16.5±2.9)vs(20.1±3.1),P<0.001;(13.7±3.0)vs(18.2±3.9),P<0.001],AKS score[(96.3±10.5)vs(80.4±9.9),P<0.001;(113.5±13.3)vs(103.8±10.4),P<0.001],knee ROM[(107.1±9.3)°vs(99.0±7.8)°,P<0.001;(111.9±9.0)°vs(105.0±9.1)°,P<0.001]18 weeks postoperatively and the latest follow up.With respect of imaging,MRI grading of cartilage injury in the CPM group was signifi-cantly improved at the last follow-up compared with the preoperative period(P<0.05),but there was no significant change in MRI grade of cartilage injury in routine group(P>0.05).At the last follow-up,the MRI grade of cartilage injury in the CPM group was significantly betterthan that in the routine group[0/I/II/III/IV,(1/7/11/13/8)vs(0/2/

关 键 词：软骨损伤 修复 关节镜下微骨折术 早期持续被动活动 

分 类 号：R687[医药卫生—骨科学]