摘要
目的 探究关节镜双后内入路手术结合早期运动康复与物理治疗对后交叉韧带胫骨止点撕脱骨折膝关节功能的影响.方法 前瞻性选取2020年4月至2022年4月在秦皇岛市第一医院接受关节镜双后内入路手术的后交叉韧带胫骨止点撕脱骨折患者90例,按照信封法将其分为研究组与对照组,每组各45例.在常规治疗的基础上,对照组接受物理治疗,研究组接受早期运动康复治疗.随访6个月,对两组患者术后疗效、下肢功能恢复情况(下床行走时间、住院时间、骨折愈合时间、术后下肢负重时间)、膝关节活动范围[屈曲角度、伸直受限角度及关节活动范围]、美国特种外科医院膝关节评分(HSS)量表(疼痛、功能、活动度、肌力、屈曲畸形及稳定性HSS)、患者满意度进行记录,并分析组间差异.结果 研究组患者的治疗有效率为91.11％,高于对照组(75.56％),差异有统计学意义(P＜0.05).研究组患者下床行走时间、住院时间、骨折愈合时间、术后下肢负重时间均短于对照组,差异均有统计学意义(P＜0.05).治疗后6个月,两组患者的屈曲角度、关节活动范围均较治疗前增大,伸直受限角度均较治疗前减小,研究组屈曲角度、关节活动范围分别为(112.55±5.16)°、(108.66±11.02)°,均大于对照组[(97.89±4.51)°、(95.16±12.04)°],研究组伸直受限角度为(3.35±1.08)°,小于对照组[(4.89±1.62)°],差异均有统计学意义(P＜0.05);治疗后6个月,两组患者在疼痛、功能、活动度、肌力、屈曲畸形及稳定性等方面的评分均较治疗前升高,且研究组在各方面的评分均高于对照组,差异均有统计学意义(P＜0.05).研究组患者的满意率为95.56％,高于对照组(80.00％),差异有统计学意义(P＜0.05).结论 关节镜双后内入路手术结合早期运动康复对后交叉韧带胫骨止点撕脱骨折的治疗效果较好,可以明显改善患者的症状、促进愈合、提高膝关节功能,同时提高患者的满意度.
Abstract
Objective To explore the effect of arthroscopic double posterior internal approach surgery combined with early exercise reha-bilitation and physical therapy on the knee function of posterior cruciate ligament tibial arrest avulsion fracture.Methods A total of 90 patients with posterior cruciate ligament tibial stop avulsion fracture who underwent arthroscopic double posterior internal approach surgery in Qinhuangdao No.1 Hospital from April 2020 to April 2022 were selected,and all patients received conventional treatment after surgery.According to the enve-lope method,the patients were divided into the study group and the control group,with 45 cases in each group.On the basis of conventional treat-ment,the control group received physical therapy,and the study group received early exercise rehabilitation treatment,followed up for 6 months.The postoperative efficacy,recovery of lower limb function(time to get out of bed and walk,length of hospital stay,fracture healing time,weight-bearing time of lower limbs after surgery),range of motion of knee joint(flexion angle,extension limitation angle and range of motion),hospi-tal for special surgery knee score(HSS)scale(pain,function,range of motion,muscle strength,flexion deformity and stability HSS),patient satisfaction were recorded,and the differences between the two groups were analyzed.Results The therapeutic efficacy of the study group was 91.11％,which was higher than that of the control group(75.56％),and the difference was statistically significant(P＜0.05).The time for patients to get out of bed and walk,hospitalization time,fracture healing time,and postoperative lower limb weight-bearing time were shorter in the study group than those in the control group,and the differences were statistically significant(P＜0.05).After six months of treatment,the flexion angle and range of joint motion of the two groups of patients were biger than those before treatment,and the extension limitation angle were less than those before treatment,the flexion angle and range of joint motion of the study group were(112.55±5.16)° and(108.66±11.02)°,which were biger than those of the control group[(97.89±4.51)° and(95.16±12.04)°],the extension limitation angle of the study group was(3.35±1.08)°,which was less than that of the control group[(4.89±1.62)°],the differences were statistically significant(P＜0.05).After six months of treatment,the scores of pain,function,range of motion,muscle strength,flexion deformity and stability of the two groups of patients were higher than those before treatment,and the scores of the study group in all aspects were higher than those of the control group,and the differences were statistically significant(P＜0.05).The satisfaction rate of the study group(95.56％)was higher than that of the control group(80.00％),and the difference was statistically significant(P＜0.05).Conclusion Arthroscopic double posterior internal approach com-bined with early exercise rehabilitation has a good effect on the treatment of posterior cruciate ligament tibial stop avulsion fracture knee joint,which can significantly improve the symptoms of patients,promote healing,improve knee joint function,and improve patient satisfaction.
基金项目
河北省医学科学研究重点课题计划项目(20171253)
秦皇岛市科学技术研究与发展计划项目(201805A099)
NETL
NSTL
万方数据