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

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。

Abstract:

[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 (0/2/8/15/14), P＜0.001] . [Conclusion] Early continuous passive motion afterarthroscopic microfracture for knee cartilage injury can greatly improve the clinical symptoms and knee function, with considerable carti-lage repair effect and fewer complications.