膝多发韧带损伤一期修复重建的个性阶段化康复

Individualized phased rehabilitation for one-stage repair and reconstruction of multi-ligamentous knee injuries

摘要:

[目的] 评价膝多发韧带损伤 （multi-ligamentous knee injuries, MLKI） 一期修复重建术后个性阶段化康复的临床结果。[方法]回顾性分析 2016 年 1 月—2023 年 12 月本院骨科收治的 20 例 MLKI 患者，均给予一期手术修复重建，并给予个性阶段化康复，评估患者临床资料。[结果]所有患者均顺利手术，20 例患者中，10 例为 ACL/PCL/MCL 联合损伤；6 例为 ACL/ PCL/PLC 联合损伤； 3 例为 ACL/MCL 联合损伤，1 例为 PCL/PLC 损伤。行 ACL 修补 1 例，ACL 重建 18 例；PCL 修补 1 例， PCL 重建者 16 例；PMC 修补者 11 例，PMC 重建者 2 例；PLC 修补 1 例，PLC 重建 6 例。随术前、术后 1 个月和末次随访的时间推移，膝 ROM [(76.0±2.6)°, (79.2±2.2)°, (130.0±2.5)°, P＜0.001]、VAS 评分 [(5.0±0.5), (4.2±0.4), (1.1± 0.2), P＜0.001]、Lysholm 评分 [(38.0±1.8), (42.0±2.3), (87.2±2.9), P＜0.001]、IKDC 评分 [(42.2±1.9), (45.3±2.4), (87.4±1.8), P＜0.001] 和 KSS 评分 [(40.0±1.9), (43.3±1.7), (87.0±1.8), P＜0.001] 均显著改善。随访过程中，所有患者均无翻修手术。[结论] 多发韧带损伤一期修复重建术后， 根据患者实际情况采取个性阶段化的康复可有效提升患者术后康复效果，减少术后膝关节功能障碍的发生。

Abstract:

[Objective] To evaluate the clinical outcome of individualized phased rehabilitation for one-stage repair and reconstruction of multi-ligamentous knee injuries (MLKI). [Methods] A retrospective study was performed on 20 patients who admitted into our department for MLKI from January 2016 to December 2023. All of whom received one-stage surgical repair and reconstruction, followed by personalized phased rehabilitation. The clinical data of the patients were evaluated. [Results] All patients were operated on successfully. Among 20 patients, 10 patients were of ACL/PCL/MCL combined injuries, 6 of ACL/PCL/PLC combined injuries, 3 of ACL/MCL combined injuries and 1 of PCL/PLC injuries. Regarding surgical treatment, ACL repair was performed in 1 case, ACL reconstruction in 18, PCL repair in 1, PCL reconstruction in 16, PMC repair in 11, PMC reconstruction in 2, PLC repair in 1 and PLC reconstruction in 6 cases. As time elapsed preoperatively, 1 month after operation and the last follow-up, knee ROM [(76.0±2.6)°, (79.2±2.2)°, (130.0±2.5)°, P＜0.001], VAS score [(5.0±0.5), (4.2±0.4), (1.1±0.2), P＜0.001], Lysholm score [(38.0±1.8), (42.0±2.3), (87.2±2.9), P＜0.001], IKDC scores [(42.2±1.9), (45.3±2.4), (87.4±1.8), P＜0.001] and KSS score [(40.0±1.9), (43.3±1.7), (87.0±1.8), P＜0.001] were significantly improved. During the followup, none of the patients had revision surgery. [Conclusion] After the onestage repair and reconstruction of MLKI, individualized stage rehabilitation according to the actual situation of patients does effectively improve the consequence and reduce the occurrence of postoperative knee dysfunction.