中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (4): 628-635.doi: 10.3969/j.issn.2095-4344.1045

• 骨与关节综述 bone and joint review • 上一篇    下一篇

自体腘绳肌腱重建前交叉韧带后的康复策略

覃华生1,潘玮敏2,李 然1,李新通1,曲 蕾1,祝新蕊1   

  1. 西安体育学院,1研究生部,2健康科学系,陕西省西安市 710068
  • 出版日期:2019-02-08 发布日期:2019-02-08
  • 通讯作者: 潘玮敏,博士,教授,西安体育学院健康科学系,陕西省西安市 710068
  • 作者简介:覃华生,男,1993年生,陕西省西安市人,壮族,西安体育学院在读硕士,主要从事运动损伤预防与康复研究。
  • 基金资助:

    国家自然科学基金项目(81201409),项目负责人:潘玮敏;国家体育总局重点攻关项目(10B019),项目负责人:潘玮敏

Rehabilitation strategy after anterior cruciate ligament reconstruction using autologous hamstring tendon

Qin Huasheng1, Pan Weimin2, Li Ran1, Li Xintong1, Qu Lei1, Zhu Xinrui1   

  1. 1Graduate School, 2Department of Health Sciences, Xi’an Physical Education University, Xi’an 710068, Shaanxi Province, China
  • Online:2019-02-08 Published:2019-02-08
  • Contact: Pan Weimin, MD, Professor, Department of Health Sciences, Xi’an Physical Education University, Xi’an 710068, Shaanxi Province, China
  • About author:Qin Huasheng, Master candidate, Graduate School, Xi’an Physical Education University, Xi’an 710068, Shaanxi Province, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81201409 (to PWM); the Key Research & Development Project of General Administration of Sport of China, No. 10B019 (to PWM)

摘要:

文章快速阅读:

 
 

 

文题释义:
腘绳肌(hamstring tendon):是大腿后侧的肌群,包括半腱肌、半膜肌、股二头肌长头,腘绳肌与强有力的股四头肌相对应。股二头肌长头、半腱肌、半膜肌起于坐骨结节,股二头肌短头起于股骨粗线。股二头肌长头和短头止于胫骨外面于腓骨,半腱肌、半膜肌止于胫骨内侧髁。股二头肌长头、半腱肌、半膜肌收缩动作是髋伸展和膝屈曲,股二头肌短头收缩动作是膝屈曲。它收缩的主要功能就是屈膝和后伸髋关节,是维持膝关节稳定性,尤其是防止胫骨过度前向错动的重要动力性稳定结构,运动员易发生腘绳肌的扭伤、撕裂等形式的损伤。
本体感觉:是指肌、腱、关节等运动器官本身在不同状态(运动或静止)时产生的感觉(例如,人在闭眼时能感知身体各部的位置)。因位置较深,又称深部感觉。此外,在本体感觉传导通路中,还传导皮肤的精细触觉(如辨别两点距离和物体的纹理粗细等)。主要涉及躯干和四肢的本体感觉传导通路(属于顶叶功能)。
 
摘要
背景:前交叉韧带重建术后的康复对恢复患者的日常生活和运动能力至关重要,而以腘绳肌腱作为移植物的前交叉韧带重建,由于移植物在骨道外无骨块固定,且骨隧道极易扩大,外加愈合过程中重建血运时间长等因素,导致其术后康复策略具有较大争议。
目的:叙述自体腘绳肌腱重建前交叉韧带术后相关康复手段,阐述国内外相关方法的研究现状。
方法:由第一作者检索2002年1月至2018年6月期间PubMed/MEDLINE、Cochrane、CINAHL、CNKI数据库收录的前交叉韧带重建术后各类康复手段及研究进展。中文检索词为:“前交叉韧带;前交叉韧带重建;腘绳肌腱;康复;研究进展;护具;关节活动训练;功能训练;下地时机、负重;本体感觉训练”,英文检索词为:“Anterior cruciate ligament;Anterior cruciate ligament reconstruction;Hamstring tendon;Rehabilitation;Research progress;Protective devices;Joint movement training;Functional training; Down time,load;Proprioceptive”。
结果与结论:前交叉韧带自体腘绳肌移植重建后常用的康复手段:①早期及恢复期护具的佩戴、早期疼痛与肿胀的控制有利于后期运动康复,合适的负重时机、关节活动的训练以及肌力、本体感觉、步态、核心训练等都具有较好的疗效。推荐早期的治疗要控制疼痛,保持膝关节伸直位,重点是保护移植物的稳定性;②在中期需要恢复正常的屈伸关节活动度,正常的步态,重点依然是保护移植物的稳定性。

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
ORCID: 0000-0002-5262-3352(覃华生)

关键词: 前交叉韧带, 前交叉韧带重建, 腘绳肌腱, 关节活动训练, 本体感觉训练, 移植物稳定性

Abstract:

BACKGROUND: Rehabilitation after anterior cruciate ligament reconstruction is critical for the recovery of patients’ daily life and motor ability. However, the strategy of anterior cruciate ligament reconstruction with hamstring tendon as graft remains controversial, because of the decrease of hamstring muscle strength and the long-time of reconstructing blood supply.

OBJECTIVE: To review the rehabilitation methods after anterior cruciate ligament reconstruction using autologous hamstring tendon, and to clarify the status of related methods at home and abroad.
METHODS: The first author retrieved the articles addressing various rehabilitation methods and research progress of rehabilitation of anterior cruciate ligament after hamstring transplantation in the databases of PubMed, MEDLINE, Cochrane, CINAHL and CNKI from January 2002 to June 2018. The key words were “anterior cruciate ligament, anterior cruciate ligament reconstruction, hamstring tendon, rehabilitation, research progress, protective devices, joint movement training, functional training, down time, load, proprioceptive” in English and Chinese, respectively.
RESULTS AND CONCLUSION: The commonly used rehabilitation methods after anterior cruciate ligament reconstruction using autologous hamstring tendon include: (1) wearing early muscle recovery stage protective device, early pain and swelling control are conducive to sports rehabilitation. Load timing, joint activity training and muscle strength, proprioception, gait, and core training have good curative effect. In early-term treatment, we should focus on pain control and keep knee joint in extending position, and keep the stability of the implant. (2) At the middle-stage, we aim at restoring the range of the motion in flexion and extension and gait, and focus on keeping the stability of the implant. 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

Key words: Anterior Cruciate Ligament, Tendons, Transplantation, Rehabilitation, Tissue Engineering

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