摘要目的 比较前交叉韧带重建术后采用开链运动(OKC)、闭链运动(CKC)与有限OKC加CKC相结合的运动康复效果.方法 选择单侧ACL断裂并已行ACL解剖重建手术患者94例,按数字表法分为OKC组(采用OKC康复方案治疗)、CKC组(采用CKC康复方案治疗)和联合训练组(采用有限OKC加CKC相结合的康复方案治疗),其中OKC组33例,CKC组30例,联合训练组31例.术前3组患者的Lysholm膝关节评分、国际膝关节文献委员会膝关节评估表(IKDC)评分、KT-1000值的差异无统计学意义(P＞0.05).分别比较3组患者术后3个月和6个月的Lysholm膝关节评分、IKDC评分、KT-1000值及主动、被动关节活动度差值.结果 治疗前,3组患者的Lysholm膝关节评分和IKDC评分及其KT-1000值和主动、被动关节活动度差值组间比较,差异均无统计学意义(P＞0.05).术后3个月,OKC组、CKC组和联合训练组的Lysholm膝关节评分分别为(87.00±4.79)、(83.67±3.55)和(86.71土3.62)分,IKDC评分分别为(89.45土4.79)、(86.40±3.76)和(88.58±3.60)分;主动活动度差值分别为(10.06±2.06)、(7.73±1.41)和(8.10±1.35)°;被动活动度差值分别为(9.76±2.26)、(7.87±1.89)和(8.39±1.62)°;KT-1000值分别为(1.99±0.30)、(1.05±0.26)和(1.02±0.24) mm.3组患者的Lysholm膝关节评分、IKDC评分、主动活动度差值、被动活动度差值、KT-1000值的组间差异均有统计学意义(P＜0.05).术后6个月,OKC组、CKC组和联合训练组的Lysholm膝关节评分分别为(91.33±5.68)、(91.23±5.48)和(92.00±4.40)分;IKDC评分分别为(93.45±4.35)、(92.40±3.96)和(93.18±4.61)分;主动活动度差值分别为(5.33±1.73)、(3.20±1.45)和(3.52±1.03)°;被动活动度差值分别为(4.45±0.94)、(4.03±1.27)和(3.90±1.01)°;KT-1000值分别为(2.13±0.36)、(1.11±0.21)和(1.12±0.26) mm.3组患者术后6个月时的Lysholm膝关节评分和IKDC评分差异均无统计学意义(P＞0.05),但在主动活动度差值、被动活动度差值、KT-1000值的差异均有统计学意义(P＜0.05).并且OKC组的Lysholm膝关节评分和IKDC评分与联合训练组同时间点比较,差异无统计学意义(P＞0.05),而在主动活动度差值、被动活动度差值、KT-1000值的差异有统计学意义(P＜0.05);CKC组在Lysholm膝关节评分、IKDC评分、主动活动度差值、被动活动度差值、KT-1000值方面与联合训练组比较,差异无统计学意义(P＜0.05).结论 采取有限OKC加CKC相结合的康复训练是前交叉韧带重建术后功能恢复的一种安全、可靠的康复训练方法.

abstractsObjective To compare the clinical effects of open kinetic chain (OKC) exercises with those of closed kinetic chain (CKC) exercises and limited open kinetic chain combined with closed kinetic chain exercises on rehabilitation after the anterior cruciate ligament reconstruction.Methods Ninety-four patients recovering from single-bundle anterior ligament reconstructions were enrolled and randomly divided into an OKC group (n =33),a CKC group (n =30) or a limited open kinetic chain combined with closed kinetic chain group (combined group) (n =31).Lysholm score,International Knee Documentation Committee (IKDC) score,KT-1000,and active and passive range of motion were evaluated for the 3 groups three and six months after the surgery.Results Three months after surgery,significant differences were found among the 3 groups in Lysholm scores [(87.00±4.79),(83.67± 3.55) and (86.71±3.62) respectively],IKDC scores [(89.45±4.79),(86.40±3.76) and (88.58±3.60) respectively],KT-1000[(1.99±0.30),(1.05±0.26) and (1.02±0.24) mm],as well as active and passive range of motion [(10.06±2.06),(7.73±1.41) and (8.10±1.35) mm;(9.76±2.26),(7.87±1.89) and (8.39±1.62) mm] (P＜ 0.05).Six months after surgery,no significant differences were found in Lysholm scores and IKDC scores(P＞0.05),but significant differences were found in KT-1000,and active and passive range of motion(P＜0.05) compared to those at 3 months after surgery.Moreover,there were no significant differences between the OKC and combined groups in Lysholm scores and IKDC scores(P＞0.05),but significant differences between them in active and passive range of motion (P＜0.05).There were no significant differences between the CKC and combined groups in Lysholm scores,IKDC scores,KT-1000,and active and passive range of motion(P＜0.05).Conclusion Combining limited open kinetic chain exercise with closed kinetic chain exercise is safe and reliable in the rehabilitation after anterior cruciate ligament reconstruction.