膝部前十字韌帶重建術後之復健

Rehabilitation after Reconstruction of the Anterior Cruciate Ligament

周清隆(Ching-Long Chou) ； 吳濬哲(Jiunn-Jer Wu) ； 徐道昌(Tao-Chang Hsu)

《中華民國復健醫學會雜誌》 18期 (1990/12) Pp. 81-91

摘要

近年來膝部前十字韌帶受傷的診斷技術與治療觀念進步迅速，依重建手術之不同，復健程序亦有不同。為評估病人恢復情形，客觀之數據亟待建立。本報告集自民國73年至76年間因膝部前十字韌帶受傷在榮總接受重建術之182名病患中有完整復健治療及定期作Cybex Ⅱ+等速肌力測試之73名病患，依所用三種不同材料及性別共分為六組，材料主要為(1)以本身膝韌帶代替者(2)以達克龍人工韌帶代替者(3)以Gortex 人工韌帶代者。筆者用Lysholm 的膝部評分標準(總分 100)作為復健前後評估依據，並用CybexⅡ+ system 等速肌力測試機測量大腿肌力進步情形，於手術後二、三、六個月測試記錄作為對照。結果發現在60°/秒速度下最大力矩與體重比值：大腿伸張肌男性可由平均55.22%進步到69.1%，女性由48.14%進步到54.89%；屈曲肌男性可由平均39.0%進步到54.5%，女性由29.71%進步到38.22%，大腿伸張肌爆發力男性可由平均12.28進步到15.06，女性由9.25進步到11.43；屈曲肌爆發力男性由平均9.18進步到9.27，女性由6.92進到6.97。肌肉耐力以CYBEX 測試結果表現退步。Lysholm 評分標準對病人功能評估得分與CYBEX 肌力測試值成正比。接受Gortex 人工韌帶重建及完整治療者，恢復程度極佳：約兩個月膝關節活動度正常，六個月大腿肌力恢復正常並可回復原來之運動項目。本報告所擬之復健程序，希望能提供一客觀評估，預後判定及治療處方之參考。

關鍵字

前十字韌帶受傷 ； 等速肌力測試

並列摘要

The technique of diagnosis and concepts in management of anterior cruciate ligament injury patient have been improving tremendously in the past few years. The postoperative care for the patients who have received ACL reconstruction has been a great concern to physicians, therapists and patients themselves. The purpose of this paper is to present a suggested rehabilitation protocol which is safe and effective and also to report the prognosis of our patients following this protocol. Among the 182 patients who had been operated at our hospital during 1984 to 1987. we collected 73 patients who had completed our rehabilitation program and had been regularly evaluated in 2,3 and 6 months after reconstruction. Some patients had been followed up for more than two years. This proctol is based upon many research informations and our clinical experience. The patients were sorted into three groups by different implant materials: group P (Patellar tendon medial one third), Group D (Dacron artificial ligament) and group G (Gortex artificial ligament). In evaluation of the knee function, we use the Lysholm score scale (Total 100) for functional rating and CYBEX II + system for testing the strength, endurance and torque acceleration energy of the muscle.
After rehabilitation training, we found that the Lysholm score increased greatest and fastest in group G with significiant difference ( p＜ 0.01) from that of group D in male patients. However, group D was still better than group P. The improvement of peak torque value to body weight ratio at velocity 60°/sec in 2 months to 6 months after reconstruction were as following: Quadriceps: in male patients average increased from 55.22% to 69.1%. in female patients from 48.14% to 54.89%; Hamstrings: in male average from 39.0% to 54.5%. in female from 19.71% to 38.22%. The torque acceleration energy also increased after our training. The increase of Lysholm score is proportional to the improvement of muscle strength. The functional recovery of those patients who received Gortex artificial ligament and completed the whole protocol were excellent. Most of them could get normal ROM in 2 months. Many cases could begin the running program on 3 months and return to activities with good performance in 6 months. We hope this protocol can be proven through the test of time and adapted by more patients with ACL injury.

並列關鍵字

Injury ； Anterior cruciate ligament ； Measurement ； Isokinetic