Publication:

運動員前十字韌帶術後之下肢生物力學

研究背景：目前前十字韌帶重建手術臨床上以髕骨肌腱或膕旁肌腱自體移植最為常見。過去許多文獻針對術後膝關節功能、膝關節鬆弛度和局部膝關節肌力的評估，藉以尋求最佳手術方式。然而，很少有研究提供臨床的證據，證實目前的手術方法可以成功的恢復膝關節運動學。過去研究顯示前十字韌帶是維持膝關節旋轉穩定重要的構造，不過還不清楚目前前十字韌帶的重建技術是否可以恢復膝關節的旋轉穩定性。而且，有關膕旁肌腱自體移植前十字韌帶重建術在不同強度之動作分析或膝關節旋轉方向之探討至今研究仍少。目的：針對膕旁肌腱自體移植前十字韌帶重建術，比較相關患者術後1年以上在不同強度之下肢動作分析，尤其是膝關節進行探討。研究方法：本研究共招募已接受膕旁肌腱自體移植前十字韌帶重建手術之病人共11位做為實驗組，另外延攬下肢無任何膝痛病史的台灣體院學生共15位做為健康對照組，進行基本資料、膝功能問卷評估、下肢物理性檢查、KT-2000 之前十字韌帶鬆弛度檢測、大腿周徑測量、膝關節活動度之動作分析測量。之後分別以獨立樣本t 考驗比較健康對照組與手術患者健側腳之組間差異；另外，以配對樣本t 考驗比較重建組兩腳間之差異。結果：本研究結果顯示，在膝關節功能問卷方面，膕旁肌腱移植組之患側腳顯著低於其健側腳及健康對照組（p<0.05）。在KT-2000 量測方面，顯示膕旁肌腱移植組比起健康對照組呈現顯著鬆弛現象（p<0.05）。在膝關節外旋活動度方面，膕旁肌腱移植組之患側腳大於其健側腳，這個結果符合預期，因患側腳取部分膕旁肌可能會導致膝內旋無力。然而，在膝關節旋轉活動角度比較上，膕旁肌腱移植組的患側腳與健側腳之間並無顯著差異。結論：本研究發現前十字韌帶重建患者於術後1年雖然已於臨床上常見的客觀性檢查與評估方面已恢復至幾近正常，而且在膝關節冠狀面活動角度的比較未呈現顯著差異，然而，膕旁肌腱移植組的健側或患側腳之膝關節外翻角度都有增加的趨勢，這一點是值得關注的。另一方面，我們發現前十字韌帶重建後，脛骨之膝關節總旋轉活動角度比較上，三組彼此之間並無顯著差異。採取此種膕旁肌腱自體移植前十字韌帶重建技術的膝關節總旋轉活動角度似乎不受到影響。但是，此結果或許需要更多的樣本數來證實。總之本研究於不同強度之動作方面，對膝關節旋轉的發現將有助於降低前十字韌帶再損傷的機率。

Background: At present, the anterior cruciate ligament reconstruction with patellar tendon or hamstring tendon autograft is most popular. In past, many papers made an attempt to find the best surgical advice with the evaluation of knee function, knee laxity, and knee muscle strength. Studies have shown that the anterior cruciate ligament knee is the important structure to maintain rotation stability. However, it is unclear at present whether the anterior cruciate ligament reconstruction can restore knee rotation stability. Besides, the hamstring tendon autograft surgery in the different intensity of knee motion analysis or direction of rotation is still far less studied. Purpose: To evaluate the lower limb motion analysis in different intensity, especial in the rotation motion of the knee joint after ACL reconstruction with hamstring using Transfix technique was restored. Methods: The study recruited 11 ACL reconstruction subjects and 15 healthy control subjects for the lower extremity physical check, the evaluation of IKDC score, Lyshom score, ACL laxity, the circumference of thigh and the biomechanical analysis of lower limb. Independent t-tests was conducted to examine the difference among the healthy group and the contralateral side of reconstructed leg. Paired t tests was used to perform bilateral comparison between the reconstructed leg and the uninvolved leg. Results: The result of this study showed that the reconstruction of the affected group was significantly lower than the healthy side and the healthy control group in knee function questionnaire (p <0.05). In the KT-2000 measurements, the reconstructed group showed a significant relaxation than the healthy control group (p <0.05). In external rotation of the knee joint, the reconstructed leg was greater than the contralateral side. This result was an expectation, because the harvesting hamstring muscle led to lower internal rotation force of knee. However, there was no significant difference between the reconstructed leg and the uninvolved leg in total rotation of the knee joint. Conclusion: This study found that patient with anterior cruciate ligament reconstruction, although the common clinically assessment has been restored to almost normal and the activity in the frontal plane of knee angle did not show significant comparative difference, however, the knee valgus angle of the reconstructed group had an increasing trend. On the other hand, we found that the total rotation angle of the reconstructed group revealed no significant difference between them. The total rotation of knee joint did not seem to be affected in such anterior cruciate ligament reconstruction with hamstring using the Transfix system. However, this result should need more samples to confirm. Our study made an attempt to explore the importance of knee rotation and also provided for the purpose of decreasing the incidence of anterior cruciate ligament re-injury.