前交叉韧带重建术后膝关节运动分析研究进展
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1.上海体育学院;2.上海交通大学 生物医学工程学院

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国家重点研发计划 (2018YFF0300504);国家自然科学基金面上项目(3177040100); 上海市科委浦江人才计划 (17PJ1405000) ; 上海交通大学医工交叉研究基金 (YG2017MS09)


Progress in the Knee Joint Motion Analysis after Anterior Cruciate Ligament Reconstruction
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1.Shanghai University of Sport;2.School of Biomedical Engineering, Shanghai Jiao Tong University;3.shanghai university of sports

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    摘要:

    膝关节前交叉韧带损伤是临床常见的严重影响膝关节稳定性的运动性损伤。尽管前交叉韧带重建术可以修复韧带的结构,但却无法恢复膝关节正常的运动学与动力学。近年来,利用运动分析评估前交叉韧带重建术后的疗效是运动医学及康复医学领域的研究热点。目前运动分析主要应用在重建术后的疗效评价、个性化康复方案的制定,也是探讨前交叉韧带重建术后继发性损伤和早发性骨性关节炎的潜在危险因素的科学客观工具。未来前交叉韧带重建术后的运动分析更多关注于优化手术方案和康复治疗方案。本文回顾了近十年前交叉韧带重建术后膝关节运动分析的观察性研究和随机临床试验,介绍光学运动捕捉和双平面透视追踪在前交叉韧带重建术后运动分析中的应用进展。临床研究表明无论选择何种移植物和术式重建前交叉韧带,术后膝关节在功能任务中仍表现出异常的运动学特征,但术后膝关节生物力学的改变与早发性膝关节骨性关节炎的关系仍不清楚。恢复膝关节的旋转稳定性仍是临床前交叉韧带重建手术最大的挑战之一。未来研究应通过合理的研究设计与长期随访,探讨前交叉韧带重建术对膝关节生物力学机制的影响,帮助临床医生和物理治疗师制定更有效的干预措施。

    Abstract:

    Anterior cruciate ligament (ACL) deficiency is a common clinical injury that seriously affects the function of the knee. Although ACL reconstruction (ACLR) can rebuild the structure of the ACL, it does not restore the normal kinematics and dynamics of the knee. In recent years, motion analysis has been widely applied in sports science and rehabilitation. In clinics, motion analysis is mainly applied to the evaluation of clinical outcomes of the ACLR knee. It is also a scientific objective tool to assess the potential risk factors of secondary injury and early onset of osteoarthritis after ACLR. In-depth understanding of the knee functional kinematics and kinetics after ACLR will significantly improve the efficacy of current ACL deficiency treatment and rehabilitation regime. This article reviewed studies of the knee joint motion analysis after ACLR in the past decade. We synthesized the current knowledge of the ACLR knee motion from studies using optical motion capture and biplanar fluoroscopic imaging system based tracking technique. Clinical studies have reported that regardless of the type of graft and surgical technique of the ACLR, the postoperative knee still exhibits abnormal kinematics in functional tasks, but the relationship between early-onset OA and the biomechanical changes in the ACLR knee remains unknown. Restoring the rotational stability of the knee is still one of the biggest challenges in clinical ACLR surgery. Future studies should explore the impact of ACLR on the biomechanical mechanisms of the knee joint through an appropriate research design and long-term follow-up, and help clinicians and physiotherapists to develop more effective interventions.

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  • 收稿日期:2019-01-23
  • 最后修改日期:2019-03-11
  • 录用日期:2019-03-19
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