分析关节镜下行膝关节自体软骨移植术后早期个体化康复训练的疗效。

选取2016年1月至2017年1月在湖州市第一人民医院接受关节镜下软骨移植修复膝关节软骨缺损治疗的37例患者。其中股骨内髁负重面软骨损伤27例，股骨外髁负重面软骨损伤10例；按照国际软骨修复协会标准分级，软骨缺损深度分别为Ⅱ级3例、Ⅲ级34例；34例软骨损伤面积为1.5～3.0 cm²，3例大于3 cm²。术前通过评估建立功能档案，参与康复学堂，制定个体化康复训练方案。术后按训练方案进行早期功能锻炼。采用Brittberg-Peterson功能评定标准评估患者自体软骨移植前后膝关节功能。采用配对t检验比较患者自体软骨移植前后Brittberg-Peterson功能评分。P<0.05为差异有统计学意义。

截至2017年1月，37例患者术后随访12～20个月，均无失访。术后12个月行膝关节MRI检查，示原软骨缺损区软骨表面平整，移植骨软骨柱位置良好。经康复训练后，37例患者膝关节Brittberg-Peterson功能评定标准评分平均为(62.2±1.4)分，低于术前(81.6±1.2)分，差异有统计学意义(t＝63.21，P<0.05)；其中关节绞锁、关节肿胀、跑步困难、关节疼痛等13项指标较术前均有明显改善(P均<0.05)。

早期个体化康复训练对关节镜下膝关节自体软骨移植术后膝关节功能的恢复有显著作用。

To evaluate the effect of early and individual rehabilitation training after transplantation for patients with arthroscopic osteochondral autologous transplantation.

Thirty-seven patients who received autogenous osteochondral transplantation in the First People′s Hospital of Huzhou from January 2016 to January 2017 for the treatment of knee joint cartilage defect were selected, among whom there were 27 cases of cartilage damage in femoral internal condyle bearing surface and 10 cases of cartilage damage in external condyle bearing surface. The depth of cartilage defect was graded according to the international society for cartilage repair standard, with 3 cases of grade Ⅱ and 34 cases of grade Ⅲ respectively. The cartilage damage area of 34 cases was between 1.5 cm² and 3.0 cm^2, and 3 cases was more than 3 cm². Functional archives of patients were established through preoperative evaluation and individualized rehabilitation training programs were formulated preoperative. Meanwhile, all the patient participated in rehabilitation classes. Early functional exercise was performed according to the training programs after operation. Knee joint function before and after osteochondral autologous transplantation was evaluated by Brittberg-Peterson functional assessment criteria. The paired t-test was used to compare the Brittberg-Peterson functional scores before and after osteochondral autologous transplantation. P<0.05 was considered statistically significant.

Thirty-seven patients were followed up for 12 to 20 months up to January 2017, no loss of follow-up. Magnetic resonance imaging of the knee joint was performed 12 months after surgery, indicating that the cartilage surface was flat in the original cartilage defect area, and the position of the transplanted osteochondral column was good. After rehabilitation training, the Brittberg-Peterson functional assessment standard score of 37 patients with knee joint function was (62.2±1.4) points, which was lower than the preoperative (81.6±1.2) points, the difference was statistically significant (t=63.21, P<0.05); 13 items of Brittberg-Peterson functional assessment standard scores, such as joint lock, joint swelling, running pain, joint pain, were better than preoperative, and significantly lower than preoperative (P all <0.05).

Early individualized rehabilitation training has a significant effect on the improvement of knee joint function after osteochondral autologous transplantation.