两种康复锻炼方式对髌骨外侧挤压综合征术后的影响

doi:10.3877/cma.j.issn.2096-0263.2025.04.005

中华老年骨科与康复电子杂志 ›› 2025, Vol. 11 ›› Issue (04) : 222 -230. doi: 10.3877/cma.j.issn.2096-0263.2025.04.005

康复医学

两种康复锻炼方式对髌骨外侧挤压综合征术后的影响

张元华¹, 许开¹, 袁昆², 于成月³, 赵冬临⁴, 孙建威², 高小康²^,⁵^,⁶^,^†(

)

¹056002　邯郸，华北医疗健康集团峰峰总医院（邯郸市骨科医院）康复科
²056002　邯郸，华北医疗健康集团峰峰总医院（邯郸市骨科医院）骨科
³300072　天津大学
⁴300381　天津体育学院
⁵300211　天津市天津医院骨科
⁶300211　天津医科大学骨科临床学院

收稿日期:2024-12-17 出版日期:2025-08-05
通信作者: 高小康
基金资助:
河北省医学科学研究课题计划(20251364); 邯郸市科学技术研究与发展计划(21422083378)

The effects of two rehabilitation exercise methods on postoperative patients with lateral patellar compression syndrome

Yuanhua Zhang¹, Kai Xu¹, Kun Yuan², Chengyue Yu³, Donglin Zhao⁴, Jianwei Sun², Xiaokang Gao²^,⁵^,⁶^,^†()

¹Department of Rehabilitation, North China Medical and Health Group Fengfeng General Hospital, Handan 056002, China
²Department of Orthopedics, North China Medical and Health Group Fengfeng General Hospital, Handan 056002, China
³Tianjin University, Tianjin 300072, China
⁴Tianjin University of Sport, Tianjin 300381, China
⁵Department of Orthopedics, Tianjin Hospital, Tianjinn 300211, China
⁶Clinical College of Orthopedics, Tianjin Medical University, Tianjinn 300211, China

Received:2024-12-17 Published:2025-08-05
Corresponding author: Xiaokang Gao

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引用本文：

张元华, 许开, 袁昆, 于成月, 赵冬临, 孙建威, 高小康. 两种康复锻炼方式对髌骨外侧挤压综合征术后的影响[J/OL]. 中华老年骨科与康复电子杂志, 2025, 11(04): 222-230.

Yuanhua Zhang, Kai Xu, Kun Yuan, Chengyue Yu, Donglin Zhao, Jianwei Sun, Xiaokang Gao. The effects of two rehabilitation exercise methods on postoperative patients with lateral patellar compression syndrome[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2025, 11(04): 222-230.

目的

对于髌骨外侧挤压综合征术后的患者，对比观察在康复计划中增加股内侧肌锻炼和内推髌骨与执行常规康复计划的效果。

方法

回顾性分析2020年08月至2023年7月通过关节镜下松解外侧支持带治疗髌骨外侧挤压综合征的患者，共47例，男性15例，女性32例，平均年龄（46.07±3.81）岁，分为两组，常规组23例，试验组24例。常规组执行常规下肢术后康复流程，试验组在此基础上，增加侧抬腿、坐位夹球和内推髌骨特殊康复步骤。

结果

常规组和试验组术前、术后3月、术后6月和术后12月进行重复测量设计的方差分析，两组间Lysholm、IKDC2000和Kujala评分差异有统计学意义（P<0.05），不同时间点间差别有统计学意义（P=0.000），组别与时间点间存在交互作用（P<0.05），各时间点除术前外，两组差别均有统计学意义（P<0.05）；两组间VAS评分差异无统计学意义（P>0.05），不同时间点间差别有统计学意义（P=0.000），组别与时间点间不存在交互作用（P>0.05），各时间点两组差别均无统计学意义P>0.05）。术后3、6、12月时，试验组的肌肉萎缩率均小于常规组，试验组的主观满意度均高于常规组，试验组总体康复效果优于常规组。

结论

髌骨外侧挤压综合征术后的患者，在康复流程中增加股内侧肌锻炼和内推髌骨，术后膝关节功能更好，主观满意度更高。

关键词: 髌骨外侧挤压综合征, 康复锻炼, 侧抬腿, 坐位夹球, 内推髌骨

Objective

For patients with lateral patellar compression syndrome after surgery, to compare the effect of increasing the vastus medialis exercise and pushing the patella inward in the postoperative rehabilitation with the routine rehabilitation program.

Methods

A retrospective analysis was conducted on 47 patients with lateral patellar compression syndrome who underwent arthroscopic release of the lateral retinaculum from August 2020 to July 2023. There were 15 males and 32 females with an average age of (46.07± 3.81) years. The patients were divided into two groups, 23 cases in the conventional group and 24 cases in the experimental group. The routine group carried out the routine postoperative rehabilitation process of lower limbs, and the experimental group added the special rehabilitation steps of raising legs straight in the lateral position, sitting with legs holding the ball, and pushing the patella inward.

Results

Anova of repeated measurement design was performed before surgery, 3 months after surgery, 6 months after surgery and 12 months after surgery between the conventional group and the experimental group. There were statistically significant differences in Lysholm, IKDC2000 and Kujala scores between the two groups (P<0.05), and there were statistically significant differences at different time points (P=0.000). There was an interaction between the groups and time points (P<0.05), and the difference between the two groups was statistically significant at each time point except before surgery (P<0.05). There was no statistically significant difference in VAS score between the two groups, there was statistically significant difference between different time points (P=0.000), there was no interaction between the groups and time points, and there was no statistically significant difference between the two groups at each time point. At 3, 6 and 12 months after operation, the muscle atrophy rate of the experimental group was lower than that of the conventional group, and the subjective satisfaction of the experimental group was higher than that of the conventional group. The overall rehabilitation effect of the experimental group was better than that of the conventional group.

Conclusion

In the postoperative patients with lateral patellar compression syndrome, increasing the exercise of the vastus medialis and internal push of the patella in the rehabilitation process can improve the knee function and subjective satisfaction.

Key words: Lateral patellar compression syndrome, Rehabilitation exercise, Raising legs straight in the lateral position, Sitting with legs holding the ball, Pushing the patella inward

表1 两组髌骨外侧挤压综合征患者一般资料比较

组别	例数	性别（例）	年龄（岁，±s）	病程（月，±s）	侧别（例）
组别	例数	男/女	年龄（岁，±s）	病程（月，±s）	左/右
常规组	23	8/15	45.29±3.41	24.56±14.92	15/8
试验组	24	7/17	46.81±4.23	26.56±12.43	14/10
χ²/F值		0.170	0.424	0.526	0.236
P值		0.680	0.290	0.675	0.627

表1 两组髌骨外侧挤压综合征患者一般资料比较

组别	例数	性别（例）	年龄（岁，±s）	病程（月，±s）	侧别（例）
组别	例数	男/女	年龄（岁，±s）	病程（月，±s）	左/右
常规组	23	8/15	45.29±3.41	24.56±14.92	15/8
试验组	24	7/17	46.81±4.23	26.56±12.43	14/10
χ²/F值		0.170	0.424	0.526	0.236
P值		0.680	0.290	0.675	0.627

图1 患者女，47岁，诊断：1，右侧髌骨挤压综合征。2，右侧髌股关节炎。图示关节镜下"L"型松解外侧支持带过程。图a　关节镜下探查见外侧髌股关节挤压；图b　射频钩刀准备松解外侧支持带；图c　松解外侧支持带进行中；图d　松解轨迹呈"L"型

图2 两组均执行的靠墙静蹲。图a　正面观，背部和臀部靠墙，双足展开与肩同宽。图b　侧面观，膝关节屈曲70~80°，不超过90°，膝关节不超过足尖

图3 试验组执行的侧抬腿。a　正面观，侧卧位，患侧在下，直抬患肢。b　背面观，患肢与床面呈约15°

图4 试验组执行的坐位夹球。图a　双足分开，双大腿用力夹球。图b　双足并拢夹球

图5 试验组执行的内推髌骨。图a　整体观，患者平卧，放松患肢肌肉。图b　双手拇指置于髌骨外侧。图c　双手拇指用力向内侧推动髌骨

表2 两组LPCS患者术前、术后3、6、12月Lysholm评分比较（分，

±s）

组别	例数	术前	3月	6月	12月	F值	P值
常规组	23	42.52±9.31	80.23±7.49^*	80.58±7.69^*	81.97±7.28^*	159.333	0.000
试验组	24	42.19±10.09	85.12±6.59^*	84.85±6.71^*	85.96±6.77^*	164.726	0.000
F值		0.087	8.956	3.271	9.116
P值		0.770	0.012	0.031	0.038

表2 两组LPCS患者术前、术后3、6、12月Lysholm评分比较（分，

±s）

组别	例数	术前	3月	6月	12月	F值	P值
常规组	23	42.52±9.31	80.23±7.49^*	80.58±7.69^*	81.97±7.28^*	159.333	0.000
试验组	24	42.19±10.09	85.12±6.59^*	84.85±6.71^*	85.96±6.77^*	164.726	0.000
F值		0.087	8.956	3.271	9.116
P值		0.770	0.012	0.031	0.038

表3 两组LPCS患者术前、术后3、6、12月IKDC2000评分比较（分，

±s）

组别	例数	术前	3月	6月	12月	F值	P值
常规组	23	53.94±4.90	82.81±7.49^*	82.71±7.52^*	83.03±7.19^*	78.611	0.000
试验组	24	52.69±5.45	86.58±5.95^*	86.62±6.16^*	86.73±5.50^*	79.939	0.000
F值		0.037	15.163	4.708	15.973
P值		0.647	0.043	0.039	0.036

表3 两组LPCS患者术前、术后3、6、12月IKDC2000评分比较（分，

±s）

组别	例数	术前	3月	6月	12月	F值	P值
常规组	23	53.94±4.90	82.81±7.49^*	82.71±7.52^*	83.03±7.19^*	78.611	0.000
试验组	24	52.69±5.45	86.58±5.95^*	86.62±6.16^*	86.73±5.50^*	79.939	0.000
F值		0.037	15.163	4.708	15.973
P值		0.647	0.043	0.039	0.036

表4 两组LPCS患者术前、术后3、6、12月Kujala评分比较（分，

±s）

组别	例数	术前	3月	6月	12月	F值	P值
常规组	23	50.42±4.70	81.87±9.25^*	80.97±8.90^*	81.42±8.43^*	170.014	0.000
试验组	24	49.50±4.16	86.73±7.18^*	85.96±8.82^*	86.23±8.06^*	167.318	0.000
F值		0.264	14.546	4.236	16.764
P值		0.610	0.033	0.039	0.033

表4 两组LPCS患者术前、术后3、6、12月Kujala评分比较（分，

±s）

组别	例数	术前	3月	6月	12月	F值	P值
常规组	23	50.42±4.70	81.87±9.25^*	80.97±8.90^*	81.42±8.43^*	170.014	0.000
试验组	24	49.50±4.16	86.73±7.18^*	85.96±8.82^*	86.23±8.06^*	167.318	0.000
F值		0.264	14.546	4.236	16.764
P值		0.610	0.033	0.039	0.033

表5 两组LPCS患者术前、术后3、6、12月VAS评分比较（分，

±s）

组别	例数	术前	3月	6月	12月	F值	P值
常规组	23	6.03±1.11	2.10±1.22^*	1.81±1.05^*	1.71±1.01^*	81.177	0.000
试验组	24	6.04±1.22	1.96±1.15^*	1.69±1.05^*	1.65±0.85^*	83.618	0.000
F值		0.011	0.373	0.768	0.064
P值		0.919	0.428	0.684	0.824

表5 两组LPCS患者术前、术后3、6、12月VAS评分比较（分，

±s）

组别	例数	术前	3月	6月	12月	F值	P值
常规组	23	6.03±1.11	2.10±1.22^*	1.81±1.05^*	1.71±1.01^*	81.177	0.000
试验组	24	6.04±1.22	1.96±1.15^*	1.69±1.05^*	1.65±0.85^*	83.618	0.000
F值		0.011	0.373	0.768	0.064
P值		0.919	0.428	0.684	0.824

表6 两组LPCS患者术后3、6、12月肌肉萎缩比较

术后时间	组别	股四头肌有无萎缩		萎缩率（%）	χ ²值	P值
术后时间	组别	有（个）	无（个）	萎缩率（%）	χ ²值	P值
3月	常规组	5	18	21.7	0.195	0.659
3月	试验组	4	20	16.7	0.195	0.659
6月	常规组	3	20	13.0	0.274	0.601
6月	试验组	2	22	8.3	0.274	0.601
12月	常规组	2	21	8.7	0.403	0.525
12月	试验组	1	23	4.2	0.403	0.525

表6 两组LPCS患者术后3、6、12月肌肉萎缩比较

术后时间	组别	股四头肌有无萎缩		萎缩率（%）	χ ²值	P值
术后时间	组别	有（个）	无（个）	萎缩率（%）	χ ²值	P值
3月	常规组	5	18	21.7	0.195	0.659
3月	试验组	4	20	16.7	0.195	0.659
6月	常规组	3	20	13.0	0.274	0.601
6月	试验组	2	22	8.3	0.274	0.601
12月	常规组	2	21	8.7	0.403	0.525
12月	试验组	1	23	4.2	0.403	0.525

表7 两组LPCS患者术后末次随访主观满意度比较

组别	主观满意度（个）					满意度占比（个/率）	χ ²值	P值
组别	非常满意	满意	一般	较差	很差	满意度占比（个/率）	χ ²值	P值
常规组	10	7	3	3	0	17（73.9%）	3.421	0.331
试验组	11	9	4	0	0	20（83.3%）	3.421	0.331

表7 两组LPCS患者术后末次随访主观满意度比较

组别	主观满意度（个）					满意度占比（个/率）	χ ²值	P值
组别	非常满意	满意	一般	较差	很差	满意度占比（个/率）	χ ²值	P值
常规组	10	7	3	3	0	17（73.9%）	3.421	0.331
试验组	11	9	4	0	0	20（83.3%）	3.421	0.331

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The effects of two rehabilitation exercise methods on postoperative patients with lateral patellar compression syndrome

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The effects of two rehabilitation exercise methods on postoperative patients with lateral patellar compression syndrome