蘇麗文 前十字韌帶斷裂 內視鏡手術 愈早做愈好

[TC]

蘇麗文 前十字韌帶斷裂 內視鏡手術 愈早做愈好

文中提到 : "早日手術，仍為前十字韌帶斷裂的黃金定律。" 這句話, 但事實上 前十字韌帶斷裂根本不能太早做手術, 這是骨科基本的常識, 因為太早做會造成關節纖維化, 除非是已經消腫, 消炎, 運動範圍恢復(約4-6週), 否則是不能太早做手術的.

不過他說的"越早做越好", 如果是考量關節軟骨因為前十字韌帶斷裂未治療而造成退化的問題, 那也沒錯, 在此考量下 4-6 週消腫後做手術, 比起好幾年後關節退化了才做手術, 也是算做"提早做"的時間範圍吧.

Orthopedic Knowledge Update 5

The timing of surgery is an important factor when minimizing postoperative knee-motion complications. A higher incidence of arthrofibrosis was noted in patients who underwent reconstruction via open arthrotomy less than 3 weeks after injury. In another retrospective study, it was noted that motion complications were associated with surgery performed less than 4 weeks after injury, and that they occurred in males and in those individuals who had associated medial collateral ligament (MCL) or posterior oblique ligament surgical treatment. Data from other studies have implicated locked displaced meniscal tears as a contributing factor when meniscal repair was performed concomitantly with ACL reconstruction. The current treatment principle is to defer early surgical reconstruction until the patient has nearly normal motion (0 to 120 degrees) and the knee has a noninflamed appearance and a minimal effusion. The time from injury to early surgical reconstruction is probably less critical than the overall appearance of the knee and its range of motion.

不過文中也提到:

The advantage of early surgical treatment is a reduced incidence of secondary chondral injuries and meniscal tears that may occur in the more chronic situation.

OKU 6 也有提到, 6週內做手術都算是 "Acute reconstruction".

[sjchen]

感恩