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十字韧带断裂或膝关节退化,是不是一定要开刀?

2020-06-20 159浏览量

随着运动人口的增加和平均寿命的增加,膝盖疼痛的问题变得越来越常见。不论是年轻人的十字韧带断裂或是年长者的膝关节退化,如果发生了就一定要开刀吗?如果不开刀,是不是就不会好呢?

为什幺膝盖痛?

我们的膝盖由肌肉、韧带和硬软骨共同提供活动与稳定,因此当我们有膝盖疼痛的问题时,自然就会联想到是不是这些地方出了问题。十字韧带断裂是年轻及运动族群最常见的运动伤害,由于前十字韧带断裂后会在被动的稳定测试出现阳性反应,因此通常会建议藉由开刀进行人工重建。而膝关节退化则是被认为是年长者族群膝盖疼痛的主因,虽然我们的肌力、活动力等都会随着年纪的增长而衰退,进而增加膝盖痛的机会,但是通常要经过X光检查判定退化严重度达重度至重度时,才会建议接受人工关节置换术。

十字韧带与重建术

究竟十字韧带断裂是否需要开刀,这就要看开刀的目的为何?

从研究看来,韧带重建手术能有效改善关节稳定度及减少半月板磨损,但是在日常生活功能的改善及重回运动场的部分,和单纯只做复健训练的结果是相同的,也就是不论有没有开刀,日后的生活品质和运动表现是一样的。 另外 60%半月板磨损的人完全没有症状外, 65%的青少年在未接受十字韧带重建手术下,仍旧可以重回原来的运动强度,而且这些青少年中,也只有9.5%的人因此出现半月软骨磨损。

所以在考量是否要开刀时,应该先评估自己是否因为十字韧带断裂而持续地感受到膝盖痠痛或软脚,或是因此无法工作或运动。若出现:

    运动时有不稳定感(软脚)。因膝盖的不稳定感严重影响日常生活。合併出现多条韧带断裂时

会建议接受韧带重建术,反之,则会建议先以物理治疗作为优先选择。

膝关节退化与人工关节十字韧带断裂或膝关节退化,是不是一定要开刀? Photo Credit: Depositphotos

根据骨科的临床指引,(1)膝关节达到中度到严重的退化或(2)疼痛等症状严重影响到生活品质时,就会建议进行人工关节置换。而通常被诊断有关节退化问题的族群,通常会伴随肌肉力量不足或肌肉控制的问题,所以在手术前后搭配物理治疗,关节置换后的成效都会比单纯开刀来的有效。

不过目前研究发现,膝盖疼痛等问题并不全然来自于关节退化或半月软骨受损。而且16-67%半月板破损的人,透过合适的活动训练,即使没有开刀依然能达到疼痛减少与生活功能改善的成效。因此,怀疑有膝盖退化导致疼痛的话,不妨先接受复健治疗啰!

物理治疗能做什幺?

简单的说,就是用非侵入式的方法(例如开刀或吃药)改善疼痛的问题。以髋和膝关节退化的人来说,经过物理治疗的介入后,可以有效:

    改善疼痛和相关的行动障碍。减少因为疼痛和活动障碍而衍生的忧郁和焦虑。促进日常生活功能。

也就是说现在物理治疗师们不再倚靠电疗、热敷或拉腰等仪器。转而是透过一对一的访谈与评估,来解决活动与疼痛的问题。所以当膝盖的治疗遭遇瓶颈时,也许可以检视一下是不是目前为止,都只是坐在椅子上利用电疗和热敷在「复健」呢?

结论

十字韧带断裂和膝关节退化究竟需不需要开刀,目前仍是个未定论。但是透过结合适当的活动训练,不论有没有开刀,都能为膝盖带来正向的结果。也就是说除了开刀之外,我们依然有其他的选择来帮助我们跨越活动的藩篱!

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