重返工作或运动：多韧带膝关节损伤的系统评价 21 项研究和 524 例患者
Return to Work or Sport After Multiligament Knee Injury: A Systematic Review of 21 Studies and 524 Patients.
机构信息
Sports Medicine, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A.
Ohio State University College of Medicine, Columbus, Ohio, U.S.A.
出版信息
Arthroscopy. 2018 May;34(5):1708-1716. doi: 10.1016/j.arthro.2017.12.025. Epub 2018 Feb 9.
PURPOSE
To systematically review multiligament knee injury (MLKI) outcome studies to determine overall rates of return to work or sport after MLKI and risk factors for lack of return to work or sport after MLKI.
METHODS
A search was performed of MLKI outcome studies from 1950 to March 1, 2017. Ninety-two studies were identified. All included reported return to work, return to sport, or Tegner activity scores. Rates of return to work or sport were determined for overall population and by obesity status, injury severity, and presence of peroneal nerve or vascular injury.
RESULTS
A total of 524 patients (21 studies) were included. Return to high-level sport was low (22%-33%). Return to any level of sport was 53.6% overall (178/332), with a higher rate reported in studies with all surgical patients (59.1%, 114/193 patients) versus studies with mixed surgical and nonoperative treatment (46.0%, 64/139 patients) (P = .02). Rate of return to work with little or no modifications was 62.1% (146/200) and return to any work was 88.4% (190/215). Obese patients had lower postoperative Tegner scores than a general population (obese: mean 1.7 ± 1.2; nonobese: mean 4.5 ± 1.0; P < .001). Among studies without Schenck grade IV and V injuries, return to work with no or minimal modifications (100%, 12/12 patients) was higher than studies including grade IV and V patients (66.0%, 70/106 patients) (P = .017). Return to any work was higher in studies without vascular injuries (96.3%, 105/109) versus those including them (80.2%, 85/106) (P < .001).
CONCLUSIONS
Return to sport after MLKI occurs in approximately 60% of surgically treated patients, though return to high-level sport is lower. Return to work is frequently possible after MLKI though it may require workplace or job duty modifications. Obesity, nonoperative treatment, higher injury severity, and vascular injury are associated with poorer functional outcomes.
LEVEL OF EVIDENCE
Level IV, systematic review of level III and IV studies.
目的
系统回顾多韧带膝关节损伤（MLKI）的研究结果，以确定 MLKI 后总体的工作或运动恢复率，以及 MLKI 后无法工作或运动的风险因素。
方法
从 1950 年到 2017 年 3 月 1 日，对 MLKI 结果研究进行了检索。共确定了 92 项研究。所有研究均报告了工作或运动的恢复情况，或 Tegner 活动评分。根据肥胖状态、损伤严重程度以及是否存在腓总神经或血管损伤，确定总体人群和特定人群的工作或运动恢复率。
结果
共纳入 524 例患者（21 项研究）。高水平运动的恢复率较低（22%-33%）。总体而言，任何水平的运动恢复率为 53.6%（178/332），其中所有手术患者的报告率更高（59.1%，114/193 例患者），而混合手术和非手术治疗的研究中则较低（46.0%，64/139 例患者）（P=0.02）。术后几乎或无需修改即可恢复工作的比例为 62.1%（146/200），而任何工作均可恢复的比例为 88.4%（190/215）。肥胖患者术后 Tegner 评分低于普通人群（肥胖：平均 1.7±1.2；非肥胖：平均 4.5±1.0；P<0.001）。在无 Schenck 分级 IV 和 V 损伤的研究中，无或最小修改即可恢复工作（100%，12/12 例患者）的比例高于包括分级 IV 和 V 患者的研究（66.0%，70/106 例患者）（P=0.017）。无血管损伤的研究中，可恢复任何工作的比例较高（96.3%，105/109），而包括血管损伤的研究中则较低（80.2%，85/106）（P<0.001）。
结论
接受手术治疗的 MLKI 患者中，约有 60%可恢复运动，但高水平运动的恢复率较低。尽管 MLKI 后可能需要工作场所或工作任务的修改，但仍可频繁恢复工作。肥胖、非手术治疗、较高的损伤严重程度和血管损伤与较差的功能结果相关。
证据等级
IV 级，对 III 级和 IV 级研究的系统回顾。
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