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                 這段時間,暨南大學附屬第一醫院運動醫學中心迎來了不少因運動導致關節損傷的案例,在這些患者中,有的是因激烈運動動作不當平添新傷,有的則是陳年舊傷突然發作,一部分患者甚至要追溯十多年前的受傷經歷,才知道原來自己曾經埋下了隱患。專科醫生提醒,膝關節韌帶上神經分布不多,不少患者在斷裂或者部分斷裂后沒有劇烈痛感,休息一周沒事就不以為然了,殊不知,斷裂的韌帶容易破壞關節原有穩定性,為軟骨損傷、半月板損傷、骨關節退行性病變埋下潛在隱患。

            大學生韌帶斷裂不自知 半年后半月板撕裂嚴重

            韌帶、半月板是對膝關節起穩定、保護作用的重要組織,在日常運動中,如打籃球、踢足球、打羽毛球等,在動作不規范或體位不正確的情況下容易發生損傷。

            廣州中青年實力醫生、暨南大學附屬第一醫院運動醫學中心副主任李劼若副主任醫師介紹,最近收治了一位比較年輕但是半月板傷情比較嚴重的患者。這名20歲的男青年是名大一新生,平時熱愛運動,一周打兩到三次籃球。

            半年前,這位大學生打籃球時受傷了,膝關節腫痛了幾日,消腫后并沒有感到明顯不舒服,他以為只是簡單的淤傷,淤血散了就沒事了,于是重返球場。半年后,這名學生發現最近走路、上下樓梯膝關節有痛感,而且有使不上力氣的感覺,于是前往醫院就診,一拍磁共振片發現韌帶斷裂合并半月板撕裂。

            “手術中我從關節鏡上觀察吃了一驚,他半月板傷得不輕,幾乎集齊了平時說的各種撕裂類型:橫裂、縱裂、水平裂、瓣狀裂,是我近段時間收治半月板損傷患者中最嚴重的一個。” 李劼若介紹,導致他半月板受傷這么嚴重,一方面是因為半年前膝關節受傷時沒有得到正確的處理,另一方面是在韌帶斷裂半月板容易磨損的情況下他仍然維持高頻率的劇烈運動,導致傷情進一步加重。

            能走能跑不代表沒事 要復診確保不留后患

            “這位小伙子如果當時立刻采取制動措施,視乎韌帶斷裂情況及時處理,半月板很可能就不用遭受這么大的‘打擊’了。”李劼若介紹。

            據介紹,膝關節主要有四條韌帶,分別是前交叉韌帶、后交叉韌帶、內側副韌帶和外側副韌帶,這些韌帶就像一根根繩子,隨著繩子兩端骨頭的運動而轉動,如果“繩子”斷裂了,關節活動的穩定性就會受到影響。

            在運動過程中,比較常見的是前交叉韌帶損傷,有時是出現部分斷裂,嚴重的會發生完全斷裂,由于里面的神經分布并不多,所以痛感并不明顯。“這種斷裂的發生,不需要強烈碰撞,78%的前交叉韌帶損傷發生在沒有身體接觸性對抗的時刻,常見是在起跳落地、急停急轉等時刻容易出現狀況,沒有產生劇烈疼痛,因此經常被忽略。”專家指出。

            由于痛感不明顯,加上不少年輕人恢復能力強,在休養幾日后就發現照常能走能跑,于是就沒有多加理會,殊不知,失去了重要韌帶維系關節的穩定,時間一長,為半月板撕裂、軟骨損傷、關節退化加快等種種問題埋下了伏筆和隱患。

            專家提醒,一般人很難靠自己去判斷運動損傷是一般淤傷還是內部組織有撕裂,因此,受傷后經過制動、冷敷等處理后,需要一個觀察期。如果前往醫院拍攝X光片發現骨頭沒事也不可掉以輕心,在一周后可以拍片復查,這時候腫脹消失,膝關節損傷通過拍核磁共振、踝關節通過拍B超,可以觀察內部恢復情況,確保內部沒有隱蔽傷情。如果自行制動休養后,在3個月后或者半年后,患處出現使不上力氣、不適疼痛時,要提高警惕,早日到醫院就診復查舊患。

            做不做手術有講究 把握時機是關鍵

            很多人在發現膝關節韌帶斷裂后會問醫生:我能走能跑,不用處理也可以吧?李劼若表示,是否有必要手術需要經過醫生綜合評估,把握好時機更有利于患處康復。

            在人體受損的組織中,有的很容易重生,有的失去了就永久失去,膝關節韌帶有一定的重生能力,但是這種能力比較弱。李劼若介紹,韌帶斷裂后需不需要手術,要根據具體情況來分析,要看它損傷的程度,另外要看損傷的部位,如果損傷較輕微,損傷程度不大,這個部位不是太受力,可保守治療4~6周,如果它能自身修復,恢復后沒有疼痛、功能正常,說明已經修復好,這種情況不需要手術;如果損傷的程度較嚴重,甚至完全撕裂,局部的功能有障礙、關節不穩定,通過保守治療機體不能修復,這種情況需要通過手術去治療。

            “一些患者寄希望于自我修復,實際上,對于斷裂程度比較嚴重的患者,即使韌帶自行黏合了,受傷的部位修復的多是瘢痕組織,與原來的韌帶是不一樣的組織,這些新生瘢痕猶如濕水的棉花,失去了韌勁,難以起到維持張力作用。”專家提醒,如果斷裂比較嚴重、對運動需求比較明確的患者,應經過醫生綜合評估來衡量治療方案。

            目前,關節鏡下重建前交叉韌帶已是常規術式,可采用自體或人工肌腱重建,有創口小、感染率低及恢復快等優點,手術過后,在正規康復師指導下的康復運動可以幫助韌帶恢復原有功能。

            “關節的穩定除了需要韌帶的保護,還需要借助強肌肉力量來保護,當肌肉強壯了,運動時對韌帶的負荷就會減少。”專家提醒,無論是一般人還是做過重建手術的患者,都需要通過合理科學的運動來鍛煉肌肉,有利于增強對關節的保護。

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