本体觉促进训练对前交叉韧带重建术后患者膝关节功能和姿势控制的效果
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摘要
目的探讨本体觉促进训练对前交叉韧带重建术后患者膝关节功能及姿势控制的影响。方法 2017年3月至2018年9月,前交叉韧带重建术后患者30例于术后8周进行常规康复训练,第9周随机分成对照组(n=15)和试验组(n=15)。对照组继续进行常规康复训练,试验组在常规康复的基础上联合本体觉促进训练;治疗第8周和第16周采用膝关节Lysholm评分、多关节等速肌力测试及训练系统,以及平衡测试仪进行测试。结果治疗后,两组Lysholm评分显著提高(t> 16.687, P <0.001),患侧膝关节15°、45°、75°角度再现差值降低(t> 2.433, P <0.05),闭眼稳定平面、闭眼泡沫平面下重心摆动速度降低(t> 2.444, P <0.05);试验组Lysolm评分高于对照组(t=4.150, P <0.05),15°、45°角度再现差值低于对照组(t> 2.710, P <0.05),闭眼泡沫平面下重心摆动速度低于对照组(P <0.05)。结论本体觉促进训练能进一步改善前交叉韧带重建术后患者本体觉功能,提高膝关节功能和姿势控制能力。
Objective To investigate the clinical effect of proprioceptive trainning on patients after anterior cruciate ligament recon‐struction.Methods From March, 2017 to September, 2018, 30 patients after anterior cruciate ligament reconstruction were ran‐domly divided into control group(n = 15) and experimental group(n = 15). All the patients received routine reha‐bilitation for eight weeks after operation. Then, the control group received routine rehabilitation, while the experi‐mental group received proprioceptive trainning in addition, for eight weeks. They were assessed with Lysholm score, Isokinetic Testing and Training System, and Dynamic Balance Tester eight and 16 weeks of training.Results Lysholm score increased in both groups after treatment(t > 16.687, P < 0.001), with decrease of error of knee flexion in 15°, 45° and 75°(t > 2.433, P < 0.05), and speed of centre of gravity moving with eyes closed on sta‐ble and unstable floors(t > 2.444, P < 0.05). Compared with the control group, Lysholm score was more(t =4.150, P < 0.05), errors of knee flexion in 15° and 45° were less(t > 2.710, P < 0.05), and speed of centre of grav‐ity moving with eyes closed on unstable floors was less(P<0.05) in the experimental group.Conclusion Proprioceptive trainning is effective on proprioception and function of knee after anterior cruciate ligament reconstruction, to improve postural control.
Objective To investigate the clinical effect of proprioceptive trainning on patients after anterior cruciate ligament recon‐struction.Methods From March, 2017 to September, 2018, 30 patients after anterior cruciate ligament reconstruction were ran‐domly divided into control group(n = 15) and experimental group(n = 15). All the patients received routine reha‐bilitation for eight weeks after operation. Then, the control group received routine rehabilitation, while the experi‐mental group received proprioceptive trainning in addition, for eight weeks. They were assessed with Lysholm score, Isokinetic Testing and Training System, and Dynamic Balance Tester eight and 16 weeks of training.Results Lysholm score increased in both groups after treatment(t > 16.687, P < 0.001), with decrease of error of knee flexion in 15°, 45° and 75°(t > 2.433, P < 0.05), and speed of centre of gravity moving with eyes closed on sta‐ble and unstable floors(t > 2.444, P < 0.05). Compared with the control group, Lysholm score was more(t =4.150, P < 0.05), errors of knee flexion in 15° and 45° were less(t > 2.710, P < 0.05), and speed of centre of grav‐ity moving with eyes closed on unstable floors was less(P<0.05) in the experimental group.Conclusion Proprioceptive trainning is effective on proprioception and function of knee after anterior cruciate ligament reconstruction, to improve postural control.
引文
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[19]Ordahan B,Kü?ük?en S,Tuncay I.The effect of proprioception exercises on functional status in patients with anterior cruciate ligament reconstruction[J].J Back Musculoskelet Rehabil.2015,28(3):531-537.
[20]R?ijezon U,Clark N C,Treleaven J.Proprioception in musculoskeletal rehabilitation.Part 1:basic science and principles of assessment and clinical interventions[J].Man Ther,2015,20(3):368-377.
[21]R?ijezon U,Clark N C,Treleaven J.Proprioception in musculoskeletal rehabilitation.Part 2:clinical assessment and intervention[J].Man Ther,2015,20(3):378-387.
[22]Kruse L M,Gray B,Wright R W.Rehabilitation after anterior cruciate ligament reconstruction:a systematic review[J].JBone Joint Surg Am,2012,94(19):1737-1748.
[23]郑光新,赵晓鹏,常智跃.等速运动系统测试膝关节本体觉的信度研究[J].中华物理医学与康复杂志,2013,35(8):609-611.
[24]Cinar-Medeni O,Baltaci G,Bayramlar K,et al.Core stability,knee muscle strength,and anterior translation are correlated with postural stability in anterior cruciate ligament-reconstructed patients[J].Am J Phys Med Rehabil,2015,94(4):280-287.
[25]Lehmann T,Paschen L,Baumeister J.Single-leg assessment of postural stability after anterior cruciate ligament injury:a systematic review and meta-analysis[J].Sports Med Open2017,3(1):32-44.
[2]Papalia R,Franceschi F,Tecame A.Anterior cruciate ligament reconstruction and return to sport activity:postural control as the key to success[J].Int Orthop(SICOT),2015,39(3):527-534.
[3]Arockiaraj J,Korula R J,Oommen A T,et al.Proprioceptive changes in the contralateral knee joint following anterior cruciate injury[J].Bone Joint J,2013,95(2):188-191.
[4]Sanchez-Ramirez D C,van der Leeden M,Knol D L,et al.Association of postural control with muscle strength,proprioception,self-reported knee instability and activity limitations in patients with knee osteoarthritis[J].J Rehabil Med,2013,45(2):192-197.
[5]Bonfim T R,Jansen Paccola C A,Barela J A.Proprioceptive and behavior impairments in individuals with anterior cruciate ligament reconstructed knees[J].Arch Phys Med Rehabil,2003,84(8):1217-1223.
[6]Dargo L,Robinson K J.Prevention of knee and anterior cruciate ligament injuries through the use of neuromuscular and proprioceptive training:an evidence-based review[J].J Athlet Train,2017,52(12):1171-1172.
[7]Coronado R A,Bird M L,Van Hoy E E,et al.Do psychosocial interventions improve rehabilitation outcomes after anterior cruciate ligament reconstruction?A systematic review[J].Clin Rehabil,2018,32(3):287-298.
[8]do Carmo Almeida T C,de Alcantara Sousa L V,de Melo Lucena D M,et al.Evaluation of functional rehabilitation physiotherapy protocol in the postoperative patients with anterior cruciate ligament reconstruction through clinical prognosis:an observational prospective study[J].BMC Res Notes,2016,9(1):287-298.
[9]Ghai S,Driller M,Ghai I.Effects of joint stabilizers on proprioception and stability:a systematic review and meta-analysis[J].Phys Ther Sport,2017,25(5):65-75.
[10]Zhang L,Qi J,Zeng Y.Proprioceptive changes in bilateral knee joints following unilateral anterior cruciate ligament injury in cynomolgus monkeys[J].Med Sci Monit,2018,24(6):105-113.
[11]Relph N,Herrington L,Tyson S.The effects of ACL injury on knee proprioception:a meta-analysis[J].Physiotherapy,2014,100(3):187-195.
[12]Bonfim T R,Jansen Paccola C A,Barela J A.Proprioceptive and behavior impairments in individuals with anterior cruciate ligament reconstructed knees[J].Arch Phys Med Rehabil,2003,84(8):1217-1223.
[13]Howells B E,Ardern C L,Webster K E.Is postural control restored following anterior cruciate ligament reconstruction?Asystematic review[J].Knee Surg Sports Traumatol Arthrosc,2011,19(7):1168-1677.
[14]Howells B E,Clark R A,Ardern C L,et al.The assessment of postural control and the influence of a secondary task in people with anterior cruciate ligament reconstructed knees using a Nintendo Wii Balance Board[J].Br J Sports Med,2013,47(14):914-919.
[15]Wikstrom E A,Song K,Pietrosimone B G,et al.Visual utilization during postural control in anterior cruciate ligament deficient and reconstructed patients:systematic reviews and metaanalyses[J].Arch Phys Med Rehabil,2017,98(10):2052-2065.
[16]Negahban H,Mazaheri M,Kingma I,et al.A systematic review of postural control during single-leg stance in patients with untreated anterior cruciate ligament injury[J].Knee Surg Sports Traumatol Arthrosc,2014,22(7):1491-1504.
[17]Ahmed M M,Mosalem D M,Khairet S M,et al.Evaluation of dynamic posturography in anterior cruciate ligament injury patients[J].Maced J Med Sci,2011,4(2):167-173.
[18]Paterno M V,Schmitt L C,Ford K R,et al.Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport[J].Am J Sports Med,201038(10):1968-1978.
[19]Ordahan B,Kü?ük?en S,Tuncay I.The effect of proprioception exercises on functional status in patients with anterior cruciate ligament reconstruction[J].J Back Musculoskelet Rehabil.2015,28(3):531-537.
[20]R?ijezon U,Clark N C,Treleaven J.Proprioception in musculoskeletal rehabilitation.Part 1:basic science and principles of assessment and clinical interventions[J].Man Ther,2015,20(3):368-377.
[21]R?ijezon U,Clark N C,Treleaven J.Proprioception in musculoskeletal rehabilitation.Part 2:clinical assessment and intervention[J].Man Ther,2015,20(3):378-387.
[22]Kruse L M,Gray B,Wright R W.Rehabilitation after anterior cruciate ligament reconstruction:a systematic review[J].JBone Joint Surg Am,2012,94(19):1737-1748.
[23]郑光新,赵晓鹏,常智跃.等速运动系统测试膝关节本体觉的信度研究[J].中华物理医学与康复杂志,2013,35(8):609-611.
[24]Cinar-Medeni O,Baltaci G,Bayramlar K,et al.Core stability,knee muscle strength,and anterior translation are correlated with postural stability in anterior cruciate ligament-reconstructed patients[J].Am J Phys Med Rehabil,2015,94(4):280-287.
[25]Lehmann T,Paschen L,Baumeister J.Single-leg assessment of postural stability after anterior cruciate ligament injury:a systematic review and meta-analysis[J].Sports Med Open2017,3(1):32-44.