下肢骨折术后早期负重训练的研究进展
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摘要
下肢骨折术后长时间的制动会影响骨及周围软组织的愈合,而骨折断端的应力刺激有助于骨折的愈合,但是下肢骨折愈合过程中过重的压力会导致骨折延迟愈合或骨不连。因此,临床医师建议下肢骨折患者需早期进行部分负重训练,以便在骨折愈合的各个阶段产生最佳的机械环境促进骨折愈合,通过控制不同时期负重量的大小保证负重训练的安全性。当前的下肢负重训练方法仍存在许多不足之处,早期负重训练效果并不理想。研究设计一种安全、有效、实用的技术来帮助患者进行早期科学负重训练将有很高的临床价值。
Long time immobilization has a negative effect on the healing of bone and surrounding soft tissue after lower limb fracture surgery. Stress stimulation at the broken end of fracture is helpful to the healing of fracture. However,excessive stress can lead to delayed union or nonunion during lower limb fracture healing. Therefore,clinicians recommend that patients with lower extremity fractures need to undergo early partial weight-bearing training in order to produce the best mechanical environment to promote fracture healing at all stages of fracture healing. The safety of load training is ensured by controlling the load in different periods. There are still many deficiencies in the current methods of lower limb weight-bearing training,and the effect of early weight-bearing training is not ideal. The design and development of a safe,effective and practical technology to help patients scientifically carry out the early weight-bearing training will have a high clinical value in the future.
Long time immobilization has a negative effect on the healing of bone and surrounding soft tissue after lower limb fracture surgery. Stress stimulation at the broken end of fracture is helpful to the healing of fracture. However,excessive stress can lead to delayed union or nonunion during lower limb fracture healing. Therefore,clinicians recommend that patients with lower extremity fractures need to undergo early partial weight-bearing training in order to produce the best mechanical environment to promote fracture healing at all stages of fracture healing. The safety of load training is ensured by controlling the load in different periods. There are still many deficiencies in the current methods of lower limb weight-bearing training,and the effect of early weight-bearing training is not ideal. The design and development of a safe,effective and practical technology to help patients scientifically carry out the early weight-bearing training will have a high clinical value in the future.
引文
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[29] North K,Kubiak EN, Hitchcock RW,et al. Load monitoring system for partial weight bearing therapy for rehabilitation of lower extremity fractures[J]. Conf Proc IEEE Eng Med Biol Soc,2013,2013:152455.
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[31] Hustedt JW, Blizzard DJ, Baumgaertner MR,et al. Is it possible to train patients to limit weight bearing on a lower extremity?[J].Orthopedics,2012,35(1):e31-37.
[32] Hurkmans HL,Bussmann JB,Benda E, et al. Effectiveness of audio feedback for partial weight-bearing in and outside the hospital:A randomized controlled trial[J]. Arch Phys Med Rehabil,2012,93(4):565-570.
[33] Braun BJ,Bushuven E,Hell R,et al. A novel tool for continuous fracture aftercare—Clinical feasibility and first results of a new telemetric gait analysis insole[J]. Injury,2016,47(2):490-494.
[34] Raaben M, Holtslag HR, Leenen LPH, et al. Real-time visual biofeedback during weight bearing improves therapy compliance in patients following lower extremity fractures[J]. Gait Posture,2018,59:206-210.
[35] Hershko E,Tauber C,Carmeli E,et al. Biofeedback versus physiotherapy in patients with partial weight-bearing[J]. Am J Orthop,2008,37(5):e92-95.
[36] Fu MC,DeLuke L,Buerba RA,et al. Haptic biofeedback for improving compliance with lower-extremity partial weight bearing[J].Orthopedics,2014,37(11):e993-998.
[2] Haak KT,Palm H, Holck K,et al. Immediate weight-bearing after osteosynthesis of proximal tibial fractures may be allowed[J]. Dan Med J,2012,59(10):A4515.
[3]Vasarhelyi A,Baumert T,Fritsch C,et al. Partial weight bearing after surgery for fractures of the lower extremity-is it achievable?[J]. Gait Posture,2006,23(1):99-405.
[4] Kalmet PHS,Meys G, Evers S,et al. Permissive weight bearing in trauma patients with fracture of the lower extremities:Prospective multicenter comparative cohort study[J]. BMC Surg,2018,18(1):8.
[5] Kubiak EN,Beebe MJ,North K,et al. Early weight bearing after lower extremity fractures in adults[J]. Am Acad Orthop Surg,2013,21:727-738.
[6] Black JD, Bhavikatti M, Al-Hadithy N, et al. Early weight-bearing in operatively fixed ankle fractures:A systematic review[J]. Foot(Edinb),2013,23(2/3):78-85.
[7] Haller JM, Potter MQ,Kubiak EN. Weight bearing after a periarticular fracture:What is the evidence?[J]. Orthop Clin North Am,2013,44(4):509-519.
[8] Pataky Z, De Leon Rodriguez D, Golay A, et al. Biofeedback training for partial weight bearing in patients after total hip arthroplasty[J]. Arch Phys Med Rehabil,2009,90(8):1435-1438.
[9] Schuller M, Weninger P, Tschegg E, et al. Micromotion at the fracture site after tibial nailing with four unreamed small-diameter nails—a biomechanical study using a distal tibia fracture model[J].Trauma, 2009,66(5):1391-4397.
[10] Hughes-Fulford M. Signal transduction and mechanical stress[J]. Sci STKE,2004(249):RE12.
[11] Ellegaard M, Kringelbach T, Syberg S, et al. The effect of PTH(1-34)on fracture healing during different loading conditions[J]. Bone Miner Res,2013,28(10):2145-2155.
[12] Hoerth RM,Seidt BM,Shah M, et al. Mechanical and structural properties of bone in non-critical and critical healing in rat[J].Acta Biomater,2014,10(9):4009-4019.
[13] Baumann AP, Aref MW,Turnbull TL,et al.Development of an in vivo rabbit ulnar loading model[J].Bone,2015,75:55-61.
[14] Schwarz C, Wulsten D,Ellinghaus A, et al. Mechanical load modulates the stimulatory effect of BMP2 in a rat nonunion model[J]. Tissue Eng Part A,2013,19(1/2):247-254.
[15] Shadmehr A, Esteki A, Oliaie GR, et al. Augmentation of bone healing by specific frequency and amplitude compressive strains[J]. Orthopedics,2009,32(3):173.
[16] Hausman MR,Schaffler MB,Majeska RJ. Prevention of Fracture Healing in Rats by an Inhibitor of Angiogenesis[J]. Bone,2001,29(6):560-564.
[17] Takeda T,Narita T,Ito H. Experimental study on the effect of mechanical stimulation on the early stage of fracture healing[J].Nippon Med Sch,2004,71:252-262.
[18] Boerckel JD,Uhrig BA, Willett NJ,et al. Mechanical regulation of vascular growth and tissue regeneration in vivo[J]. Proc Natl Acad Sci U S A,2011,108(37):E674-E680.
[19] Isaksson H. Recent advances in mechanobiological modeling of bone regeneration[J]. Mech Res Commun,2012,42:22-31.
[20] Morgan EF, Gleason RE, Hayward LN, et al. Mechanotransduction and fracture repair[J]. Bone Joint Surg Am,2008,90 Suppl 1:25-30.
[21] Yu X,Guo Y,Kang Q,et al. Effects and mechanisms of mechanical stress on secondary fracture healing[J]. Front Biosci(Landmark Ed),2013,18:1344-1348.
[22] Abdalbary SA. Partial weight bearing in hip fracture[J]. Future Sci OA,2017,12(4):FS0254.
[23] Thompson SG,Phillip RD,Roberts A. How do orthopaedic surgeons and rehabilitation professionals interpret and assess'toe touch'weight bearing and'partial'weight bearing status in the rehabilitation setting[J]. BMJ Open Sport Exerc Med,2018,4(1):e000326.
[24] Ruiz FK,Fu MC,Bohl DD,et al. Patient compliance with postoperative lower extremity touch-down weight-bearing orders at a level I academic trauma center[J]. Orthopedics,2014,37(6):E552-556.
[25] Yu S, McDonald T, Jesudason C, et al. Orthopedic Inpatients'Ability to Accurately Reproduce Partial Weight BearingOrders[J].Orthopedics,2014,37(1):e10-48.
[26] Raaben M, Holtslag HR, Augustine R, et al. Technical aspects and validation of a new biofeedback system for measuring lower limb loading in the dynamic situation[J].Sensors(Basel),2017,17(3):658-668.
[27] Chamorro-Moriana G, Sevillano JL, Ridao-Femandez C. A Compact Forearm Crutch Based on Force Sensors for Aided Gait:Reliability and Validity[J]. Sensors(Basel),2016,21,16(6):925-
[28] Chamorro Moriana G, Roldan JR, Rejano JJ, et al. Design and validation of GCH System 1.0 which measures the weight-bearing exerted on forearm crutches during aided gait[J]. Gait Posture,2013,37(4):564-569.
[29] North K,Kubiak EN, Hitchcock RW,et al. Load monitoring system for partial weight bearing therapy for rehabilitation of lower extremity fractures[J]. Conf Proc IEEE Eng Med Biol Soc,2013,2013:152455.
[30] Hurkmans HL, Bussmann JB,Benda E, et al. Techniques for measuring weight bearing during standing and walking[J]. Clin Biomech(Bristol,Avon),2003,18(7):576-589.
[31] Hustedt JW, Blizzard DJ, Baumgaertner MR,et al. Is it possible to train patients to limit weight bearing on a lower extremity?[J].Orthopedics,2012,35(1):e31-37.
[32] Hurkmans HL,Bussmann JB,Benda E, et al. Effectiveness of audio feedback for partial weight-bearing in and outside the hospital:A randomized controlled trial[J]. Arch Phys Med Rehabil,2012,93(4):565-570.
[33] Braun BJ,Bushuven E,Hell R,et al. A novel tool for continuous fracture aftercare—Clinical feasibility and first results of a new telemetric gait analysis insole[J]. Injury,2016,47(2):490-494.
[34] Raaben M, Holtslag HR, Leenen LPH, et al. Real-time visual biofeedback during weight bearing improves therapy compliance in patients following lower extremity fractures[J]. Gait Posture,2018,59:206-210.
[35] Hershko E,Tauber C,Carmeli E,et al. Biofeedback versus physiotherapy in patients with partial weight-bearing[J]. Am J Orthop,2008,37(5):e92-95.
[36] Fu MC,DeLuke L,Buerba RA,et al. Haptic biofeedback for improving compliance with lower-extremity partial weight bearing[J].Orthopedics,2014,37(11):e993-998.