本体感觉测训方法在膝关节半月板损伤康复中的应用研究
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摘要
近年来,本体感觉在运动、运动损伤预防与康复中的作用已经引起了运动医学、临床医学和康复医学界的高度重视。本体感觉与伤病的发生、发展及康复有紧密的联系,半月板术后早期介入本体感觉功能加强训练,并对训练效果进行评定具有重要意义,本体感觉功能的评定成为临床损伤状况评估重要的组成部分。文献显示本体感觉的测评指标多,方法多,由于设置测评角度过多,造成结果评定的复杂多样性。为了适应临床测试节省时间、准确评定的需求,本研究首先选取60名健康普通人进行本体感觉测试并完成指标的选择,后对患者不同阶段的临床状况采用相应的方法加以评定。研究利用SPSS17.0统计软件对测试指标进行统计学分析,角度指标选择使用因子分析、变异系数和相关分析等。根据本体感觉测试特异性角度指标,选择临床膝关节半月板术后患者25人,分为常规康复训练组(13人)和本体感觉加强训练组(12人),对术前、术后2周、4周和8周的相关指标进行测试,对比不同阶段不同干预方法下本体感觉、等长肌力和等张功率的变化情况,临床康复训练效果的评定使用重复测量方差分析方法。研究结论如下：
1.通过因子分析、变异系数及相关系数分析,主动关节位置觉30°、被动关节位置觉60°、运动觉60°是具有特异性的本体感觉测评指标。
2.组间相比,8周不同训练方法干预对患者膝关节被动60°位置觉的变化具有显著性差异(P<0.05),60°运动觉的变化具有非常显著性差异(P<0.001),本体感觉加强训练相对于常规训练能更好地促进膝关节术后患者被动位置觉和运动觉功能的改善。
3.组间相比,8周不同训练方法干预对患者膝关节主动30°位置觉和三维本体感觉的影响均无显著性差别(P>0.05),本体感觉加强训练相对于常规训练对主动关节位置觉和三维本体感觉的影响更加明显,但无统计学差异性。
4.组间对比,8周不同训练方法干预对患者等长30°和等长60°肌力和等张功率的影响均无显著性差别(P>0.05)。
5.同术前相比,本体感觉功能术后2周时呈下降趋势,与患者术后关节不适及适应术后正常步态行走有关,4周后明显好转,4～8周变化趋势最明显。
In recent years, the roles of proprioception in training, sports injury prevention and rehabilitation have been taken into serious account by sports medicine and clinical and rehabilitation profession. Proprioception is closely linked with injury occurrence, development and recovery, It is important to seek good method to strengthen proprioception training early after operation, and to assess the effect of training, The assessment to proprioception function has become an important part of clinical assessment. There are too many evaluation indexes for assessing proprioception in literature, and these indexes and methods have led to complex results. In order to meet the clinical need: time-saving and accuracy,60 healthy people were selected randomly to conduct proprioception test and complete index selection, then conduct function assessment through corresponding methods according to the patient's condition at different clinical stages. SPSS17.0 was used for statistical analysis, including factor analysis, Coefficient of variation and Correlation analysis. According to proprioception test specific Angle index,25 clinical meniscectomy patients were divided into two groups:conventional rehabilitation training (13 people) and proprioception strengthen training group (12 people). Related indexes were tested and evaluated at diffenrent time points:preoperative and postoperative 2 weeks,4 weeks and 8 weeks to compare the change of proprioception, muscle strength and istonic power in different intervention mode. Repeated measures was used to evaluate the effect of clinical rehabilitation training. Conclusions are as follows:
1. Through factor analysis, coefficient of variation and correlation coefficient analysis, active joint position sense at 30°, passive joint position sense at 60°, kinesthesia at 60°are specific indicators for proprioception evaluation.
2. There is significant difference (P<0.05) between the two groups in knee joint passive position sense at 60°, and there are significant difference (P<0.001) in kinesthesias at 60°through different training methods with patients in 8 weeks. Compared with regular training, the proprioception strengthening training can better promote the function of passive joint position sense and kinesthesia after knee surgery.
3. There is no significant difference (P>0.05) between groups in knee joint active joint position sense and three-dimensional proprioception at 30°with different training methods in patients in 8 weeks. The influences of proprioception strengthen training on active joint position sense and three-dimensional proprioception is obvious than conventional rehabilitation training, but show no statistical difference.
4. There is no significant difference (P>0.05) between groups with different training methods with patients in Strength of Isometric at 30°and 60°and Isotonic contraction power.
5. Compare to preoperative, proprioception function shows a downward trend 2 weeks after surgery in two groups, this may relate to the discomfort in joint and the adapting to normal gaits after surgery. This situation improved after 4 weeks and the improvement becomes more obvious from 4 to 8weeks.
1.通过因子分析、变异系数及相关系数分析,主动关节位置觉30°、被动关节位置觉60°、运动觉60°是具有特异性的本体感觉测评指标。
2.组间相比,8周不同训练方法干预对患者膝关节被动60°位置觉的变化具有显著性差异(P<0.05),60°运动觉的变化具有非常显著性差异(P<0.001),本体感觉加强训练相对于常规训练能更好地促进膝关节术后患者被动位置觉和运动觉功能的改善。
3.组间相比,8周不同训练方法干预对患者膝关节主动30°位置觉和三维本体感觉的影响均无显著性差别(P>0.05),本体感觉加强训练相对于常规训练对主动关节位置觉和三维本体感觉的影响更加明显,但无统计学差异性。
4.组间对比,8周不同训练方法干预对患者等长30°和等长60°肌力和等张功率的影响均无显著性差别(P>0.05)。
5.同术前相比,本体感觉功能术后2周时呈下降趋势,与患者术后关节不适及适应术后正常步态行走有关,4周后明显好转,4～8周变化趋势最明显。
In recent years, the roles of proprioception in training, sports injury prevention and rehabilitation have been taken into serious account by sports medicine and clinical and rehabilitation profession. Proprioception is closely linked with injury occurrence, development and recovery, It is important to seek good method to strengthen proprioception training early after operation, and to assess the effect of training, The assessment to proprioception function has become an important part of clinical assessment. There are too many evaluation indexes for assessing proprioception in literature, and these indexes and methods have led to complex results. In order to meet the clinical need: time-saving and accuracy,60 healthy people were selected randomly to conduct proprioception test and complete index selection, then conduct function assessment through corresponding methods according to the patient's condition at different clinical stages. SPSS17.0 was used for statistical analysis, including factor analysis, Coefficient of variation and Correlation analysis. According to proprioception test specific Angle index,25 clinical meniscectomy patients were divided into two groups:conventional rehabilitation training (13 people) and proprioception strengthen training group (12 people). Related indexes were tested and evaluated at diffenrent time points:preoperative and postoperative 2 weeks,4 weeks and 8 weeks to compare the change of proprioception, muscle strength and istonic power in different intervention mode. Repeated measures was used to evaluate the effect of clinical rehabilitation training. Conclusions are as follows:
1. Through factor analysis, coefficient of variation and correlation coefficient analysis, active joint position sense at 30°, passive joint position sense at 60°, kinesthesia at 60°are specific indicators for proprioception evaluation.
2. There is significant difference (P<0.05) between the two groups in knee joint passive position sense at 60°, and there are significant difference (P<0.001) in kinesthesias at 60°through different training methods with patients in 8 weeks. Compared with regular training, the proprioception strengthening training can better promote the function of passive joint position sense and kinesthesia after knee surgery.
3. There is no significant difference (P>0.05) between groups in knee joint active joint position sense and three-dimensional proprioception at 30°with different training methods in patients in 8 weeks. The influences of proprioception strengthen training on active joint position sense and three-dimensional proprioception is obvious than conventional rehabilitation training, but show no statistical difference.
4. There is no significant difference (P>0.05) between groups with different training methods with patients in Strength of Isometric at 30°and 60°and Isotonic contraction power.
5. Compare to preoperative, proprioception function shows a downward trend 2 weeks after surgery in two groups, this may relate to the discomfort in joint and the adapting to normal gaits after surgery. This situation improved after 4 weeks and the improvement becomes more obvious from 4 to 8weeks.
引文
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