中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (33): 5311-5316.doi: 10.12307/2022.725

• 人工假体 artificial prosthesis • 上一篇    下一篇

全膝关节置换后早期髋外展肌强化训练改善平衡及步行能力

权宏磊1,郑洁皎1,2,丰有燕1,张  杰2,朱颖慧1   

  1. 1上海中医药大学,上海市   201203;2复旦大学附属华东医院,上海市   200040
  • 收稿日期:2021-09-30 接受日期:2021-11-17 出版日期:2022-11-28 发布日期:2022-03-30
  • 通讯作者: 郑洁皎,教授,上海中医药大学,上海市 201203;复旦大学附属华东医院,上海市 200040
  • 作者简介:权宏磊,男,1997年生,山西省运城市人,汉族,上海中医药大学在读硕士,主要从事老年运动与平衡方面的研究。
  • 基金资助:
    国家重点研发计划项目(2020YFC2008700),项目参与人:郑洁皎;上海康复医学临床医学研究中心(21MC1930200),项目负责人:郑洁皎

Early hip abductor training to improve balance and walking ability after total knee arthroplasty

Quan Honglei1, Zheng Jiejiao1, 2, Feng Youyan1, Zhang Jie2, Zhu Yinghui1   

  1. 1Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; 2Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
  • Received:2021-09-30 Accepted:2021-11-17 Online:2022-11-28 Published:2022-03-30
  • Contact: Zheng Jiejiao, Professor, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
  • About author:Quan Honglei, Master candidate, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
  • Supported by:
    National Key Research and Development Program, No. 2020YFC2008700 (to ZJJ); Shanghai Rehabilitation Medicine Clinical Research Center, No. 21MC1930200 (to ZJJ)

摘要:

文题释义:
全膝关节置换:是一种人工关节置换外科手术,借助膝关节表面假体取代人体膝关节无法自行修复的关节面,是治疗严重膝关节疾患、解除膝关节疼痛、重建膝关节功能的主要手段。
相对峰力矩:又称峰力矩体质量比,指单位体质量的峰力矩值,反映了肌肉的相对肌力,可用于不同体质量人群之间肌力的对比。

背景:全膝关节置换后患者功能恢复并不理想,常规康复更多地关注患者膝关节周围组织的康复,而忽视了髋外展肌的训练。髋外展肌与全膝关节置换患者肢体功能存在相关性,但具体疗效仍然有待研究。
目的:探究髋外展肌强化训练对全膝关节置换患者平衡及步行功能恢复的影响。
方法:纳入2020年3月至2021年5月在复旦大学附属华东医院接受单侧全膝关节置换的患者60例,采用随机数字表法分为对照组和试验组(n=30)。对照组采用常规康复训练方法,试验组在常规康复基础上增加髋外展肌训练。两组患者分别在治疗前和治疗4周后进行髋外展肌等速肌力、膝关节功能评分、单腿站立测试、计时起立-行走测试以及三维步态分析。
结果与结论:①治疗4周后,试验组髋外展肌相对峰力矩明显高于对照组,差异有显著性意义(P < 0.05);②治疗4周后,试验组美国膝关节协会功能评分明显高于对照组,差异有显著性意义(P < 0.05);③治疗4周后,试验组单腿站立测试时间明显长于对照组,计时起立-行走测试时间明显短于对照组,差异均有显著性意义(P < 0.05);④治疗4周后,试验组步幅和患侧支撑相占比明显优于对照组,差异有显著性意义(P < 0.05);⑤结果表明全膝关节置换后早期髋外展肌强化训练能够在一定程度上增加髋外展肌肌力,提高患者的平衡及步行功能,但其康复方案及长期疗效仍需进一步研究。
缩略语:美国膝关节协会评分:Knee Society Score,KSS;计时起立-行走测试:Timed’Up and Go’Test,TUGT

https://orcid.org/0000-0001-5510-5422 (权宏磊) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 全膝关节置换, 髋外展肌, 康复训练, 平衡, 步行功能

Abstract: BACKGROUND: The functional recovery of patients after total knee arthroplasty is not ideal. Routine rehabilitation pays more attention to the rehabilitation of the tissue around the knee joint, but neglects the training of the abductor muscle of the hip. There is a correlation between hip abductor and limb function of patients with total knee arthroplasty, but the specific effect remains to be studied.  
OBJECTIVE: To explore the effect of hip abductor training on balance and walking function recovery in patients with total knee arthroplasty.
METHODS:  From March 2020 to May 2021, 60 patients with unilateral total knee arthroplasty from Huadong Hospital Affiliated to Fudan University were randomly divided into trial group (n=30) and control group (n=30). The control group received conventional treatment. The trial group received conventional treatment and hip abductor training. Hip abductor isokinetic muscle strength, knee function score, single leg stance, Timed Up and Go test, and three-dimensional gait analysis were assessed in both groups before and 4 weeks after treatment.  
RESULTS AND CONCLUSION: (1) The hip abductor isokinetic muscle strength was significantly higher in the trial group than that of the control group 4 weeks after treatment (P < 0.05). (2) At 4 weeks after treatment, Knee Society Score was significantly higher in the trial group than that of the control group (P < 0.05). (3) At 4 weeks after treatment, single leg stance time was significantly longer in the trial group than that in the control group; Timed Up and Go test time was significantly shorter in the trial group than that in the control group (P < 0.05). (4) At 4 weeks after treatment, the proportion of walking amplitude and affected side support phase was significantly better in the trial group than that in the control group (P < 0.05). (5) These findings have verified that early hip abductor training after total knee arthroplasty can increase hip abductor muscle strength and improve patients’ balance and walking function. However, its rehabilitation program and long-term efficacy still need further research.

Key words: total knee arthroplasty, hip abductor, rehabilitation training, balance, walking function

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