早期减重步行训练对前交叉韧带重建术后功能恢复及骨隧道改变的影响研究

doi:10.12114/j.issn.1007-9572.2019.00.026

摘要/Abstract

摘要： 背景　前交叉韧带（ACL）损伤是一种较为常见的膝关节损伤，早期手术重建稳定性是目前公认的治疗方法，但是术后部分患者仍存在本体感觉差、步行能力下降等问题。减重步行训练（BWSTT）是近年来运动康复领域研究的热点，然而临床上多运用在中枢神经损伤患者的步行训练中，ACL重建术后运用BWSTT的报道尚不多见。目的　探讨早期BWSTT对ACL重建术后功能恢复及骨隧道改变的影响。方法　选取2017年5月—2018年5月德阳市人民医院收治的ACL重建术患者60例，采用随机数字表法将其分为观察组、对照组各30例。对照组术后进行进阶性下肢功能训练；观察组在对照组基础上进行改良的BWSTT，将本体感觉训练加入BWSTT中。术后12周采用肌电图检测术侧下肢被动关节活动度（ROM）重现偏差度，判断本体感觉恢复情况，并测定股内侧肌表面肌电的积分肌电值（iEMG）；术后4、12周行常规磁共振成像检测骨隧道宽度、移植物信号强度、腱骨结点T2值，采用2000国际膝部文件委员会（IKDC）主观膝部评估表、Lysholm评分评价运动功能，采用Fugl-Meyer平衡量表、Berg平衡量表（BBS）评估平衡功能。结果　术后4、12周观察组骨隧道宽度均小于对照组，术后4周观察组信号强度、腱骨结点T2值均高于对照组，术后12周观察组信号强度、腱骨结点T2值均低于对照组（P<0.05）；两组术后12周骨隧道宽度均大于术后4周，信号强度、腱骨结点T2值均低于术后4周（P<0.05）。术后12周观察组0 °~40 °区、41 °~80 °区、81 °~120 °区的被动ROM重现偏差度、iEMG均优于对照组（P<0.05）。术后12周观察组的2000 IKDC主观膝部评估表评分高于对照组（P<0.05）；术后4、12周观察组Lysholm评分、Fugl-Meyer平衡量表评分、BBS评分均高于对照组（P<0.05）。术后12周两组的2000 IKDC主观膝部评估表评分、Lysholm评分、Fugl-Meyer平衡量表评分、BBS评分均高于术后4周（P<0.05）。术后12周的骨隧道宽度与Lysholm评分、BBS评分均呈负相关（r=-0.32、-0.35，P<0.05）。结论　早期BWSTT中加入本体感觉训练可以加速腱骨的恢复速度，增加肌力和本体感觉，改善运动功能和平衡功能。

关键词: 前交叉韧带重建, 早期减重步行训练, 膝关节, 骨隧道

Abstract: Background　Anterior cruciate ligament （ACL） injury is a common knee injury.Early surgical reconstruction has been a currently recognized treatment，but some patients still have problems such as poor proprioception and decreased walking ability after operation.Body weight-supported treadmill training （BWSTT） is a hotspot in the field of sports rehabilitation in recent years.However，it is mostly used in the walking training of patients with central nervous system injury in clinic.BWSTT has not been widely reported in ACL reconstruction.Objective　To investigate the effect of early BWSTT on functional recovery and bone tunnel changes after ACL reconstruction.Methods　Sixty patients after ACL reconstruction in People's Hospital of Deyang City from May 2017 to May 2018 were selected and randomly divided into observation and control group，each with 30 cases.The control group began progressive lower limb function training one day after operation，while the observation group received early BWSTT one week after operation on the basis of training of the control group，that is，to integrate proprioceptive training into early BWSTT.The recovery of proprioceptive sensation was assessed by electromyography （EMG） at 12 weeks after operation，and the integral electromyogram （iEMG） of electromyography of medial femoral muscle was measured at 12 weeks after operation.Routine MRI at 4 weeks and 12 weeks was used to detect the width of bone marrow canal，signal intensity of graft，and T2 value of tendon and bone node.The motor function was evaluated by 2000 International Knee Documents Committee （IKDC） Subjective Knee Evaluation Scale and Lysholm score.The balance function was evaluated by Fugl-Meyer Balance Scale and Berg Balance Scale （BBS）．Results　The width of bone marrow canal in the observation group at 4 and 12 weeks after operation was narrower than that in the control group，signal intensity of graft and T2 value of tendon and bone node in the observation group at 4 weeks was higher than that in the control group，while the signal intensity of graft and T2 value of tendon and bone node in the observation group at 12 weeks was lower than that in the control group（P<0.05）．The width of bone marrow canal at 12 weeks after operation in both groups was higher than that at 4 weeks after operation，and the signal intensity and T2 value of tendon-bone node were lower than that at 4 weeks after operation （P<0.05）．Reproducibility deviation of passive range of motion （ROM） and iEMG in 0 °-40 °，41 °-80 °，81 °-120 ° in the observation group at 12 weeks after operation were better than those in the control group （P<0.05）．The 2000 IKDC Subjective Knee Evaluation Scale score of the observation group was higher than that of the control group at 12 weeks postoperatively （P<0.05）；the Lysholm score，Fugl-Meyer Balance Scale score and BBS score of the observation group were higher than those of the control group at 4 and 12 weeks after operation （P<0.05）．The 2000 IKDC Subjective Knee Evaluation Scale score，Lysholm score，Fugl-Meyer Balance Scale score and BBS score of the two groups at 12 weeks after operation were higher than those at 4 weeks after operation （P<0.05）．At 12 weeks after operation，the enlargement of bone marrow canal was negatively correlated with Lysholm score and BBS score （r=-0.32，r=-0.35，P<0.05）．Conclusion　Adding proprioceptive training to early walking training can accelerate the recovery of tendon and bone，increase muscle strength and proprioception，and improve motor and balance function.

Key words: Anterior cruciate ligament reconstruction, Early body weight-supported treadmill training, Knee joint, Bone tunnel

赵卫卫,邵晨兰,付鹏,等. 早期减重步行训练对前交叉韧带重建术后功能恢复及骨隧道改变的影响研究[J]. 中国全科医学, 2019, 22(29): 3643-3647. DOI: 10.12114/j.issn.1007-9572.2019.00.026.
ZHAO Weiwei,SHAO Chenlan,FU Peng, et al. Effect of Early Weight-supported Treadmill Training on Functional Recovery and Bone Tunnel Changes after Anterior Cruciate Ligament Reconstruction　[J]. Chinese General Practice, 2019, 22(29): 3643-3647. DOI: 10.12114/j.issn.1007-9572.2019.00.026.

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