反重力跑台系统在前交叉韧带重建术后步行训练的应用

doi:10.3877/cma.j.issn.1674-134X.2023.04.005

目的

探讨反重力跑台系统在前交叉韧带重建术(ACLR)术后患者步行训练中的应用效果。

方法

回顾性分析2020年10月至2022年5月于海军青岛特勤疗养中心行康复治疗的ACLR术后患者，选取符合纳入排除标准的40例患者，以随机数字表法分为观察组和对照组各20例。纳入标准：单侧前交叉韧带(ACL)损伤合并半月板损伤，首次受伤后4~5周行ACLR，术后1周开始康复治疗。排除标准：陈旧性ACL损伤，膝关节手术史，合并后交叉韧带损伤及侧副韧带损伤、下肢骨折等，认知功能障碍及心血管系统疾病。两组患者康复训练时间均为8周。对照组给予常规的步行训练，观察组利用反重力跑台系统行减重步行训练。采用Isoforce等速肌力康复评估系统进行主动关节角度重现偏差度测试、德国Steinbichler三维步态分析系统对两组患者进行步态分析、Lysholm评分对两组患者进行评定。计数资料使用频数进行描述，卡方检验分析，正态分布的计量资料以(±s)描述，采用重复测量方差分析。

结果

术后第8、12周观察组Lysholm评分优于对照组，差异有统计学意义(t＝14.630、8.568，均为P<0.05)、主动关节角度重现偏差度优于对照组，差异有统计学意义(30°：t＝5.273、5.410，60°：t＝4.420、3.934，均为P<0.05)、步态分析评分优于对照组，差异有统计学意义(步长：t＝5.704，7.780；步频：t＝8.270、5.725，步速：t＝6.068、2.758，均为P<0.05)。

结论

反重力跑台系统减重步行训练可改善ACLR术后患者的膝关节功能及本体感觉，是一种能提升ACLR术后患者步行能力的有效方法。

关键词: 前交叉韧带重建, 重力，改变, 步行

Objective

To explore the application effect of anti-gravity treadmill system in walking training of patients after anterior cruciate ligament reconstruction (ACLR).

Methods

From October 2020 to May 2022, 40 patients with ACLR who underwent rehabilitation treatment in Naval Qingdao Special Service Rehabilitation Center were selected and divided into observation group and control group by random number table method, with 20 cases in each group. Inclusion criteria: the patients who have unilateral anterior cruciate ligament (ACL)injury combining meniscus injury, accept ACLR four to five weeks after injury, and start rehabilitation at one week after surgery. Exclusion criteria: old ACL injury, knee surgery history, combining posterior cruciate ligament and collateral ligaments injuries and lower limb fractures etc., cognitive dysfunctions and cardiovascular diseases The rehabilitation training time of the two groups was eight weeks. Patients in the control group were given routine walking training, while patients in the observation group were given walking training with anti-gravity treadmill system. The isoforce isokinetic muscle strength rehabilitation evaluation system was used for active joint angle reproducibility deviation test, the German Steinbichler three-dimensional gait analysis system was used for gait analysis, and the Lysholm score was used to evaluate the two groups of patients. The count data were described by frequency, the difference was analyzed by chi square analysis, and the measurement data of normal distribution were described by(±s), and analysed by repeated measures ANOVA.

Results

The Lysholm score of the observation group was better than that of the control group at eight and 12 weeks after operation, and the differences were statistically significant (t=14.630, 8.568, both P<0.05). The active joint angle recurrence deviation was better than that of the control group, and the differences were statistically significant (30°: t=5.273, 5.410; 60°: t=4.420, 3.934, all P<0.05). Gait analysis score of the experimental group were better than those of the control group, and the differences were statistically significant (step length : t=5.704, 7.780; stride frequency: t=8.270, 5.725; gait speed: t=6.068, 2.758; all P<0.05).

Conclusions

Weight-loss walking training with anti-gravity treadmill system can improve the knee joint function and proprioception of patients after ACLR. It is an effective method to improve the walking ability of patients after ACLR.

Key words: Anterior cruciate ligament reconstruction, Gravity, altered, Walking

图3 反重力跑台显示系统

Figure 3 Anti-gravity treadmill display system

表1 两组患者一般资料

Table 1 General data of the two groups of patients

分组Groups	例数Number of cases	性别(男/女) Gender (male/female)	年龄[岁，(±s)] Age(years)	膝关节(左/右) Knee joint (left/right)	受伤至手术时间[周，(±s)] Time from injury to surgery(weeks)	重建方式(单束/双束) Reconstruction method(single bundle/double bundle)	BMI [kg /m²，(±s)]
观察组Observation group	20	15/5	30.4±6.4	11/9	4.8±2.3	11/9	21.3±2.2
对照组Control group	20	15/5	31.8±5.2	12/8	4.1±1.2	11/9	21.8±2.0
统计值		χ²＝0	t＝0.795	χ²＝0.102	t＝1.098	χ²＝0	t＝0.767
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表1 两组患者一般资料

Table 1 General data of the two groups of patients

分组Groups	例数Number of cases	性别(男/女) Gender (male/female)	年龄[岁，(±s)] Age(years)	膝关节(左/右) Knee joint (left/right)	受伤至手术时间[周，(±s)] Time from injury to surgery(weeks)	重建方式(单束/双束) Reconstruction method(single bundle/double bundle)	BMI [kg /m²，(±s)]
观察组Observation group	20	15/5	30.4±6.4	11/9	4.8±2.3	11/9	21.3±2.2
对照组Control group	20	15/5	31.8±5.2	12/8	4.1±1.2	11/9	21.8±2.0
统计值		χ²＝0	t＝0.795	χ²＝0.102	t＝1.098	χ²＝0	t＝0.767
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

表2 两组患者Lysholm评分比较[分，(±s)]

Table 2 Comparison of Lysholm scores between the two groups

组别Groups	例数Number of cases	第3周Three weeks after surgery	第8周Eight weeks after surgery	第12周12 weeks after surgery	F值	P值
观察组Observation group	20	33.5±1.4	83.1±3.3^a	91.1±2.3^ab	98.930	<0.001
对照组Control group	20	33.8±1.8	72.6±2.3^a	85.0±2.0^ab
t值		0.348	14.630	8.568
P值		>0.05	<0.001	<0.001

表2 两组患者Lysholm评分比较[分，(±s)]

Table 2 Comparison of Lysholm scores between the two groups

组别Groups	例数Number of cases	第3周Three weeks after surgery	第8周Eight weeks after surgery	第12周12 weeks after surgery	F值	P值
观察组Observation group	20	33.5±1.4	83.1±3.3^a	91.1±2.3^ab	98.930	<0.001
对照组Control group	20	33.8±1.8	72.6±2.3^a	85.0±2.0^ab
t值		0.348	14.630	8.568
P值		>0.05	<0.001	<0.001

表3 两组患者主动关节角度重现偏差度比较[°，(±s)]

Table 3 Comparison of active joint angle reproducibility deviation between the two groups

组别Groups	例数Number of cases	术后3周Three weeks after surgery		术后8周Eight weeks after surgery		术后12周12 weeks after surgery		F值	P值
组别Groups	例数Number of cases	30°	60°	30°	60°	30°	60°	F值	P值
观察组Observation group	20	4.95±0.71	5.95±0.67	3.34±0.43^a	3.93±0.29^a	2.28±0.30^ab	2.68±0.47^ab	测量次数：12.949	测量次数：<0.001
对照组Control group	20	5.00±0.65	6.10±0.55	4.18±0.44^a	4.75±0.34^a	2.98±0.34^ab	3.28±0.47^ab	组间交互：6.032	组间交互：<0.001
t值		0.316	0.984	5.273	5.410	4.420	3.934
P值		>0.05	>0.05	<0.001	<0.001	<0.001	<0.001

表3 两组患者主动关节角度重现偏差度比较[°，(±s)]

Table 3 Comparison of active joint angle reproducibility deviation between the two groups

组别Groups	例数Number of cases	术后3周Three weeks after surgery		术后8周Eight weeks after surgery		术后12周12 weeks after surgery		F值	P值
组别Groups	例数Number of cases	30°	60°	30°	60°	30°	60°	F值	P值
观察组Observation group	20	4.95±0.71	5.95±0.67	3.34±0.43^a	3.93±0.29^a	2.28±0.30^ab	2.68±0.47^ab	测量次数：12.949	测量次数：<0.001
对照组Control group	20	5.00±0.65	6.10±0.55	4.18±0.44^a	4.75±0.34^a	2.98±0.34^ab	3.28±0.47^ab	组间交互：6.032	组间交互：<0.001
t值		0.316	0.984	5.273	5.410	4.420	3.934
P值		>0.05	>0.05	<0.001	<0.001	<0.001	<0.001

表4 两组患者步态分析数据比较(±s)

Table 4 Comparison of gait analysis data between the two groups

组别Groups	例数Number of cases	步长(cm) Step length		F值	P值
组别Groups	例数Number of cases	术后8周	术后12周	F值	P值
观察组Observation group	20	78.9±3.1	91.1±4.0^*	3.807	>0.05
对照组Control group	20	72.9±2.4	83.0±3.6^*	3.807	>0.05
t值		5.704	7.780
P值		<0.001	<0.001
组别Groups	例数Number of cases	步频(步/min) Step frequency (step /min)		F值	P值
组别Groups	例数Number of cases	术后8周	术后12周	F值	P值
观察组Observation group	20	115.3±2.1	126.3±4.5^*	4.903	0.033
对照组Control group	20	106.9±2.1	120.5±3.5^*	4.903	0.033
t值		8.270	5.725
P值		<0.001	<0.001
组别Groups	例数Number of cases	步速(cm/s) Walking speed		F值	P值
组别Groups	例数Number of cases	术后8周	术后12周	F值	P值
观察组Observation group	20	108.3±5.9	115.5±5.1^*	22.861	<0.001
对照组Control group	20	97.3±6.3	110.5±5.7^*	22.861	<0.001
t值		6.068	2.758
P值		<0.001	<0.015

表4 两组患者步态分析数据比较(±s)

Table 4 Comparison of gait analysis data between the two groups

组别Groups	例数Number of cases	步长(cm) Step length		F值	P值
组别Groups	例数Number of cases	术后8周	术后12周	F值	P值
观察组Observation group	20	78.9±3.1	91.1±4.0^*	3.807	>0.05
对照组Control group	20	72.9±2.4	83.0±3.6^*	3.807	>0.05
t值		5.704	7.780
P值		<0.001	<0.001
组别Groups	例数Number of cases	步频(步/min) Step frequency (step /min)		F值	P值
组别Groups	例数Number of cases	术后8周	术后12周	F值	P值
观察组Observation group	20	115.3±2.1	126.3±4.5^*	4.903	0.033
对照组Control group	20	106.9±2.1	120.5±3.5^*	4.903	0.033
t值		8.270	5.725
P值		<0.001	<0.001
组别Groups	例数Number of cases	步速(cm/s) Walking speed		F值	P值
组别Groups	例数Number of cases	术后8周	术后12周	F值	P值
观察组Observation group	20	108.3±5.9	115.5±5.1^*	22.861	<0.001
对照组Control group	20	97.3±6.3	110.5±5.7^*	22.861	<0.001
t值		6.068	2.758
P值		<0.001	<0.015

[19]	Shanbehzadeh S, Mohseni Bandpei MA, Ehsani F. Knee muscle activity during gait in patients with anterior cruciate ligament injury: a systematic review of electromyographic studies[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(5): 1432-1442.
[20]	Nazary-Moghadam S, Salavati M, Esteki A, et al. Gait speed is more challenging than cognitive load on the stride-to-stride variability in individuals with anterior cruciate ligament deficiency[J]. Knee, 2019, 26(1): 88-96.
[21]	刘德健，李彦林，毛健宇，等. 内减张技术辅助前交叉韧带重建的运动学分析[J/CD]. 中华关节外科杂志(电子版), 2020, 14(1): 17-23.
[22]	张磊，扶世杰，周鑫，等. NT-3/TrkC信号通路在猴前交叉韧带本体感觉损伤中的作用[J]. 中国康复医学杂志，2018, 33(5): 513-519.
[23]	朱洪江，郭长利，张弘毅，等. 股四头肌锻炼在前交叉韧带重建术后本体感觉恢复中的作用[J]. 中国老年学杂志，2016, 36(14): 3507-3509.
[24]	张磊，李义凯. 膝关节前交叉韧带本体感觉的研究进展[J]. 中国康复医学杂志，2017, 32(2): 245-247.
[1]	Ardern CL, Eka°s G, Grindem H, et al. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(4): 989-1010.
[2]	Lai CCH, Ardern CL, Feller JA, et al. Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes[J]. Br J Sports Med, 2018, 52(2): 128-138.
[3]	孔芳草，付丛会，李小通，等. 反重力跑台系统在老年脑卒中患者平衡及步行训练中的疗效[J]. 中国康复，2021, 36(5): 274-277.
[4]	Nyland J, Collis P, Huffstutler A, et al. Quadriceps tendon autograft ACL reconstruction has less pivot shift laxity and lower failure rates than hamstring tendon autografts[J]. Knee Surg Sports Traumatol Arthrosc, 2020, 28(2): 509-518.
[5]	周天平，徐一宏，徐卫东. 前交叉韧带损伤处理相关国际指南解读及其临床应用[J/CD]. 中华关节外科杂志(电子版), 2021, 15(6): 718-724.
[6]	Weng CJ, Yeh WL, Hsu KY, et al. Clinical and functional outcomes of anterior cruciate ligament reconstruction with autologous hamstring tendon in patients aged 50 years or older[J]. Arthroscopy, 2020, 36(2): 558-562.
[7]	赵立连，卢明峰，邢基斯，等. 前交叉韧带重建术后膝关节功能及三维运动步态分析[J/CD]. 中华关节外科杂志(电子版), 2021, 15(1): 23-32.
[8]	邵晨兰，覃波，赵卫卫，等. 早期减重步态训练对前交叉韧带重建术后运动功能恢复的影响[J]. 实用医院临床杂志，2017, 14(6): 249-251.
[9]	王雪强，王于领，译．骨科术后康复[M]．北京：北京科学技术出版社，2021：475-477.
[10]	Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J]. Am J Sports Med, 1982, 10(3): 150-154.
[11]	Barrett DS. Proprioception and function after anterior cruciate reconstruction[J]. J Bone Joint Surg Br, 1991, 73(5): 833-837.
[12]	林在龙，顾旭东，傅建明，等. 下肢康复机器人结合虚拟现实训练对前交叉韧带重建术后步行能力的影响[J]. 华西医学，2022, 37(5): 717-721.
[13]	付常喜，陈现超. 本体感觉训练对前交叉韧带损伤重建术后患者运动功能的影响研究[J]. 中国学校体育(高等教育), 2017, 4(7): 82-86.
[14]	Fan Z, Yan J, Zhou Z, et al. Delayed versus accelerated weight-bearing rehabilitation protocol following anterior cruciate ligament reconstruction: a systematic review and meta-analysis[J/OL]. J Rehabil Med, 2022, 54: jrm00260. DOI: 10.2340/jrm.v53.1438.
[15]	Yardley IE, Donaldson LJ. Patient safety matters: reducing the risks of nasogastric tubes[J]. Clin Med, 2010, 10(3): 228-230.
[16]	陈维生，张一臣，胡北，等. 促胃动力药在神经重症患者螺旋型鼻肠管置管中的应用[J]. 实用医学杂志，2013, 29(20): 3343-3345.
[17]	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, 3652.
[18]	吴茂东，苏清伦，杜海敏，等. 减重支持训练对前交叉韧带重建术后患者动态足底压力的影响[J]. 中国康复医学杂志，2021, 36(12): 1523-1528.

[1]	黄子荣, 罗渝鑫, 杨文瀚, 陈小虎, 谢环宇, 朱伟民. 前交叉韧带重建对膝关节稳定性影响的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 847-854.
[2]	梁家敏, 黄子荣, 崔家鸣, 钟名金, 冯文哲, 陈康, 胡艳, 欧阳侃, 杨雷, 王大平, 王满宜, 朱伟民. 前交叉韧带保留残端重建促进膝关节功能的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(05): 708-714.
[3]	刘延子, 王维军, 韩向东, 田学东. 保留残余腱束与残端重建前交叉韧带后外侧束[J]. 中华关节外科杂志(电子版), 2023, 17(03): 439-442.
[4]	赵宇, 赵松, 赵金忠. 前交叉韧带损伤及重建后继发性膝骨关节炎的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(03): 415-423.
[5]	周兰, 徐一宏, 徐卫东. 前交叉韧带重建术后重返运动的评估[J]. 中华关节外科杂志(电子版), 2023, 17(03): 409-414.
[6]	刘日, 高丽姝, 魏海强, 谢坤南, 于俊, 戴士峰. 关节镜下腓骨长肌腱单束重建前交叉韧带[J]. 中华关节外科杂志(电子版), 2023, 17(01): 136-140.
[7]	崔毅鹏, 李若尘, 刘蔚, 陈曦, 杨佩, 王坤正, 李苗. 前交叉韧带重建术后膝前疼痛的危险因素分析[J]. 中华关节外科杂志(电子版), 2022, 16(06): 690-696.
[8]	李铭, 孟繁钢, 何爱珊. 前交叉韧带胫骨止点大体及影像学解剖研究进展[J]. 中华关节外科杂志(电子版), 2022, 16(05): 605-610.
[9]	谢环宇, 傅子财, 黄勇, 刘澍雨, 王辰, 孙一嘉, 王大平, 王满宜, 杨雷, 朱伟民. 前交叉韧带重建术后评估何时重返运动指标的研究进展[J]. 中华关节外科杂志(电子版), 2022, 16(05): 599-604.
[10]	杨少铮, 潘剑英, 曾春. 不同直径混合肌腱重建前交叉韧带对膝关节运动学特征影响[J]. 中华关节外科杂志(电子版), 2022, 16(03): 278-286.
[11]	周兰, 徐一宏, 徐卫东. 前交叉韧带重建术后加速重返运动的术前干预研究[J]. 中华关节外科杂志(电子版), 2022, 16(02): 219-224.
[12]	周天平, 徐一宏, 徐卫东. 前交叉韧带重建股骨骨隧道定位的理论依据及演变[J]. 中华关节外科杂志(电子版), 2022, 16(01): 79-85.
[13]	耿倩, 鹿青, 李莎, 臧雅静, 顾聚源. 循环渐进式康复策略促进前交叉韧带重建术后患者下肢功能恢复的临床研究[J]. 中华老年骨科与康复电子杂志, 2023, 09(02): 101-107.
[14]	张军, 王宝军, 黄妍, 赵海, 梁磊, 安旭, 金渊媛. 躯干姿势调整对脑卒中偏瘫患者步行能力的影响[J]. 中华脑科疾病与康复杂志(电子版), 2022, 12(06): 338-343.
[15]	代菊红, 杨光, 黄竞敏, 孙玉文, 魏余晋, 杨丹丹, 张强强. 针灸联合运动疗法对前交叉韧带重建术后功能康复的临床研究[J]. 中华针灸电子杂志, 2021, 10(04): 140-145.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Application of anti-gravity treadmill system in walking training after anterior cruciate ligament reconstruction

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Application of anti-gravity treadmill system in walking training after anterior cruciate ligament reconstruction