本体感觉训练对踝关节周围骨折患者步行能力的改善

doi:10.3877/cma.j.issn.1674-134X.2024.04.007

目的

探索本体感觉训练提高踝关节周围骨折患者平衡及步行功能的研究。

方法

收集在苏州瑞盛康复医院就诊的术后2个月32例踝关节周围骨折患者，入选患者骨折对位对线良好，且可以独立站立及步行，除外严重神经肌肉损伤、创伤性关节炎及足部残缺患者，按随机数字表法分成对照组（n=16）和实验组（n=16）。两组患者均进行常规康复治疗，实验组再增加本体感觉训练治疗，每周治疗5~7 d，两组患者均进行1个月康复治疗。两组患者在治疗前及治疗1个月后分别进行10 m步行时间评定，平衡检测仪上进行重心轨迹长度评定。组间比较采用t检验，对比两组患者的疗效差异。

结果

经过1个月治疗，两组间进行比较，实验组的10 m步行时间、重心轨迹长度的改善均高于对照组（t=-3.561，P=0.008；t=2.85，P=0.001）。

结论

踝关节周围骨折患者，在常规康复治疗基础上增加本体感觉训练可以提高患者的平衡及步行功能，促进患者尽快康复，加快康复进程。

关键词: 踝关节, 康复, 本体感觉, 姿势平衡, 步行速度

Objective

To improve the equilibrium and mobility function in ankle fracture patients by using Proprioceptive training.

Methods

A total of 32 patients with peri-ankle fractures who were treated in Suzhou Ruisheng Rehabilitation Hospital two months after surgery were collected. The included patients had good fracture alignment and could stand and walk independently, while the patients with severe neuromuscular injury, traumatic arthritis and foot mutilation were exluded. The patients were divided into observation group and control group (n=16 for each group) by random number method. Balance training with proprioceptive training (once or twice a day, five to seven days a week) and comprehensive rehabilitation therapy were used in observation group, and control group were treated only with comprehensive rehabilitation therapy. The patients were assessed using 10-meter walking test and balance assessment system in length of gravity center (LNG) after training for one month. The therapeutic effect difference was analyzed by t test.

Results

After one month of treatment, comparing between observation group and control group, the balance and mobility function of the patients in observation group had more significant improvements than the control group (t=-3.561, P=0.008; t=2.85, P=0.001).

Conclusion

Proprioceptive training can promote the recovery of the balance and mobility function of the patients with ankle fracture and accelerate the recovery process.

Key words: Ankle fracture, Rehabilitation, Proprioception, Posture balance, Walking speed

表1 两组患者基础资料比较

Table 1 Comparison of general data between the two groups

组别 Groups	例数 Number of case	年龄［岁，（）］ Age（year）	病程［d，（）］ Course of disease	性别(例) Gender
组别 Groups	例数 Number of case	年龄［岁，（）］ Age（year）	病程［d，（）］ Course of disease	男Male	女 Female
对照组 Control group	16	41.5±9.5	4.4±1.6	13	3
实验组 Experimental group	16	39.7±7.5	4.3±1.4	10	6
统计值 Statistical value		t=0.73	t=1.26	χ²=1.391
P值		>0.05	>0.05	>0.05

表1 两组患者基础资料比较

Table 1 Comparison of general data between the two groups

组别 Groups	例数 Number of case	年龄［岁，（）］ Age（year）	病程［d，（）］ Course of disease	性别(例) Gender
组别 Groups	例数 Number of case	年龄［岁，（）］ Age（year）	病程［d，（）］ Course of disease	男Male	女 Female
对照组 Control group	16	41.5±9.5	4.4±1.6	13	3
实验组 Experimental group	16	39.7±7.5	4.3±1.4	10	6
统计值 Statistical value		t=0.73	t=1.26	χ²=1.391
P值		>0.05	>0.05	>0.05

表2 两组患者治疗前后重心轨迹长度［mm，（

）］

Table 2 Length of gravity trajectory center before and after treatment of the two groups

组别 Groups	例数 Number of case	治疗前 Before treatment	治疗后 After treatment	治疗前后差 Difference before and after treatment	t值	P值
对照组 Control group	16	55±33	44±27	5（-8，23）	1.857	>0.05
实验组 Experimental group	16	73±42	28±14	42（17，63）	4.371	0.001
统计值 Statistical value		t=-1.425	t=3.082	Z=-2.676
P值		>0.05	0.008	0.008

表2 两组患者治疗前后重心轨迹长度［mm，（

）］

Table 2 Length of gravity trajectory center before and after treatment of the two groups

组别 Groups	例数 Number of case	治疗前 Before treatment	治疗后 After treatment	治疗前后差 Difference before and after treatment	t值	P值
对照组 Control group	16	55±33	44±27	5（-8，23）	1.857	>0.05
实验组 Experimental group	16	73±42	28±14	42（17，63）	4.371	0.001
统计值 Statistical value		t=-1.425	t=3.082	Z=-2.676
P值		>0.05	0.008	0.008

表3 两组患者治疗前后10 m步行时间［s，（

）］

Table 3 Ten-meter walking time before and after treatment of the two groups

组别 Groups	例数 Number of case	治疗前 Before treatment	治疗后 After treatment	治疗前后差 Difference before and after treatment	t值	P值
对照组 Control group	16	13.3±4.6	11.2±4.1	2.0±1.6	4.970	<0.001
实验组 Experimental group	16	13.9±3.8	8.6±1.7	5.3±3.3	6.437	<0.001
t值		-0.322	2.188	-3.561
P值		>0.05	>0.05	0.001

表3 两组患者治疗前后10 m步行时间［s，（

）］

Table 3 Ten-meter walking time before and after treatment of the two groups

组别 Groups	例数 Number of case	治疗前 Before treatment	治疗后 After treatment	治疗前后差 Difference before and after treatment	t值	P值
对照组 Control group	16	13.3±4.6	11.2±4.1	2.0±1.6	4.970	<0.001
实验组 Experimental group	16	13.9±3.8	8.6±1.7	5.3±3.3	6.437	<0.001
t值		-0.322	2.188	-3.561
P值		>0.05	>0.05	0.001

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Improvements on mobility function with proprioceptive training in patients with ankle fracture

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Improvements on mobility function with proprioceptive training in patients with ankle fracture