膝关节位置重现对前交叉韧带重建患者本体感觉的研究

发布时间：2018-08-27 14:57

【摘要】：研究背景:随着全民健身运动意识的提高,运动损伤导致前交叉韧带(Anterior Cruciate Ligament,ACL)断裂的发病率逐年增加,而且常发生于中青年。ACL重建(ACL reconstruction,ACLR)是ACL断裂的现行标准治疗手段。ACLR后ACL功能的恢复,不仅依赖于解剖结构的恢复,其本体感觉功能的恢复同样重要。膝关节位置重现作为本体感觉训练和测试的方法之一,已成功运用于膝关节本体感觉的测试,但运用此方法进行本体感觉训练的研究并不多。目的:本研究借助可视化数字软件及互联网通讯,应用膝关节位置重现训练强化患者本体感觉,观察其对ACLR后患者的影响,求证膝关节位置重现在治疗ACLR中的有效性和实用性,为其临床应用和推广提供一定的科学依据。方法:收集符合纳入标准的患者,将其随机分为实验组和对照组,对照组患者行康复教育、物理治疗、自我训练等常规治疗;实验组患者在常规治疗的基础上增加可视化数字软件下膝关节位置重现训练。评估两组患者术前、术后1周、术后5周膝关节位置重现(评估15°、30°、45°)的差异值、下肢周径萎缩指数、Berg 量表(Berg Balance Scale,BBS)、Barthel指数(Barthel lndex,BI)、视觉模拟评分表(Visual Analog Scale,VAS)等临床指标。采用20.0版SPSS软件行统计分析,评估疗效,P值0.05具统计学意义。结果:本研究最终纳入符合标准的患者61例,其中实验组31例,对照组30例。1.膝关节本体感觉功能1.1与术前相比,术后5周两组患者患侧膝关节位置重现差异与术前测量值相比有显著意义(P0.05),且实验组差异值较对照组小,两组健侧相比无统计学差异(P0.05)。1.2术后5周两组相比,实验组患侧膝关节位置重现差异值在30°、45°时有统计学差异(P0.05),实验组患侧15°以及健侧所有目标角度无统计学差异(P0.05)。2.下肢周径萎缩指数2.1与术前相比,术后5周两组患者髌上10cm周径萎缩指数(P0.001),髌下10cm周径萎缩指数(P0.05)有统计学意义,实验组的萎缩指数小于对照组。2.2术后5周,实验组和对照组髌上10cm、髌下10cm周径萎缩指数相比有统计学差异(P0.05)。3.Lysholm 评分、VAS、BBS、BI3.1两组患者术前与术后1周、术后1周与术后5周的Lysholm评分、VAS、BBS、BI的结果具有显著性差异(P0.001),两组患者术前和术后5周VAS、BI结果有统计学意义(P0.05),Lysholm评分及BBS结果无显著性差异(P0.05)。3.2两组患者相比,术后1周、术后5周Lysholm评分、VAS、BBS、BI的结果均无统计学意义(P0.05),但术后5周实验组Lysholm评分、BBS、BI的结果较对照组大,VAS的结果较对照组小。结论:ACLR后在常规康复治疗的基础上,辅以可视化数字软件下膝关节位置重现训练有利于患者本体感觉的恢复、预防肌肉萎缩以及提高膝关节整体功能,且此方法简便易行,适于居家康复,值得临床推广和应用。
[Abstract]:Background: with the improvement of national fitness awareness, the incidence of anterior cruciate ligament (Anterior Cruciate Ligament,ACL) rupture caused by sports injury is increasing year by year. ACL reconstruction (ACL reconstruction,ACLR), which often occurs in young and middle-aged people, is the current standard treatment for ACL rupture. The recovery of ACL function depends not only on the restoration of anatomical structure, but also on the restoration of proprioceptive function. As one of the methods of proprioceptive training and testing, position reconstruction of knee joint has been successfully applied to the testing of proprioceptive sensation of knee joint. However, there are few researches on proprioceptive training using this method. Objective: to evaluate the effectiveness and practicability of knee joint position reconstruction in the treatment of ACLR by means of visual digital software and Internet communication to strengthen the patient's proprioceptive perception, to observe its effect on the patients after ACLR, and to verify the effectiveness and practicability of knee joint position reconstruction in the treatment of ACLR. It provides a scientific basis for its clinical application and popularization. Methods: the patients who met the inclusion criteria were randomly divided into the experimental group and the control group. The patients in the control group received routine treatment such as rehabilitation education, physical therapy, self-training and so on. On the basis of routine treatment, the patients in the experimental group were trained in knee joint position reconstruction with visual digital software. To evaluate the difference of knee joint position (15 掳~ 30 掳~ 45 掳), lower extremity circumference atrophy index (Berg Balance Scale,BBS), Barthel index (Barthel lndex,BI) and visual analogue scale (Visual Analog Scale,VAS) between the two groups before operation, 1 week after operation and 5 weeks after operation. Statistical analysis was carried out with 20.0 SPSS software, and there was statistical significance in evaluating curative effect (P = 0. 05). Results: 61 patients were included in the study, including 31 patients in the experimental group and 30 patients in the control group. The knee proprioceptive function 1.1 was significantly different between the two groups at 5 weeks after operation (P0.05), and the difference was smaller in the experimental group than that in the control group. There was no significant difference between the two groups in the healthy side (P0.05) .1.2 after 5 weeks after operation, there was statistical difference between the two groups at 30 掳to 45 掳(P0.05), and there was no significant difference in the 15 掳of the affected side and all the target angles of the healthy side in the experimental group (P0.05) .2. The atrophy index of 10cm (P0. 001) and subpatellar 10cm (P0. 05) were significantly lower in the experimental group than in the control group at 5 weeks after operation, and the atrophy index in the experimental group was lower than that in the control group at 5 weeks after operation. There were significant differences between the experimental group and the control group in suprapatellar 10 cm and subpatellar 10cm circumference atrophy index (P0.05). 3. Lysholm score before operation and 1 week after operation. There was significant difference in Lysholm scores between the first week and the fifth week after operation (P0. 001). There was no significant difference between the two groups in VAS,BI scores before and 5 weeks after operation (P0.05) and BBS results (P0.05), 1 week after operation, there was no significant difference between the two groups (P0.05). There was no significant difference in the results of Lysholm scores and Lysholm scores 5 weeks after operation (P0.05), but the results of Lysholm scores in the experimental group were smaller than those in the control group (P0.05). Conclusion on the basis of routine rehabilitation therapy, the reconstruction training of knee joint position under visual digital software is beneficial to the recovery of proprioceptive sensation, the prevention of muscular atrophy and the improvement of the whole function of knee joint, and this method is simple and convenient. It is suitable for family rehabilitation and is worth popularizing and applying in clinic.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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