多种康复方式对老年人工全膝关节置换后下肢运动功能的影响  

Effects of combination therapy on the movement function of lower extremity after total knee arthroplasty in the elderly

作　　者：陈慧[1] 杜珊珊[2] 范丽娟[1] 姜婕[1] 梁晓燕[1] 甄平[1] 李旭升[1] 刘军[1] 

机构地区：[1]解放军兰州军区总医院全军骨科中心关节外科,甘肃省兰州市730050 [2]解放军兰州军区总医院体检中心,甘肃省兰州市730050

出　　处：《中国组织工程研究》2017年第31期4939-4944,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金资助项目(81371513);甘肃省青年科技基金(1606RJYA300);甘肃省自然科学基金(1606RJZA208);甘肃省科技支撑计划(S04671)~~

摘　　要：背景:研究发现,肌电生物反馈康复治疗对术后患者的步行能力有明显改善作用。目的:比较多种康复方式对老年人工全膝关节置换后患者下肢运动功能的影响。方法:采用电脑随机分配法将153例人工全膝关节置换后患者分为常规基础康复组、肌电生物反馈康复组及联合康复组。入选患者均给予常规基础康复训练,肌电生物反馈康复组辅以股四头肌肌电生物反馈康复治疗,联合康复组则在常规康复方式基础上加用肌电生物反馈及减重平板训练。治疗8周后,对3组患者下肢运动功能、ADL能力、平衡功能、膝关节屈伸活动度、步行能力、膝关节功能HSS评分,下肢功能评分(LEFS)进行量化评估;并评估疼痛目测类比评分、静息和主动运动状态下的股四头肌积分肌电值(sE MG)、踝背伸拮抗肌协同收缩率、Fugl-Meyer量表(FMA)评分、Barthel指数(MBI)、Berg平衡量表(BBS)、通用量角器及Holden步行功能分级。结果与结论:(1)与治疗前、常规基础康复组及肌电生物反馈康复组比较,联合康复组治疗后目测类比评分明显降低(P<0.01);(2)联合康复组中HHS评分及LEFS评分高于常规基础康复训练组及肌电生物反馈康复组(P<0.05);(3)联合康复组sE MG分值、拮抗肌协同收缩率、下肢FMA评分、MBI评分、膝关节屈伸活动度、最大步速、步长及Holden步行功能均优于其余2组(P<0.05);(4)在选取的多种术后康复方式中,联合康复疗法能显著提高老年人工全膝关节置换后患者的下肢运动功能,增加下肢肌力,提高术后的康复疗效。BACKGROUND： Electromyographic biofeedback therapy has been reported to contribute to the functional recovery ofthe lower limb after arthroplasty.OBJECTIVE： To compare the effect of different rehabilitation therapies on the movement function of lower limb in elderlypatients after total knee replacement.METHODS： Totally 153 patients undergoing total knee replacement were randomly divided into conventional,electromyographic biofeedback and combination groups （n=51 per group）, and then subjected to the conventionalrehabilitation training, electromyographic biofeedback at the quadriceps femoris, and conventional rehabilitation training,electromyographic biofeedback plus body weight supported treadmill training, respectively. At 8 weeks after treatment,the movement function of lower limbs, activities of daily living and balance abilities, range of flexion-extension of the kneejoint, walking ability, Hospital for Special Surgery of the lower limbs, as well as the Lower Extremity Functional Scalescores were evaluated. Besides, the Visual Analogue Scale scores, surface electromyogram of the quadriceps femoris atrest and in activity, co-contraction ratio of antagonistic muscle when ankle dorsiflexion, Fugl-Meyer assessment,modified Barthel index, Berg Balance Scale, and Holden walking function classification were detected.RESULTS AND CONCLUSION： （1） The Visual Analogue Scale scores after treatment in the combination group weresignificantly lower than those before treatment, in the conventional and electromyographic biofeedback groups （P 〈 0.01）.（2） The Hospital for Special Surgery and Lower Extremity Functional Scale scores in the combination group weresignificantly higher than those in the conventional and electromyographic biofeedback groups （P 〈 0.05）. （3） The surfaceelectromyogram values, co-contraction ratio of antagonistic muscle, Fugl-Meyer assessment, modified Barthel index,range of flexion-extension of the knee joint, maximum step length and velocity as well as Holden walking fu

关 键 词：骨科植入物 人工假体 肌电生物反馈康复 膝关节置换 下肢运动功能 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]