踝扭伤后关节生物力学和本体感觉变化特征及相关性  

Biomechanics Characteristics and Its Correlation with Proprioception of Ankle Post Sprain

作　　者：杨绯[1] 潘钰[1] 吴琼[1] 徐泉[1] 李欣[1] 张丽春[1] YANG Fei;PAN Yu;WU Qiong;XU Quan;LI Xin;ZHANG Li-chun(Department of Rehabilitation,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院清华大学临床医学院

出　　处：《中国康复理论与实践》2019年第12期1365-1369,共5页Chinese Journal of Rehabilitation Theory and Practice

基　　金：北京市科技计划项目(No.Z181100003118004);北京市自然科学基金项目(No.L182028)~~

摘　　要：目的通过观察踝扭伤恢复期患者踝关节活动度、肌力、刚度和本体感觉变化,分析踝关节生物力学和本体感觉定量评价对踝扭伤康复的指导价值。方法 2019年4月至7月,选取21例恢复期踝扭伤患者,记录双侧踝关节活动度、肌力,采用踝关节测试训练系统评估双侧踝关节刚度,即背屈末端、跖屈20°和跖屈末端位置时关节活动所需力矩;同时定量评估踝关节本体感觉,包括关节活动阈值(MPT)和关节位置觉(PAPS)。比较双侧踝关节活动度、肌力、关节刚度和本体感觉,分析关节活动度、关节刚度和本体感觉之间相关性。结果患侧踝关节背屈和跖屈活动度小于健侧(|t|> 2.817, P <0.05);背屈和跖屈肌力明显小于健侧(|t|> 5.785,P <0.01);患侧跖屈末端刚度明显大于健侧(t=3.036, P=0.007),而背屈末端和跖屈20°时关节刚度与健侧无显著性差异(t <0.874, P> 0.05);两侧MPT和PAPS无显著性差异(t <0.695, P> 0.05)。患侧跖屈活动度与跖屈末端刚度(r=-0.466, P <0.05)、MPT (r=-0.613, P <0.05)均呈负相关,MPT与跖屈末端刚度呈正相关(r=0.469, P <0.05)。结论踝扭伤恢复期患者背屈、跖屈关节活动度和肌力下降,跖屈末端关节僵硬度升高,且与本体感觉相关。踝关节生物力学和本体感觉定量测量有助于定量指导踝关节康复策略。踝扭伤患者康复需加强关节周围肌肉力量、背屈和跖屈活动度训练,尤其要重视跖屈刚度改善,可能有助于本体感觉和运动功能恢复。Objective To quantitatively evaluate the biomechanical properties and proprioception by comparing the range of motion(ROM), muscle strength, stiffness and proprioception of ankle joint in patients with ankle sprain, in order to provide therapeutic strategy for the patients with ankle sprain.Methods From April to July, 2019, 21 patients with ankle sprain were included. The ROM and muscle strength of bilateral ankle joint were recorded, and the stiffness was evaluated by ankle joint training assistant system, at the end of dorsiflexion and plantarflexion, and plantarflexion 20°. The proprioception of ankle was quantitatively evaluated,including motion perception threshold(MPT) and passive position sense(PAPS). The ROM, muscle strength,joint stiffness, MPT and PAPS were compared, and the correlation among ROM, joint stiffness and proprioception were analyzed.Results Compared with the unaffected side, the dorsiflexion and plantarflexion ROM decreased(|t| > 2.817, P < 0.05),the dorsiflexion and plantarflexion muscle strength decreased(|t| > 5.785, P < 0.01), the stiffness at the end of plantarflexion increased(t = 3.036, P = 0.007) in the affected side. However, there was no significant difference in stiffness at the end of dorsiflexion and dorsiflexion 20° between two sides(t < 0.874, P > 0.05), nor in MPT and PAPS(t < 0.695, P > 0.05). The plantarflexion ROM on the affected side was negatively correlated with the stiffness at the end of plantarflexion(r =-0.466, P < 0.05) and MPT(r =-0.613, P < 0.05), and MPT was positively correlated with the stiffness at the end of plantarflexion(r = 0.469, P < 0.05).Conclusion The dorsiflexion and plantarflexion ROM and muscle strength decreased in the patients with ankle sprain,while the stiffness at the end of plantarflexion increased, which was related to proprioception. Quantitative measurements of ankle joint biomechanics and proprioception contributed to making ankle rehabilitation strategies.Rehabilitation after ankle sprain included training for ROM and muscle strength,

关 键 词：踝扭伤 跖屈 关节活动度 刚度 本体感觉 

分 类 号：R684.7[医药卫生—骨科学]