反重力跑台训练在股骨干骨折加压钢板螺钉内固定术后康复治疗中的应用  

Application of anti-gravity treadmill training to functional rehabilitation after compression plate and screw in-ternal fixation for treatment of femoral shaft fracture

作　　者：李克军 刘水根 蒋拥军 何梦凡 秦健君 LI Kejun;LIU Shuigen;JIANG Yongjun;HE Mengfan;QIN Jianjun(Shenzhen Pingle Orthopedic Hospital(Shenzhen Pingshan District Hospital of Traditional Chinese medicine),Shenzhen 518010,Guangdong,China)

机构地区：[1]深圳平乐骨伤科医院/深圳市坪山区中医院,广东深圳518010

出　　处：《中医正骨》2023年第8期20-25,42,共7页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:探讨反重力跑台训练在股骨干骨折加压钢板螺钉内固定术后康复治疗中的应用价值。方法:将58例行加压钢板螺钉内固定术后4周的股骨干骨折患者随机分为常规康复组和联合康复组,每组29例。常规康复组采用手法、运动疗法和物理疗法进行康复治疗,联合康复组在常规康复组干预措施基础上采用反重力跑台训练;均每周治疗5次,每次20 min,共治疗4周。记录并比较治疗前和治疗结束后2组患者N端骨钙素、Ⅰ型前胶原N端前肽(N-terminal propeptide of typeⅠprocollagen,PINP)、β-Ⅰ型胶原羧基端肽(β-C-terminal telopeptide of typeⅠcollagen,β-CTX)血清含量及美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分和骨痂生长评分。结果:(1)N端骨钙素血清含量。治疗结束后,2组患者N端骨钙素血清含量均高于治疗前[(10.07±2.12)ng·mL^(-1),(13.10±1.23)ng·mL^(-1),t=-6.660,P=0.000;(9.69±2.11)ng·mL^(-1),(11.93±1.89)ng·mL^(-1),t=-4.267,P=0.000],联合康复组患者N端骨钙素血清含量高于常规康复组(t=-2.798,P=0.007)。(2)PINP血清含量。治疗结束后,2组患者PINP血清含量均高于治疗前[(43.79±7.79)ng·mL^(-1),(72.52±5.03)ng·mL^(-1),t=-16.673,P=0.000;(46.3±10.76)ng·mL^(-1),(65.76±9.37)ng·mL^(-1),t=-7.339,P=0.000],联合康复组患者PINP血清含量高于常规康复组(t=-3.421,P=0.001)。(3)β-CTX血清含量。治疗结束后,2组患者β-CTX血清含量均低于治疗前[(772.93±18.29)pg·mL^(-1),(727.76±16.19)pg·mL^(-1),t=9.930,P=0.000;(765.38±25.76)pg·mL^(-1),(744.07±25.29)pg·mL^(-1),t=3.179,P=0.002],联合康复组患者β-CTX血清含量低于常规康复组(t=2.925,P=0.005)。(4)HSS膝关节评分。治疗结束后,2组患者HSS膝关节评分均高于治疗前[(63.04±6.75)分,(85.20±7.72)分,t=-8.781,P=0.000;(66.86±8.12)分,(80.14±6.24)分,t=-10.015,P=0.000],联合康复组患者HSS膝关节评分高于常规康复组(t=-2.748,P=0.008)。(5)骨痂生长评分。治疗结束�Objective:To explore the clinical applied values of anti-gravity treadmill(AlterG)training in postopenalive rehabiltation of patients who underwent compression plate and screw internal fixation for treal ment of femoral shaft fnacture.Methods:Filfy-eight patients with femonal shaft fracture who underwent compression plate and screw intemal fixation 4 weeks ago were randomly divided into conventional rehabiltation group and combination rehabilitation group,29 cases in each group.All patients in the 2 groups were treated with the same conventional rehabiliation thenapies including manipulation,kinestherapy and physiotherapy,moreover,the patients in combination rehabili tation group were further treated with AlterG training.All patients were treated five times a week,20 minutes at a time for consecutive 4 weeks.The serum levels of N-terminal osteocalcin(0C),N-terminal propeptide of type I procollagen(PINP)and B-C-terminal telopeptide of type I collagen(B-CTX),and Hospital for Special Sugery(HSS)knee score and bony callus growth score were recorded and compared between the 2 groups before the treatment and after the end of the treatment respectively.Results:①The serum level of N-terminal 0C increased in the 2 groups after the end of the treatment compared to pre-treatment(10.07+2.12 vs 13.10+1.23 ng/mL,t=-6.660,P=0.000;9.69+2.11 vs 11.93+1.89 ng/mL,t=-4.267,P=0.000),and it was higher in combination rehabilitation group compared to conventional rehabilitation group(l=-2.798,P=0.007).②The serum level of PINP increased in the 2 groups afler the end of the treat ment compared to pre-treatment(43.79+7.79 vs 72.52+5.03 ng/mL,t=-16.673,P=0.000;46.3+10.76 vs 65.76+9.37 ng/mL,t=-7.339,P=0.000),and it was higher in combination rehabiltation group compared to conventional rehabiliation group(I=-3.421,P=0.001).③The serum level ofβ-CTX decreased in the 2 groups after the end of the treatment compared to pre-treatment(772.93±18.29 vs 727.76±16.19 pg/mL,l=9.930,P=0.000;765.38±25.76 vs 744.07±25.29 pg/mL,1=3.179,P=0.002),

关 键 词：股骨骨折 骨折固定术 内 康复 反重力跑台 临床试验 

分 类 号：R687.3[医药卫生—骨科学]