前交叉韧带重建后本体感觉训练:提高关节稳定性及运动平衡能力  

Proprioceptive training after anterior cruciate ligament reconstruction:improving joint stability and motor balance ability

作　　者：叶云天 陈继鑫 刘爱峰[1,2] Ye Yuntian;Chen Jixin;Liu Aifeng(Department of Orthopedics,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300381,China;National Clinical Research Center for Traditional Chinese Medicine and Acupuncture,Tianjin 300381,China)

机构地区：[1]天津中医药大学第一附属医院骨伤科,天津市300381 [2]国家中医针灸临床医学研究中心,天津市300381

出　　处：《中国组织工程研究》2024年第27期4421-4428,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(81873316),项目负责人:刘爱峰;中华中医药学会骨病防治交叉研究项目(2023-GBJC-04),项目负责人:刘爱峰;天津市卫健委津门医学英才项目(TJSJMYXYC-D2-028),项目负责人:刘爱峰。

摘　　要：背景:前交叉韧带断裂是严重影响生活及运动表现的损伤之一,作为稳定结构,前交叉韧带对维持运动表现有着无法替代的作用。鉴于其严重的损伤表现,目前临床治疗行前交叉韧带重建手术。由于前交叉韧带损伤会引起机械感受器损失,进而引起本体感觉降低,为患者运动表现恢复带来极大困扰。目的:总结本体感觉训练对前交叉韧带重建术后临床效果的影响,探讨其背后机制,以期为临床防治提供更多参考。方法:计算机检索PubMed、中国知网、万方数据、维普数据库2013年1月至2023年3月收录的与前交叉韧带重建后本体感觉训练提高关节稳定性及运动平衡能力相关的应用文献,按纳入、排除标准筛选后最终纳入108篇文献进行综述。结果与结论:①本体感觉训练可有效改善前交叉韧带重建术后患者位置觉、运动觉等本体感觉功能,提高了关节稳定性、姿势控制及运动能力;②本体感觉训练通过刺激膝关节周围本体感受器、激活脊髓反射刺激、大脑运动控制强化和认知处理,提升三方面机制,改善本体感觉功能;③本体感觉训练可能通过激活生长相关蛋白43活性、Piezo2机械传导器和NT-3/TrkC信号通路等潜在机制,改善本体感觉功能;④前期以水疗法为主,中后期优先考虑神经肌肉训练、单独力量训练及视觉反馈训练;⑤尚未细分重建移植物、性别,以及缺少以联合多种感觉刺激为思路的设备或本体感觉训练方法。BACKGROUND:Anterior cruciate ligament rupture is one of the injuries that seriously affect life and sports performance,and the anterior cruciate ligament as a stabilizing structure is irreplaceable in maintaining sports performance.In view of its severe injury manifestations,the current treatment for anterior cruciate ligament rupture is a surgery for anterior cruciate ligament reconstruction.Since an anterior cruciate ligament injury can cause loss of mechanoreceptors,which in turn causes a reduction in proprioception,it is a great problem for patients to recover their motor performance.OBJECTIVE:To summarize the effects of proprioceptive training on clinical outcomes after anterior cruciate ligament reconstruction and to explore the underlying mechanisms,thereby providing more references for clinical prevention and treatment.METHODS:A computerized search of PubMed,CNKI,WanFang Data,and VIP databases was conducted for literature(from January 2013 to March 2023)related to proprioceptive training after anterior cruciate ligament reconstruction that improves joint stability and motor balance ability.A total of 108 articles were finally included for review.RESULTS AND CONCLUSION:Proprioceptive training can effectively improve the proprioceptive functions of patients,such as positional sense and kinesthetic sense after anterior cruciate ligament reconstruction,and improve joint stability,postural control and motor ability.The proprioceptive training improves the proprioceptive function through three mechanisms:stimulation of periprosthetic receptors around the knee joint,activation of spinal reflex stimulation,reinforcement of motor control in the brain,and enhancement of cognitive processing.The proprioceptive training may improve proprioceptive functions by activating the potential mechanisms of growth associated protein-43 activity,Piezo2 mechanotransducer,and NT-3/TrkC signaling pathway.Hydrotherapy is the mainstay in the early stages,while neuromuscular training,individual strength training and visual feedback t

关 键 词：前交叉韧带 前交叉韧带重建 本体感觉 本体感觉训练 应用策略 综述 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R493