本体感觉训练对单侧全膝关节置换术后站立姿势稳定性和步态功能的影响  

Effect of proprioceptive training on the postural stability of standing and gait function in post-operative unilateral total knee arthroplasty

作　　者：王雨生 李晓 展嘉文[2] 董继革[1] WANG Yu-sheng;LI Xiao;ZHAN Jia-wen;DONG Ji-ge(Department of Rehabilitation,Wangjing Hospital,Chinese Academy of Traditional Chinese Medicine,Beijing,100102,China)

机构地区：[1]中国中医科学院望京医院康复师治疗部,北京100102 [2]中国中医科学院望京医院运动医学三科,北京100102 [3]中国人民解放军总医院第四医学中心康复医学科,北京100048

出　　处：《中国骨与关节杂志》2024年第4期245-252,共8页Chinese Journal of Bone and Joint

基　　金：中国中医科学院科技创新工程(CI2021A02017)。

摘　　要：目的探讨本体感觉训练对单侧全膝关节置换术(total knee arthroplasty,TKA)患者站立姿势稳定性和步态功能的影响。方法于2022年9月至2023年5月在中国中医科学院望京医院关节科选取43例单侧重度膝骨关节炎行TKA患者,并将其随机分为观察组(n=20)和对照组(n=23)。两组患者均接受为期6周的康复训练,其中对照组执行常规的康复训练方案,观察组在此基础上执行系统的本体感觉训练方案。应用DC-G-150-F2足底压力测试与三维步态分析系统分别于训练前和训练后6周对两组患者睁眼和闭眼站立状态的姿势稳定性与10 m直线行走过程的步态功能进行测评。结果治疗前,两组患者在睁眼和闭眼站立状态的患侧足底压力百分比、重心移动轨迹的长度(Length)、包络面积(Area)、侧向偏移(Sway-ML)及纵向偏移距离(Sway-AP)等指标比较差异无统计学意义(P>0.05),且步行过程中的摆动时间变异性(swing time variability,STV)、步态不对称指数(gait asymmetry index,GAI)、步长、步幅、步频、步速及患侧支撑相和摆动比较差异无统计学意义(P>0.05)。经治疗后6周,观察组睁眼站立状态的患侧足底压力百分比、重心移动轨迹的Length、Area、Sway-ML及Sway-AP均较治疗前显著改善,差异有统计学意义(P<0.05);对照组的患侧足底压力百分比和Sway-AP较治疗前显著改善,差异有统计学意义(P<0.05)。观察组重心移动轨迹的Length、Area及Sway-ML均显著优于对照组,差异有统计学意义(P<0.05)。观察组闭眼站立状态的患侧足底压力百分比、重心移动轨迹的Length、Area、Sway-ML及Sway-AP均较治疗前显著改善,差异有统计学意义(P<0.05);对照组的患侧足底压力百分比及Sway-AP较治疗前显著改善,差异有统计学意义(P<0.05)。观察组重心移动轨迹的Length、Area、Sway-ML及Sway-AP均显著优于对照组,差异有统计学意义(P<0.05)。观察组步行过程中的STV、GAI、患侧支撑Objective To investigate the effect of proprioceptive training on standing postural stability and gait function in unilateral total knee arthroplasty(TKA)patients.Methods From September 2022 to May 2023,43 patients with unilateral severe knee osteoarthritis undergoing TKA were selected at the Arthritis Department of Wangjing Hospital and randomly divided into the observation group(n=20)and control group(n=23).Patients in both groups participated in rehabilitation training for 6 weeks.The control group implemented the usual rehabilitation programme,while the observation group implemented a systematic proprioceptive training programme on the former basis.The DC-G-150-F2 plantar pressure test and 3D gait analysis system were used to assess the standing postural stability and gait function of the two groups before and 6 weeks later.Results There was no significant difference in the percentage of plantar pressure of the affected side,length,area,Sway-ML and Sway-AP in standing position with eyes open and closed(P>0.05)before treatment between the two groups.There was no significant difference in STV,GAI,affected side support phase and swing phase,stride length,stride width,stride frequency and stride speed during the walking process(P>0.05).After 6 weeks of treatment,the percentage of plantar pressure on the affected side,length,area,Sway-ML and sway-AP when standing with eyes open were significantly better in the observation group than the data before treatment,with statistically significant differences(P<0.05);The control group improved significantly in the percentage of plantar pressure of the affected side and Sway-AP compared to those before treatment,with statistically significant difference(P<0.05).Length,area and Sway-ML were all significantly better in the observation group than in the control group,with statistically significant differences(P<0.05).The observation group improved significantly in the percentage of plantar pressure of the affected side,length,area,Sway-ML and Sway-AP during standing with eyes

关 键 词：关节成形术 置换 膝 本体感觉 姿势平衡 步态 

分 类 号：R687.4[医药卫生—骨科学]