前交叉韧带重建患者神经肌肉功能对落地动作生物力学损伤风险的影响  

Influence of neuromuscular function on the risk of biomechanical injury in landing manoeuvres in patients undergoing anterior cruciate ligament reconstruction

作　　者：王霞[1] 薛博士 杨辰 周志鹏[1] 郑亮亮[1] Wang Xia;Xue Boshi;Yang Chen;Zhou Zhipeng;Zheng Liangliang(College of Sports and Health,Shandong Sport University,Jinan 250102,Shandong Province,China;College of Sports and Health,Nanjing Sport Institute,Nanjing 210114,Jiangsu Province,China)

机构地区：[1]山东体育学院运动与健康学院,山东省济南市250102 [2]南京体育学院运动健康科学学院,江苏省南京市210114

出　　处：《中国组织工程研究》2025年第26期5556-5562,共7页Chinese Journal of Tissue Engineering Research

基　　金：山东省高等学校青创人才引育计划项目(2019-183),项目参与人:周志鹏。

摘　　要：背景:前交叉韧带再损伤率居高不下,神经肌肉功能与生物力学危险因素之间的关系尚不明确可能是再损伤预防及康复训练效果不佳的原因之一。目的:评估前交叉韧带重建后患者单腿跳跃落地时的膝关节生物力学和神经肌肉功能特征,进一步探究前交叉韧带重建患者肌力、本体感觉和动态姿势控制能力对落地动作中前交叉韧带损伤风险指标的影响。方法:招募前交叉韧带重建后患者和健康对照组各26名,均为男性,年龄18-35周岁,随机进行本体感觉测试、Y平衡测试和等速肌力测试,同时通过红外动作捕捉系统和测力台采集受试者在单腿跳跃落地中的膝关节运动学及动力学数据。结果与结论:①与健康对照组相比,前交叉韧带重建术后患者表现出较高的膝外翻角(P=0.021),较低的腘绳肌肌力(P<0.001)、股四头肌肌力(P<0.001)和Y平衡前向距离(P<0.001),较差的膝关节屈曲运动觉(P<0.001)和伸展运动觉(P=0.001);②膝伸展力矩的预测变量是股四头肌肌力和屈曲运动觉(R^(2)=0.298,P=0.007);膝内外翻角的预测变量是腘绳肌肌力(R^(2)=0.117,P=0.048);膝内外旋角的预测变量是腘绳肌与股四头肌峰值力矩比值(R^(2)=0.134,P=0.037);③结果表明,前交叉韧带重建术后患者仍存在膝关节额状面异常生物力学动作模式和神经肌肉功能缺陷,提高腘绳肌的肌肉力量、避免过大的股四头肌肌力及增强膝关节本体感觉有助于改善患者膝关节矢状面、额状面和水平面的生物力学模式及降低落地动作中前交叉韧带损伤风险。BACKGROUND:The re-injury rate of the anterior cruciate ligament continues to be high and the unclear relationship between neuromuscular function and biomechanical risk factors may be one of the reasons for poor injury prevention and rehabilitation.OBJECTIVE:To evaluate the biomechanics and neuromuscular function characteristics of the knee joint during landing movements after anterior cruciate ligament reconstruction,and to further explore the effects of muscle strength,proprioception,and dynamic postural control on the risk indicators of anterior cruciate ligament injury during landing maneuver.METHODS:Twenty-six male anterior cruciate ligament reconstruction patients and 26 healthy control males at the age of 18-35 years were recruited and randomized to undergo joint kinesthesia test,Y-balance test,and isometric muscle strength tests.Kinematic and kinetic data of the knee joints during single-legged jump landing tasks were collected using an infrared motion capture system and force plates.RESULTS AND CONCLUSION:(1)Compared with the healthy control group,patients after anterior cruciate ligament reconstruction demonstrated higher knee valgus angle(P=0.021),lower hamstring muscle strength(P<0.001),lower quadriceps muscle strength(P<0.001)and Y-balance anterior reach distance(P<0.001),and worse knee flexion kinesthesia(P<0.001)and extension kinesthesia(P=0.001).(2)The predictor variables of knee extension moment were quadriceps strength and knee flexion kinesthesia(R^(2)=0.298,P=0.007).The predictor variable of knee varus and valgus angle was hamstring strength(R^(2)=0.117,P=0.048).The predictor variable of knee internal and external rotation angle was the hamstring-to-quadriceps peak torque ratio(R^(2)=0.134,P=0.037).(3)The results showed that after anterior cruciate ligament reconstruction,patients still had abnormal biomechanical action patterns and neuromuscular function defects in the frontal plane of the knee joint,and elevating the muscle strength of the hamstrings,avoiding excessive quadriceps muscle stren

关 键 词：前交叉韧带重建 神经肌肉功能 肌肉力量 本体感觉 动态姿势控制能力 再损伤风险 工程化组织构建 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] G804[文化科学—运动人体科学]