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强化髋周肌力训练对踝关节骨折患者平衡及步态功能的影响_王明宇.pdf
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强化 髋周肌力 训练 踝关节 骨折 患者 平衡 步态 功能 影响 王明宇
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Circulation StrokeJ.JAyub Med Coll Abbottabad,2021,33(2):274-278.(收稿日期:2023-01-13;修回日期:2023-02-10)(本文编辑:彭 羽)强强化化髋髋周周肌肌力力训训练练对对踝踝关关节节骨骨折折患患者者平平衡衡及及步步态态功功能能的的影影响响王明宇1,2,翟宏伟1,2,刘 娜1,孟 晴2,毕迎立2,陈 伟1,2(1.徐州市中心医院康复科,徐州医科大学徐州临床学院,江苏 徐州 221009 2.徐州医科大学附属徐州康复医院康复科,江苏 徐州 221010)摘要 目的 探讨髋周肌力训练对踝关节骨折患者平衡及步态功能的影响。方法 纳入 2021 年 3 月至 2022 年 3 月踝关节骨折患者 48 例。采用随机数字表法分为观察组和对照组各 24 例。对照组患者接受常规踝关节骨折康复治疗,包括恢复关节活动度、踝关节肌力训练、平衡和步态训练及物理因子治疗;观察组加用等速髋周肌力训练,共治疗 6 周。结果 干预后两组患者髋关节外展和伸展等速相对峰力矩、Tinetti 评分、平衡仪指标、步态指标(患侧髋关节活动度、患侧步长、步态周期、步速)均较干预前改善(P0.05),且观察组(除步态周期)明显优于对照组(P0.05),观察组步态周期干预前后差值即进步效果优于对照组(P0.05)。结论 强化髋周肌力训练可进一步改善踝关节骨折患者平衡及步态功能。关键词 踝关节骨折;髋周肌群;平衡;步态中图分类号 R493 文献标志码 A 文章编号 1672-6170(2023)03-0087-05The effects of intensive hip muscle strength training on balance and gait function in patientswith ankle fracture WANG Ming鄄yu1,2,ZHAI Hong鄄wei1,2,LIU Na1,MENG Qing2,BI Ying鄄li2,CHENWei1,2(1.Rehabilitation Department,Xuzhou Central Hospital,Xuzhou Clinical College,Xuzhou MedicalUniversity,Xuzhou 221009,China;2.Rehabilitation Department,The Affiliated Xuzhou RehabilitationHospital,Xuzhou Medical University,Xuzhou 221010,China)Corresponding author CHEN WeiAbstract Objective To investigate the effect of intensive hip muscle strength training on balance and gait function inpatients with ankle fracture.Methods Forty-eight patients with ankle fracture from March 2021 to March 2022 were randomly dividedinto an observation group and a control group,24 in each group.The control group received routine rehabilitation treatment for anklefracture,including recovery of joint range of motion,ankle muscle strength training,balance and gait training and physical factortreatment.Isokinetic hip muscle strength training was further added to the observation group.The treatment time was 6 weeks.Results After treatment,the relative peak moment of isokinetic hip abduction and extension,Tinetti score,balance instrument index and gaitindex(range of motion of the affected hip,length of the affected side,gait cycle and gait speed)of the two groups were improved whencompared to those before treatment(P0.05),and the observation group(except for the gait cycle)was better than the control group(P0.05).The difference of gait cycle before and after intervention,that is,the process effect,in the observation group was betterthan that in the control group(P0.05),见表 1。本研究患者均知情同意。已取得徐州市康复医院伦理委员会科研项目伦理审查。表 1 两组患者基线资料比较组别男n(%)女n(%)年龄(岁)身高(cm)病程(月)骨折类型n(%)单踝双踝三踝观察组16(66.7)8(33.3)42.649.25167.506.533.160.4616(66.7)6(25)2(8.3)对照组14(58.3)10(41.8)43.549.37168.257.413.090.4217(70.8)5(20.8)2(8.5)统计量2=0.590t=-3.462t=-0.304t=0.5872=-0.224P0.5510.7340.7640.5600.941基金项目徐州市科技项目(编号:KC21228)通讯作者陈 伟1.2 治疗 两组患者均给予踝关节骨折术后常规康复治疗,观察组在此基础上另增加强化髋周肌群力量训练内容。常规康复治疗方式包括药物治疗(改善循环、促进骨折愈合等)和常规综合康复治疗。康复治疗师对患者进行一对一为期 6 周的康复训练,治疗强度与患者基础情况相适应。1.2.1 常规综合康复治疗3.4 恢复关节活动度:主动运动:由患者主动进行各运动轴方向运动,遵守循序渐进的原则,运动幅度逐渐增大。在治疗师指导下以不产生疼痛为原则进行,每日至少 20min。关节松动技术:治疗师一手固定关节近端,另一手握住关节远端,在轻度牵引下,完成前后、内外及旋转松动,使骨端能在关节囊和韧带等软组织的弹性范围内发生移动。用于缓解疼痛和僵硬,并增加关节活动度,根据患者情况逐渐增加手法等级(14 级

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