体外冲击波疗法联合下肢肌力...定性活动度及平衡功能的影响_张怡.pdf

6 夏晓英,李枢,孙诗博,等.卡格列净联合二甲双胍对初诊超重或肥胖 2 型糖尿病患者的疗效及体脂、代谢状态的影响J.中国医药指南,2020,18(24):35-37.7 赵帆,林昕,何訸,等.GLP-1 类似物治疗 2 型糖尿病的Meta 分析J.重庆医学,2019,48(18):3159-3166.8 Lingvay I,Catarig AM,Frias JP,et al.Efficacy and safety of once-weekly semaglutide versus daily canagliflozin as add-on to metformin in patients with type 2 diabetes(SUSTAIN 8):a double-blind,phase 3b,randomised controlled trial J.Lancet Diabetes Endocrinol,2019,7(11):834-844.9 Zinman B,Bhosekar V,Busch R,et al.Semaglutide once weekly as add-on to SGLT-2 inhibitor therapy in type 2 di-abetes(SUSTAIN 9):a randomised,placebo-controlled tri-al J.Lancet Diabetes Endocrinol,2019,7(5):356-367.10 Gerstein HC,Colhoun HM,Dagenais GR,et al.Dulaglutide and cardiovascular outcomes in type 2 diabetes(RE-WIND):a double-blind,randomised placebo-controlled trial J.Lancet,2019,394(10193):121-130.【文章编号】1006-6233(2023)04-0587-05体外冲击波疗法联合下肢肌力训练对关节镜下前交叉韧带重建术后患者关节稳定性活动度及平衡功能的影响张怡,谷媛媛,曲径直,赵焕(联勤保障部队 983 医院康复医学科,天津 300000)【摘要】目的:探讨体外冲击波疗法(extracorporeal shock wave therapy,ESWT)联合下肢肌力训练对关节镜下前交叉韧带重建术(Anterior Cruciate Ligament Reconstruction,ACLR)后患者关节稳定性、活动度(range of motion,ROM)及平衡功能的影响。方法:选取 2020 年 1 月至 2021 年 9 月期间联勤保障部队 983 医院收治的 92 例关节镜下 ACLR 术后患者为研究对象,随机分为观察组(n=46)与对照组(n=46),对照组予常规术后下肢肌力训练,观察组患者在上述基础上加用 ESWT,持续 5 周。比较两组患者干预前、干预后 10 周的患侧与健侧胫骨后向前移动距离的差值(以下简称“胫骨前移差”)、膝关节ROM、国际膝关节文献委员会(international knee documentation committee,IKDC)膝关节功能评分及 Berg平衡量表(Berg Balance Scale,BBS)。结果:组内比较,两组患者干预后的胫骨前移差低于干预前,膝关节 ROM、IKDC 及 BBS 评分高于干预前(P0.05)。组间比较,观察组患者干预后的胫骨前移差值低于同期对照组,膝关节 ROM、IKDC 及 BBS 评分及干预前后各指标的差值高于对照组(P0.05)。结论:ESWT 联合下肢肌力训练能显著改善关节镜下 ACLR 术后患者的膝关节稳定性、ROM 及平衡功能,值得临床推广应用。【关键词】体外冲击波疗法;关节镜下前交叉韧带重建术;膝关节稳定性;活动度【文献标识码】A 【doi】10.3969/j.issn.1006-6233.2023.04.012Effects of Extracorporeal Shock Wave Therapy Combined with Lower Limb Muscle Strength Training on Joint Stability Range of Motion and Balance Function in Patients after Arthroscopic Anterior Cruciate Ligament ReconstructionZHANG Yi,GU Yuanyuan,QU Jingzhi,et al(983 Hospital of Joint Support Forces,Tianjin 300000,China)【Abstract】Objective:To investigate the effect of extracorporeal shock wave therapy(ESWT)combined with lower limb muscle strength training on joint stability,range of motion(ROM)and balance function of pa-tients after arthroscopic anterior cruciate ligament reconstruction(ACLR).Methods:92 post-arthroscopic ACLR patients admitted to Hospital 983 of the Joint Security Force between January 2020 and September 2021 were selected for the study and randomly divided into the observation group(n=46)and the control group(n785 第 29 卷 第 4 期2023 年 4 月 河 北 医 学HEBEI MEDICINE Vol.29,No.4Apr.,2023 【基金项目】国家自然科学基金项目,(编号:81870713)=46),the control group was given conventional post-operative lower limb muscle strength training,and the patients in the observation group were given ESWT on top of the above for 5 weeks.The difference in the dis-tance of posterior anterior tibial movement between the affected side and the healthy side before and 10 weeks after the intervention(hereinafter referred to as tibial anterior displacement difference),the knee ROM,the knee function score of the international knee documentation committee(IKDC)and the Berg Balance Scale(BBS)were compared between the two groups.Results:In the intra-group comparison,patients in both groups had lower tibial anterior displacement difference after the intervention than before the intervention,and higher knee ROM,IKDC and BBS scores than before the intervention(P0.05).For comparison between groups,the difference in tibial anterior displacement of patients in the observation group after intervention was lower than that of the control group during the same period,and the difference in knee ROM,IKDC and BBS scores and each index before and after intervention was higher than that of the control group(P0.05),具有可比性。详见表 1。表 1 两组患者的一般资料比较n(%),?xs组别n男性年龄(岁)致伤原因运动 车祸 其他观察组4628(60.9)35.037.3325(54.3)15(32.6)6(13.0)对照组4629(63.0)33.806.8326(56.5)15(32.6)5(10.9)2/t0.0460.8330.111P0.8300.4070.946885 第 29 卷 第 4 期2023 年 4 月 河 北 医 学HEBEI MEDICINE Vol.29,No.4Apr.,2023 1.2 治疗方法:全部患者均由同一组医师完成关节镜下 ACLR 术,术后予常规下肢肌力训练,包括弹力带训练、ROM 训练、平衡训练、靠墙静蹲等,逐渐增加下肢的负重,每天训练 2 次,每次 2040min,持续 5 周。在此基础上,观察组患者联合应用 ESWT,具体方案为:取仰卧位,在膝关节股骨隧道和胫骨隧道的体表皮肤投影位置涂抹耦合剂,将 15mm EVO 蓝色治疗头(频率 7Hz、压力 2.0bar)对上述两个部位进行冲击治疗,分别冲击 2000 次,每周 1 次,持续 5 周。1.3 观察指标:在干预前、干预后 10 周,采用 KT1000膝关节动度测量仪来评估膝关节的稳定性,具体操作是:取仰卧位,屈膝 30 度后固定大腿,测量并比较胫骨相比股骨后向前移动的距离,然后计算患侧与健侧胫骨后向前移动距离的差值(以下简称“胫骨前移差”),差值越大提示膝关节稳定性越差。采用量角器测量全部 92 例患者的 ROM。采用国际膝关节文献委员会(international knee documentation committee,IKDC)膝关节功能评估量表来评估全部患者的膝关节功能康复状况,该量表包括 18 个条目,总分 0100 分,IKDC 评分越高提示患者膝关节功能康复效果越好。采用Berg 平衡量表(Berg Balance Scale,BBS)来评估平衡功能,该量表包括 14 个条目,满分 56 分,评分越高提示患者的平衡能力越佳。1.4 统计学处理:采用 SPSS23.0 统计软件进行处理,计数资料(性别、致伤原因)以例数和百分比 n(%)表示,采用2检验比较观察组和对照组的水平。本研究全部计量资料(年龄、胫骨前移差、ROM、IKDC 及 BBS评分)均呈正态分布,以算术平均数标准差(?xs)表示,组内干预前后比较采用配对 t 检验,两组比较采用独立样本 t 检验。P0.05),具有可比性。组内比较,两组患者干预后的胫骨前移差低于干预前(P0.05)。组间比较,观察组患者干预后的胫骨前移差低于同期对照组,干预前后胫骨前移差的差值高于对照组(P0.05),具有可比性。组内比较,两组患者干预后的膝关节 ROM 高于干预前(P0.05)。组间比较,观察组患者干预后的膝关节