文章摘要
刘文辉,董婕,王宏庆,董昕,孙凤龙.术前阻力训练对内侧开放式楔形截骨术患者膝关节功能、步态及生活质量的影响[J].中国康复,2023,38(10):606-609
术前阻力训练对内侧开放式楔形截骨术患者膝关节功能、步态及生活质量的影响
Effects of preoperative resistance training on knee function, gait and quality of life in patients with medial open wedge osteotomy
  
DOI:
中文关键词: 胫骨高位截骨术  阻力训练  膝关节  步态  生活质量
英文关键词: high tibial osteotomy  resistance training  knee  gait  quality of life
基金项目:首都医科大学附属北京康复医院康复临床研究培育专项青年项目(2021-057)
作者单位
刘文辉 首都医科大学附属北京康复医院骨科二康复中心北京 100144 
董婕 首都医科大学附属北京康复医院骨科二康复中心北京 100144 
王宏庆 首都医科大学附属北京康复医院骨科二康复中心北京 100144 
董昕 首都医科大学附属北京康复医院骨科二康复中心北京 100144 
孙凤龙 首都医科大学附属北京康复医院骨科二康复中心北京 100144 
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中文摘要:
  目的:观察术前阻力训练对内侧开放式楔形截骨术后患者膝关节功能、步态及生活质量的影响。方法:选取拟接受内侧开放式楔形截骨术的患者58例,随机分为康复宣教组30例和阻力训练组28例。康复宣教组在术前接受康复宣教,阻力训练组进行为期4周的术前抗阻训练。于训练前、术前训练后及手术后6个月采用美国特种外科医院膝关节功能评分(HHS)评估患者膝关节功能,使用世界卫生组织生存质量评定量表(QOL-BRER)评定患者生活质量,佩戴便携式步态评估仪评估患者在平地上完成20m步行时步长、步速、步频,使用手持式测力计测量患者股四头肌、腘绳肌肌力。结果:训练前2组HSS评分、QOL-BRER评分、步长、步速、步频比较差异无统计学意义。阻力训练组:术前训练后HSS评分、QOL-BRER评分、步速、步频较训练前增加(P<0.05),步长与训练前比较无统计学意义;术后6个月HSS评分、QOL-BRER评分、步长、步速、步频较术前训练后增加(P<0.05)。康复宣教组:HSS评分、QOL-BRER评分、步长、步速、步频较宣教前无统计学差异。术后6个月HSS评分、QOL-BRER评分、步长、步速、步频较术前宣教后增加(P<0.05)。与康复宣教组比较,阻力训练组在术前训练后HSS评分、QOL-BRER评分、步长、步速、步频均增加(P<0.05);术后6个月HSS评分、QOL-BRER评分、步长、步速、步频均增加(P<0.05)。术前训练后股四头肌肌力较训练前增加(P<0.05),术后6个月股四头肌肌力较术前训练后降低(P<0.05)。术前训练后腘绳肌肌力较训练前增加(P<0.05),术后6个月腘绳肌较术前训练后无统计学意义。结论:术前阻力训练对内侧开放式楔形截骨术患者膝关节功能、步态、生活质量及肌肉力量方面均有明显改善作用。在术前进行强化股四头肌和腘绳肌的高强度等速相互向心收缩训练,其治疗效果具有一定持续作用。
英文摘要:
  Objective: To observe the effect of 4-week preoperative resistance training on knee function, gait and quality of life in patients after medial open wedge osteotomy. Methods: A total of 60 patients who were going to undergo medial open wedge osteotomy from June 2020 to May 2022 were selected. In the enrolled 58 patients, 30 cases served as the rehabilitation education group and 28 as resistance training group by the random number table method. The rehabilitation education group received rehabilitation education before surgery, and the resistance training group underwent 4 weeks of preoperative resistance training. The knee function of the American Hospital of Special Surgery (HHS) was used to assess the knee function of the patient before training. After the preoperative training and 6 months after surgery, the quality of life was assessed by the World Health Organization Quality of Life Rating Scale (QOL-BRER). The step length, pace of the patient and cadence were assessed when completing a 20-meter walk on flat ground by wearing a portable gait evaluator. A handheld ergometer was used to measure the strength of the patient’s quadriceps and hamstrings. Results: There were no significant significances in HSS score, QOL-BRER score, step length, stride speed and cadence frequency between two groups before training. In the resistance training group, HSS score, QOL-BRER score, stride speed and cadence increased after preoperative training as compared with those before training (P<0.05), but there was no significant difference in the stride length before and after training. HSS score, QOL-BRER score, step length, stride speed, and cadence increased significantly at 6th month after surgery (P<0.05) as compared with those after preoperative training. In the rehabilitation education group, HSS score, QOL-BRER score, step length, stride speed, and cadence showed no no significant difference from those before education (P>0.05). HSS score, QOL-BRER score, step length, stride speed, and cadence frequency increased at 6th month after surgery as compared with those after preoperative education (P<0.05). As compared with the rehabilitation education group, the HSS score, QOL-BRER score, step length, stride speed and cadence frequency in the resistance training group increased after preoperative training (P<0.05). HSS score, QOL-BRER score, step length, stride speed, and cadence frequency increased at 6th month after surgery (P<0.05). The strength of the quadriceps muscle after preoperative training increased as compared with that before training (P<0.05), and the strength of the quadriceps muscle decreased after 6 months after preoperative training (P<0.05). The strength of the hamstrings after preoperative training increased as compared with the preoperative training (P<0.05), and the hamstrings at 6 months after surgery showed no significant difference from those after preoperative training (P>0.05). Conclusion: Preoperative resistance training can significantly improve knee function, gait, quality of life and muscle strength in patients undergoing medial open wedge osteotomy. High-intensity isokinetic reciprocal contraction training to strengthen the quadriceps and hamstrings muscles is performed before surgery, and the therapeutic effect has a certain consistent effect.
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