水中步行训练对胫骨平台骨折术后患者关节功能和肌力恢复的影响

Effect of water walking training on function of joint and muscle strength recovery in patients with fracture of tibial plateau

目的探讨水中步行训练对胫骨平台骨折患者手术治疗后关节功能和肌力恢复的影响。方法选取2017年1月至2018年2月收治的胫骨平台骨折患者70例为研究对象,采用随机数字表法将其分为对照组和观察组,各35例。两组均行切开复位内固定术治疗,术后对照组给予综合康复治疗,观察组在综合康复治疗的基础上给予水中步行训练。比较两组患者的膝关节功能、肌力、膝关节活动度和康复效果。结果康复治疗前两组美国特种外科医院(HSS)膝关节功能评分、徒手肌力(MMT)评分、屈曲角度、伸直角度、活动范围,及康复治疗后两组伸直角度间的差异均无统计学意义(P>0. 05);康复治疗后,观察组的HSS评分和MMT评分均高于对照组[67. 30±13. 01 vs 58. 16±12. 37,t=3. 012,P=0. 004; 60. 03±6. 65 vs 56. 21±6. 71,t=2. 392,P=0. 019],屈曲角度和活动范围明显优于对照组[(114. 54±11. 60)°vs (101. 58±12. 01)°,t=4. 592,P=0. 000;(111. 53±12. 30)°vs (98. 57±21. 27)°,t=3. 121,P=0. 003]。观察组的康复优良率为94. 29%,明显高于对照组的65. 71%(χ^2=8. 929,P=0. 003)。结论水中步行训练应用于胫骨平台骨折术后患者的康复中,能够促进膝关节功能、肌力的恢复,改善膝关节活动度,应用效果优于单纯的综合康复治疗。

Objective To explore the effect of water walking training on function of joint and muscle strength recovery in patients with fracture of tibial plateau. Methods Seventy patients with fracture of tibial plateau treated between January2017 and February 2018 were selected as research objects and were divided into control group and observation group according to the random number table method( n = 35,each). After open reduction and internal fixation surgery,the comprehensive rehabilitation therapy was given in control group,and the water walking training on basis of the comprehensive rehabilitation therapy was performed in observation group. The function,muscle strength,range of motion( ROM) of knee joint and rehabilitation efficacy were compared between two groups. Results There were no significant differences in scores of Hospital for Special Surgery( HSS) for knee function,manual muscle testing( MMT),flexion angle,straightening angle and ROM before rehabilitation treatment and in straightening angle after rehabilitation treatment between two groups( all P>0. 05). After rehabilitation,the scores of HSS( 67. 30 ±13. 01 vs 58. 16 ±12. 37,t = 3. 012,P =0. 004) and MMT( 60. 03±6. 65 vs 56. 21±6. 71,t = 2. 392,P = 0. 019) in observation group were significantly higher than those in control group; the flexion angle [( 114. 54 ± 11. 60) ° vs( 101. 58 ± 12. 01) °,t = 4. 592,P = 0. 000] and ROM[( 111. 53±12. 30) °vs( 98. 57±21. 27) °,t=3. 121,P=0. 003]of knee joint in observation group were significantly better than those in control group; the excellent and good rate of rehabilitation in observation group was significantly higher than that in control group( 94. 29% vs 65. 71%,χ~2= 8. 929,P = 0. 003). Conclusion Water walking training in rehabilitation of patients with tibial plateau fracture after operation can promote the recovery of knee joint function and muscle strength,and improve the range of motion of knee joint. The effect of rehabilitation combined with water walking training is superior to that of simple comprehensive rehabilitation therapy.