踝关节不稳患者踝关节等速肌力和动态平衡能力的临床研究

Clinical study on ankle isokinetic muscle strength and dynamic balance ability of patients with ankle joint instability

目的：探讨踝关节不稳患者不同角速度下踝关节背伸、跖屈等速肌力以及动态平衡能力。方法：随机抽取30岁以下单侧踝关节不稳患者33例,男16例,女17例;左踝13例,右踝20例;年龄15~30岁,中位数22岁;病程1个月至10年,中位数12个月。同时随机抽取30岁以下踝关节正常的健康志愿者33例,男16例,女17例;年龄19~29岁,中位数22岁。采用等速肌力测定仪对踝关节不稳患者踝关节背伸、跖屈肌群进行测试,并比较角速度为60（°）·s-1和120（°）·s-1时健、患侧踝关节跖屈、背伸的峰值力矩、单位体质量峰值力矩、总做功值。采用平衡测定仪对踝关节不稳患者和健康志愿者进行平衡功能测试,并对2组受试者的总体稳定指数、前后向稳定指数及左右向稳定指数进行组间比较。结果：1踝关节峰值力矩。在60（°）·s-1和120（°）·s-1等速肌力测试时,患侧踝关节跖屈峰值力矩与健侧比较,差异均无统计学意义[（70.85±30.29）Nm,（75.15±33.76）Nm,t=1.482,P=0.148;（57.02±27.14）Nm,（60.81±30.06）Nm,t=1.716,P=0.096];患侧踝关节背伸峰值力矩与健侧比较,差异均无统计学意义[（23.65±10.50）Nm,（22.98±9.43）Nm,t=-1.026,P=0.313;（19.59±9.35）Nm,（19.16±9.27）Nm,t=-0.471,P=0.641]。2踝关节单位体质量峰值力矩。在60（°）·s-1和120（°）·s-1等速肌力测试时,患侧踝关节跖屈单位体质量峰值力矩与健侧比较,差异均无统计学意义[（113.45±36.20）Nm·kg-1,（119.68±41.21）Nm·kg-1,t=1.528,P=0.136;（90.88±32.49）Nm·kg-1,（96.54±35.70）Nm·kg-1,t=1.839,P=0.075];患侧踝关节背伸单位体质量峰值力矩与健侧比较,差异均无统计学意义[（37.08±10.00）Nm·kg-1,（36.16±9.85）Nm·kg-1,t=-0.909,P=0.370;（30.80±10.43）Nm·kg-1,（30.49±11.82）Nm·kg-1,t=-0.207,P=0.838]。3踝关节总做功值。在60（°）·s-1和120（°）·s-1等速肌力测试时,患侧踝关节跖屈总做功值小于健侧[（160.84±66.31）J,（189.01±78.65）J,t=2.609,P=0.014;（286.22±156.55）J,（318.56±182.50）J,t=2.056,P=0.048];患侧踝关节背伸总做功值与健侧比较,差异均无统计学意义[（59.80±22.17）J,（62.05±24.34）J,t=0.807,P=0.426;（80.18±38.06）J,（80.15±37.52）J,t=-0.009,P=0.993]。4踝关节稳定指数。踝关节不稳组总体稳定指数、前后向稳定指数、左右向稳定指数与踝关节正常组比较,差异均无统计学意义[0.93±0.51,0.86±0.34,t=0.593,P=0.555;0.63±0.39,0.56±0.26,t=0.895,P=0.374;0.54±0.28,0.53±0.21,t=0.169,P=0.845]。结论：踝关节不稳患者患侧踝关节的背伸肌力与健侧无明显差异,但其跖屈总做功值小于健侧,在踝关节康复治疗中应加强踝关节跖屈肌群的训练;踝关节不稳患者双脚站立时动态平衡能力与正常人无明显差异。

Objective： To investigate the ankle isokinetic muscle strength of dorsal extension and plantar flexion at different angular velocity and dynamic balance ability of patients with ankle joint instability. Methods： Thirty-three patients（ 30 yrs） with unilateral ankle instability were randomly selected. The patients consisted of 16 males and 17 females,and ranged in age from 15 to 30 years（ Median = 22yrs）. The course of disease ranged from 1 month to 10 years（ Median = 12 months）. The joint instability located in left side for 13 patients and right for 20 patients. Meanwhile,33 healthy volunteers with normal ankles were randomly selected. The volunteers consisted of 16 males and 17 females,and ranged in age from 19 to 29 years（ Median = 22 yrs）. The ankle dorsal extension and plantar flexion muscle groups were tested by using isokinetic dynamometer in patients with ankle joint instability; and the peak torque（ Pk T）,peak torque per unit body mass（ Pk T/BM） and total work（ TW） of ankle extensors and flexors were compared between affected side and uninjured side at 60° /sec and120° / sec. The balance function were evaluated by using balance determinator and compared between patients with ankle joint instability and healthy volunteers; and the total stability index（ TSI）,forward-backward stability index（ FBSI） and left-right stability index（ LRSI） were compared between the 2 groups. Results： There was no statistical difference in plantar flexion Pk T of ankle joint at 60° / sec and 120° / sec between affected side and uninjured side（ 70. 85 ＋ /- 30. 29 vs 75. 15 ＋ /- 33. 76 Nm,t = 1. 482,P = 0. 148; 57. 02 ＋ /- 27. 14 vs 60. 81 ＋ /-30. 06 Nm,t = 1. 716,P = 0. 096）. There was no statistical difference in dorsal extension Pk T of ankle joint between affected side and uninjured side（ 23. 65 ＋ /- 10. 50 vs 22. 98 ＋ /- 9. 43 Nm,t =- 1. 026,P = 0. 313; 19. 59 ＋ /- 9. 35 vs 19. 16 ＋ /- 9. 27 Nm,t =- 0. 471,P =0. 641）. There was no statistical difference in plantar flexion Pk T / BM of ankle joint at 60° / sec and 120° / sec between affected side and uninjured side（ 113. 45 ＋ /- 36. 20 vs 119. 68 ＋ /- 41. 21 Nm / kg,t = 1. 528,P = 0. 136; 90. 88 ＋ /- 32. 49 vs 96. 54 ＋ /- 35. 70 Nm / kg,t =1. 839,P = 0. 075）. There was no statistical difference in dorsal extension Pk T / BM of ankle joint between affected side and uninjured side（ 37. 08 ＋/- 10. 00 vs 36. 16 ＋/- 9. 85 Nm/kg,t =- 0. 909,P = 0. 370; 30. 80 ＋/- 10. 43 vs 30. 49 ＋/- 11. 82 Nm/kg,t =- 0. 207,P =0. 838）. The plantar flexion TW of affected side at 60° / sec and 120° / sec were less compared with that of uninjured side（ 160. 84 ＋ /-66. 31 vs 189. 01 ＋ /- 78. 65 joules（ J）,t = 2. 609,P = 0. 014; 286. 22 ＋ /- 156. 55 vs 318. 56 ＋ /- 182. 50 J,t = 2. 056,P = 0. 048）. There was no statistical difference in dorsal extension TW of ankle joint between affected side and uninjured side（ 59. 80 ＋ /- 22. 17 vs 62. 05 ＋ /-24. 34 J,t = 0. 807,P = 0. 426; 80. 18 ＋ /- 38. 06 vs 80. 15 ＋ /- 37. 52 J,t =- 0. 009,P = 0. 993）. There was no statistical difference in TSI,FBSI and LRSI between ankle instability group and normal ankle group（ 0. 93 ＋ /- 0. 51 vs 0. 86 ＋ /- 0. 34,t = 0. 593,P = 0. 555;0. 63 ＋ /- 0. 39 vs 0. 56 ＋ /- 0. 26,t = 0. 895,P = 0. 374; 0. 54 ＋ /- 0. 28 vs 0. 53 ＋ /- 0. 21,t = 0. 169,P = 0. 845）. Conclusion： There is no significant difference in dorsal extension strength between affected ankle and uninjured ankle in patients with ankle joint instability,while the plantar flexion TW of affected ankle is less than that of uninjured ankle,suggesting that strengthened ankle plantar flexion muscle exercises should be applied to ankle rehabilitation. There is no obvious difference in dynamic balance ability between patients with ankle joint instability and heath person when standing on both foot.