PNF技术在全膝关节置换术后患者功能恢复中的应用

Application of proprioceptive neuromuscular facilitation on postoperative function recovery in patients after total knee arthroplasty

目的观察神经肌肉本体感觉促进技术(PNF)对全膝关节置换术(TKA)后患者膝关节功能恢复及步行能力的影响。方法纳入江苏省苏北人民医院择期TKA术后患者50例,随机分为治疗组和对照组,各25例,两组均进行4 w康复训练,主要内容包括康复教育、肌力、关节活动度、站立平衡训练、物理因子治疗,治疗组在此基础上应用PNF技术。于治疗前、治疗4 w后采用美国特种外科医院(HSS)膝功能评分量表、Berg平衡量表评分(BBS)和6 min步行试验(6 MWT)评定患者膝关节功能和步行能力。结果治疗4 w后,治疗组和对照组患者HSS评分分别为(91.6±5.3)分和(86.8±4.4)分,高于治疗前的(52.7±4.8)分和(53.1±4.9)分,差异有统计学意义(t=4.126,t=2.722,P<0.01);其中治疗组治疗后膝关节功能和稳定性评分为(19.4±1.3)分和(9.1±0.8)分,优于对照组的(16.2±1.4)分和(8.4±1.4)分,差异均有统计学意义(t=2.049,t=2.029,P<0.05)。治疗组与对照组患者治疗后BBS评分分别为(54.4±1.9)分和(50.5±2.1)分,均显著高于治疗前的(46.7±3.1)分和(46.5±2.2)分,差异有统计学意义(t=2.523,t=2.169,P<0.05);且与对照组比较,治疗组治疗后BBS评分更高(t=2.498,P<0.05)。治疗组与对照组患者6MWT评分分别为(655±51)分和(580±56)分,均显著高于治疗前的(397±35)分和(402±42)分,差异有统计学意义(t=8.256,t=7.649,P<0.01);与对照组比较,治疗组治疗后6MWT评分更高(t=2.579,P<0.05)。结论TKA术后患者在康复训练中采用PNF技术可以促进膝关节的关节功能恢复,提高患者平衡功能和步行能力。

Objective To observe the effect of proprioceptive neuromuscular facilitation（PNF） on functional recovery and walking ability of patients with knee joint after total knee arthroplasty（TKA）. Methods Fifty patients undergoing elective TKA were randomly divided into two groups（n=25 each）, treatment group and control group. Both groups received conventional rehabilitation mainly including rehabilitation education training, muscle strength, range of motion, standing balance training, physical therapy after TKA. The treatment group also applied PNF techniques. Knee function and walking ability of the patients were assessed by the American College of Surgeons Hospital（HSS）, the Berg Balance Scale（BBS） and the 6-minute walking test（6 MWT） before treatment and after 4 weeks of treatment. Results After 4 weeks of treatment, the HSS scores of the treatment group and the control group were（91.6±5.3） and（86.8±4.4） respectively, which were significantly higher than those before treatment（52.7 ± 4.8 and 53.1 ± 4.9）, with statistically significance（t=4.126, t=2.722, P〈0. 01）. The scores of functional and stability of the knee after treatment in the treatment group were（19.4 ± 1.3） and（9.1 ± 0.8） points respectively, which were better than those in the control group[（16.2±1.4） and（8.4±1.4）], the differences were statistically significant（t=2.049, t=2.029, P〈0. 05）. The BBS scores of the two groups were（54.4 ± 1.9） and（50.5 ± 2.1）respectively, which were significantly higher than those before treatment [（46.7 ± 3.1） and（46.5 ± 2.2）],with statistically significance（t=2.523, t=2.169, P〈0. 05）.Compared with the control group, the improvement of BBS score in the treatment group was significant（t=2.498, P〈0. 05）. The 6 MWT scores of the two groups were（655±51） and（580±56） respectively, which were significantly higher than those before treatment [（397±35） and（402±42）], with statistically significance（t=8.256, t=7.649, P〈0. 01）. Compared with the control group, the 6 MWT score of the treatment group improved significantly（t=2.579, P〈0. 05）. Conclusion Postoperative patients with TKA in rehabilitation training by using PNF technology can promote knee joint function recovery, improve patient balance function and walking ability.