振动刺激促进前交叉韧带重建后本体感觉恢复机制研究进展

Mechanism progress of vibration stimulation promoting proprioception recovery after anterior cruciate ligament reconstruction

前交叉韧带(ACL)损伤后通过手术重建和康复锻炼使患者尽快恢复到受伤前活动水平是治疗关键所在。本体感觉恢复在康复锻炼中扮演着重要角色,ACL中的本体感受可以感知膝关节运动感觉、静态关节位置变化等,机械感受器包括鲁菲尼末梢、环状小体、高尔基腱器官和游离神经末梢。本体感觉功能降低可导致ACL再次损伤、膝关节骨关节炎和对侧膝关节损伤。康复锻炼可促进患者早期完全被动伸膝、本体感觉恢复、肌肉力量加强等,进而恢复到受伤前的活动水平和膝关节功能。目前,振动刺激得到手术医生和康复医生的关注,但关于振动刺激对本体感觉恢复的机制说法众多,多数学者认为振动刺激可提高本体感觉敏锐度,诱导神经适应,增加肌肉力量,改善本体感觉。现就ACL损伤后本体感觉变化、影响及ACL重建后振动刺激促进其恢复的相关机制进行综述。

After anterior cruciate ligament(ACL)injury,surgical reconstruction and rehabilitation exercise are very important to make the patients recover to the pre-injury activity level.The recovery of proprioception plays an important role in rehabilitation exercise,the proprioceptor in ACL can sense the motion sensation of knee joint and the change of static joint position,and mechanoreceptors include Ruffini receptors,Pacinian corpuscles,Golgi tendon organs and free nerve endings.Decreased proprioception can lead to ACL secondary injury,knee osteoarthritis and contralateral knee injury.Rehabilitation exercise can promote early passive knee extension,proprioception recovery,muscle strength enhancement,and then recover to the level of activity and knee function before injury.At present,vibration stimulation is concerned by surgeons and rehabilitation doctors.At present,there are many theories about the mechanism of vibration stimulation on proprioception recovery,most scholars believe that vibration stimulation can improve proprioceptive sensitivity,induce neural adaptation,and increase muscle strength to improve proprioceptive.In addition,there is no unified standard for vibration frequency,amplitude and interval time after ACL reconstruction.This paper reviews the changes and effects of proprioception after ACL injury and the related mechanisms of vibration stimulation promoting its recovery after ACL reconstruction.