全膝关节置换后早期髋外展肌强化训练改善平衡及步行能力

Early hip abductor training to improve balance and walking ability after total knee arthroplasty

背景:全膝关节置换后患者功能恢复并不理想,常规康复更多地关注患者膝关节周围组织的康复,而忽视了髋外展肌的训练。髋外展肌与全膝关节置换患者肢体功能存在相关性,但具体疗效仍然有待研究。目的:探究髋外展肌强化训练对全膝关节置换患者平衡及步行功能恢复的影响。方法:纳入2020年3月至2021年5月在复旦大学附属华东医院接受单侧全膝关节置换的患者60例,采用随机数字表法分为对照组和试验组(n=30)。对照组采用常规康复训练方法,试验组在常规康复基础上增加髋外展肌训练。两组患者分别在治疗前和治疗4周后进行髋外展肌等速肌力、膝关节功能评分、单腿站立测试、计时起立-行走测试以及三维步态分析。结果与结论:①治疗4周后,试验组髋外展肌相对峰力矩明显高于对照组,差异有显著性意义(P<0.05);②治疗4周后,试验组美国膝关节协会功能评分明显高于对照组,差异有显著性意义(P<0.05);③治疗4周后,试验组单腿站立测试时间明显长于对照组,计时起立-行走测试时间明显短于对照组,差异均有显著性意义(P<0.05);④治疗4周后,试验组步幅和患侧支撑相占比明显优于对照组,差异有显著性意义(P<0.05);⑤结果表明全膝关节置换后早期髋外展肌强化训练能够在一定程度上增加髋外展肌肌力,提高患者的平衡及步行功能,但其康复方案及长期疗效仍需进一步研究。

BACKGROUND:The functional recovery of patients after total knee arthroplasty is not ideal.Routine rehabilitation pays more attention to the rehabilitation of the tissue around the knee joint,but neglects the training of the abductor muscle of the hip.There is a correlation between hip abductor and limb function of patients with total knee arthroplasty,but the specific effect remains to be studied.OBJECTIVE:To explore the effect of hip abductor training on balance and walking function recovery in patients with total knee arthroplasty.METHODS:From March 2020 to May 2021,60 patients with unilateral total knee arthroplasty from Huadong Hospital Affiliated to Fudan University were randomly divided into trial group(n=30)and control group(n=30).The control group received conventional treatment.The trial group received conventional treatment and hip abductor training.Hip abductor isokinetic muscle strength,knee function score,single leg stance,Timed Up and Go test,and threedimensional gait analysis were assessed in both groups before and 4 weeks after treatment.RESULTS AND CONCLUSION:(1)The hip abductor isokinetic muscle strength was significantly higher in the trial group than that of the control group 4 weeks after treatment(P<0.05).(2)At 4 weeks after treatment,Knee Society Score was significantly higher in the trial group than that of the control group(P<0.05).(3)At 4 weeks after treatment,single leg stance time was significantly longer in the trial group than that in the control group;Timed Up and Go test time was significantly shorter in the trial group than that in the control group(P<0.05).(4)At 4 weeks after treatment,the proportion of walking amplitude and affected side support phase was significantly better in the trial group than that in the control group(P<0.05).(5)These findings have verified that early hip abductor training after total knee arthroplasty can increase hip abductor muscle strength and improve patients’balance and walking function.However,its rehabilitation program and long-term efficacy still need further research.