血流限制在前交叉韧带重建术后康复中应用效果的系统研究

A systematic study on the effect of blood flow restriction in rehabilitation after anterior cruciate ligament reconstruction

目的系统分析血流限制(blood flow restriction,BFR)在前交叉韧带重建(anterior cruciate ligament reconstruction,ACLR)术后康复的肌力改善效果和安全性和参数设置。方法选取1999年1月至2023年5月中国知网、万方、PubMed、Web of Science等数据库公开发表的中、英文BFR下ACLR术后康复文献,对所有文献信息进行整理及分析,并使用物理治疗证据数据库(physiotherapy evidence database,PEDro)量表对文献进行质量评估,分析BFR在ACLR术后康复的肌力改善效果、安全性和参数设置。结果共检索文献312篇,最终纳入有效文献7篇,文献类型包括随机对照试验6篇和队列研究1篇,共涉及研究对象195例。其中1项研究质量中等,6项研究质量较高。有6项研究评估了股四头肌力量,结果显示BFR后的股四头肌力量和质量显著提高。有1项研究评估训练的安全性,结果显示在青少年人群中BFR是安全的,只有轻微的不良反应。有2项研究结果显示BFR可以减缓肌肉力量下降和骨质流失。另有1项研究结果显示BFR对膝屈肌的反应不明显。结论在采用合理的BFR训练参数设置下,BFR对ACLR术后患者的肌力增长有一定的改善作用,且产生的不良反应较少。未来需要开展更多有标准化干预方案和结局测量的随机对照试验,以增加BFR下ACLR术后康复训练效果的证据。

Objective To systematically analyze the muscle strength improvement effect,safety and parameter setting of blood flow restriction(BFR)after anterior cruciate ligament reconstruction(ACLR).Methods The Chinese and English literatures on rehabilitation under the condition of postoperative blood flow restriction after ACLR from January 1999 to May 2023 were selected from CNKI,Wanfang,PubMed,Web of Science and other databases,all the literatures were sorted out and analyzed,and the the quality of the literatures were evaluated by physiotherapy evidence database(PEDro)scale,and the muscle strength improvement effect,safety and parameter setting of BFR after ACLR rehabilitation were analyzed.Results A total of 312 studies were retrieved,and seven valid articles were finally included,of which were six randomized controlled trials and one cohort study,involving a total of 195 participants.Among them,one study was of moderate quality and six studies were of high quality.Six studies evaluated the strength of quadriceps femoris,and the results showed that the strength and quality of quadriceps femoris were significantly improved after BFR.One study evaluated the safety of training,and the results showed that BFR was safe among teenagers,with only minor adverse reactions.Two studies showed that BFR slowed down the decline of muscle strength and bone loss.Another study showed that BFR had no obvious response to knee flexors.Conclusions Under the reasonable setting of training parameters,BFR can improve the muscle strength growth of patients after ACLR operation,and produce fewer adverse reactions.In the future,more randomized controlled trials with standardized intervention programs and outcome measurements are needed to increase the evidence of the effect of rehabilitation training after ACLR under BFR.