不同运动疗法对青年柔韧性扁平足患者足弓形态和下肢功能的影响

Effects of different exercise interventions on arch morphology and function of the lower extremity in young adults with flexible flatfoot

目的:对比本体感觉神经肌肉易化技术(proprioceptive neuromuscular facilitation,PNF)、向心-等长-快速离心训练、向心-等长-慢速离心训练对青年柔韧性扁平足患者的干预效果。方法:将40名受试者随机分为PNF组、向心-等长-快速离心组、向心-等长-慢速离心组、对照组,每组各10人。共进行6周运动干预,实验前后测试各组足舟骨下降试验(navicular drop test,NDt)高度差、标准舟骨高度指数(normalized navicular height truncated,NNHt)、踝关节肌肉力量、足底压力分布特征、动态平衡能力。结果:(1)足弓形态:与实验前相比,PNF组优势侧NDt值显著变小(P=0.049),向心-等长-快速离心组非优势侧NDt值显著变小(P=0.034)、NNHt指数显著变大(P=0.026);(2)踝关节力量:与实验前相比,PNF组、向心-等长-快速离心组、向心-等长-慢速离心组跖屈肌力均显著提升(优/非优势侧:P=0.003/P=0.004、P=0.000/P=0.000、P=0.001/P=0.001),PNF组、向心-等长-快速离心组内翻肌力均显著提升(优/非优势侧:P=0.011/P=0.005、P=0.003/P=0.003);(3)足底压力分布特征:与实验前相比,在非优势侧中,向心-等长-快速离心组足底压力中心(center of pressure,COP)连线增量显著降低(P=0.037),PNF组内侧纵弓负荷比例及接触面积显著降低(P=0.012、P=0.027);在优势侧中,向心-等长-慢速离心组内侧纵弓接触面积显著减小(P=0.038),对照组则显著增大(P=0.015);(4)动态平衡:与实验前相比,PNF组、向心-等长-慢速离心组优/非优势侧及向心-等长-快速离心组优势侧Y-Balance测试综合分数显著提高(P=0.006/P=0.023、P=0.001/P=0.035、P=0.011)。结论:6周PNF治疗可改善柔韧性扁平足青年的足弓形态,并提升其动态平衡能力;6周向心-等长-快速离心训练在改善柔韧性扁平足青年足弓形态方面效果最为显著,而向心-等长-慢速离心训练可显著提升柔韧性扁平足青年的动态平衡能力。

Objective To compare the effects of proprioceptive neuromuscular facilitation(PNF),con-centric-isometric-eccentric fast training(CIEFT),and concentric-isometric-eccentric slow training(CI-EST)in young adults with flexible flatfoot.Methods Forty participants were randomly allocated into a PNF group,a CIEFT group,a CIEST group and a control group,each of 10.The PNF,CIEFT and CIEST groups underwent six weeks of training as their group names indicated.Then the height differ-ence in the navicular drop test(NDt),normalized navicular height truncated(NNHt),muscle strength of ankle joint,plantar pressure distribution characteristics,and dynamic balance of all groups were re-corded before and after the intervention.Results As to the arch morphology,compared with pre-inter-vention,NDt decreased significantly in the dominant side of PNF group(P=0.049)and the non-domi-nant side of CIEFT group(P=0.034),while NNHt increased significantly in the non-dominant side of CIEFT group(P=0.026).Moreover,compared with pre-intervention,the muscle strength of plantar flex-ion increased significantly in all groups except the control group(dominant/non-dominant side:P=0.003/P=0.004,P=0.000/P=0.000,P=0.001/P=0.001),and that of inversion increased significantly in both PNF and CIEFT groups(dominant/non-dominant side:P=0.011/P=0.005,P=0.003/P=0.003).When it comes to the plantar pressure distribution characteristics,after the intervention,in the non-dominant side,the incremental center of pressure(COP)connections decreased significantly in CIEFT group(P=0.037),while the ratio of medial arch load and the contact area of the medial arch in PNF group de-creased significantly(P=0.012,P=0.027).Moreover,in the dominant side,the contact area decreased significantly in CIEST group(P=0.038),but increased significantly in the control group(P=0.015).What's more,after intervention,the Y-balance test score increased significantly in both sides of PNF and CIEST groups and the dominant side of CIEFT group(P=0.006/P=0.023,P=0.001/P=0.035,P=0.011).Conclusion Through a 6-week exercise intervention,PNF can improve the foot arch morphology and enhance dynamic balance ability in young adults with flexible flatfoot,while concentric-isometric-eccen-tric fast and slow training is superior in improving the foot arch morphology and the dynamic balance ability,respectively.