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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2023, Vol. 09 ›› Issue (06) : 343 -350. doi: 10.3877/cma.j.issn.2096-0263.2023.06.003

康复医学

模拟现实步态训练对膝关节前交叉韧带损伤的功能恢复及对跌倒恐惧的影响
邱红生, 林树体, 梁朝莹†(), 劳世高, 何荷   
  1. 535000　钦州市第一人民医院关节与运动医学科
    535000　钦州市第一人民医院神经内科
    535000　钦州市第一人民医院康复科
  • 收稿日期:2023-01-20 出版日期:2023-12-05
  • 通信作者: 梁朝莹
  • 基金资助:
    广西壮族自治区卫生健康委员会自筹经费科研课题(Z-N20221892)

The effect of simulated realistic gait training on functional recovery and fear of falling in patients with anterior cruciate ligament injury

Hongsheng Qiu, Shuti Lin, Chaoying Liang†(), Shigao Lao, he He   

  1. Department of Arthrology and Sports Medicine, Qinzhou, Guangxi 535000, China
    Department of Neurology, Qinzhou, Guangxi 535000, China
    Department of Rehabilitation, Qinzhou, Guangxi 535000, China
  • Received:2023-01-20 Published:2023-12-05
  • Corresponding author: Chaoying Liang
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引用本文：

邱红生, 林树体, 梁朝莹, 劳世高, 何荷. 模拟现实步态训练对膝关节前交叉韧带损伤的功能恢复及对跌倒恐惧的影响[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 343-350.

Hongsheng Qiu, Shuti Lin, Chaoying Liang, Shigao Lao, he He. The effect of simulated realistic gait training on functional recovery and fear of falling in patients with anterior cruciate ligament injury[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2023, 09(06): 343-350.

目的

研究模拟现实步态训练对膝关节前交叉韧带损伤患者的功能恢复及对跌倒恐惧的影响。

方法

前瞻性选取2018年1月至2020年12月符合纳入标准的膝关节前交叉韧带损伤患者92例，男72例，女20例，年龄（33.25±4.63）岁，根据住院号尾数的单双数随机分为观察组及对照组，观察组43例，对照组49例。两组患者在常规康复锻炼的基础上，观察组接受模拟现实步态训练6个月，比较干预前后两组患者膝关节活动度、稳定度及步态特征的差异，采用TSK-11及MFES评分评估患者干预前后的对跌倒恐惧的影响。

结果

干预3个月、6个月后两组患者的膝关节活动度均增大，且观察组活动度[（105.58±14.22）°、（126.39±15.66）°]大于对照组[（95.69±12.04）°、（105.28±11.32）°（P<0.05）]。观察组干预后3个月及6个月的稳定度（Pivotshift试验阳性3个月和6个月阳性率分别为32.56%和79.07%；Lachman试验3+阳性率为48.48%和81.40%）大于对照组（P<0.05）；干预后两组患者的Lysholm评分均明显升高，干预后6月时观察组为（82.53±10.36）分，高于对照组的（75.28±9.34）分；干预后患侧及健侧触地时长逐渐缩小，与对照组相比，干预后观察组患者触地时长更短（P<0.05）。观察组干预3个月、6个月MFES评分分别为（7.62±1.06）分和（9.58±10.33）分，高于对照组[（5.03±0.98）分、（7.38±9.62）分，P<0.05]。观察组干预3个月、6个月后TSK-11评分分别为（21.61±3.27）分和18.52±2.36）分高于对照组[（25.31±4.06）分、（7.38±9.62）分，P<0.05]。

结论

模拟现实步态训练有助于提高膝关节前交叉韧带损伤患者膝关节功能，改善步态及跌倒恐惧的心理影响。

关键词: 模拟现实步态训练, 膝关节前交叉韧带损伤, 功能重建, 恐动症, 跌倒恐惧
Objective

To investigate the effect of simulated realistic gait training on functional recovery and fear of falling in patients with anterior cruciate ligament injury.

Methods

A prospective selection was conducted on 92 patients with anterior cruciate ligament injury of the knee joint who met the inclusion criteria from January 2018 to December 2020, including 72 males and 20 females, aged (33.254.63) years old. They were randomly divided into an observation group and a control group based on the odd and even numbers of the hospitalization numbers. The observation group had 43 patients and the control group had 49 patients. On the basis of routine rehabilitation exercise, the two groups of patients received simulated reality gait training for 6 months in the observation group. The differences in knee joint mobility, stability, and gait characteristics between the two groups before and after intervention were compared. The TSK-11 and MFES scores were used to evaluate the impact of patients' fear of falling before and after intervention.

Results

After 3 and 6 months of intervention, the knee joint range of motion of both groups of patients increased, and the observation group had a higher range of motion (105.58±14.22 and 126.39±15.66) than the control group (95.69±12.04 and 105.28 ± 11.32) (P<0.05). Compared with the control group, the stability at 3 and 6 months after intervention (Pivotshift test positive rates at 3 and 6 months were 32.56% and 79.07%, respectively; Lachman test 3+positive rates were 48.48% and 81.40%) was higher in the observation group than in the control group (P<0.05); After intervention, the Lysholm scores of both groups of patients significantly increased. At 6 months after intervention, the observation group had (82.53±10.36) higher scores than the control group (75.28±9.34); After intervention, the duration of touchdown on the affected and healthy sides gradually decreased, and compared with the control group, the observation group had a shorter touchdown duration after intervention (P<0.05). The MFES scores of the observation group at 3 and 6 months of intervention were (7.62±1.06 points and 9.58 ± 10.33 points) higher than those of the control group (P<0.05). After 3 and 6 months of intervention, the TSK-11 scores of the observation group were (21.61±3.27 and 18.52±2.36) higher than those of the control group (P<0.05).

Conclusion

Simulated realistic gait training can improve the knee function of patients with acl injury and improve their gait and fear of falling.

Key words: Simulated Realistic Gait Training, Anterior Cruciate Ligament Injury, Functional Recovery, Kinesiophobia, Fear of Falling
表1 两组膝关节前交叉韧带损伤患者一般资料比较
组别 例数 性别（例） 年龄（岁，±s） 致伤原因（例） 侧别（例）
男 女 道路交通伤 运动伤 摔伤 其他 左膝 右膝
观察组 43 34 9 32.95±4.25 9 19 9 6 24 19
对照组 49 38 11 34.58±5.06 12 18 11 9 26 23
统计值   χ2=0.055 t=0.582 χ2=0.733 χ2=0.070
P值   0.815 0.547 0.865 0.791
组别 例数 半月板损伤（例） 软骨损伤（例） 运动强度分级（例）
有 无 有 无 低强度 高强度
观察组 43 18 25 16 27 35 8
对照组 49 20 29 23 26 37 12
统计值   χ2=0.010 χ2=0.888 χ2=0.466
P值   0.919 0.346 0.495
图1~15 模拟现实步态训练图。图1　平衡训练：单脚站立；图2　平衡训练：垫脚尖；图3　平衡训练：上斜坡；图4　平衡训练：下斜坡；图5　平衡训练：行走中用力推患者；图6　平衡训练：左右移动重心；图7　模拟现实训练：上楼梯；图8　模拟现实训练：下楼梯；图9　模拟现实训练：行走中拨打电话；图10　模拟现实训练：行走中打招呼；图11　模拟现实训练：软垫（草地）；图12　复杂行走技巧：S型行走；图13　复杂行走技巧：跨不同障碍物1；图14　复杂行走技巧：跨不同障碍物2；图15　复杂行走技巧：圆形、半圆行走
表2 两组膝关节前交叉韧带损伤患者干预前后膝关节活动度比较（°，±s）
组别 例数 干预前 干预3月 干预6月 F值 P值
观察组 43 55.36±6.38 105.58±14.22* 126.39±15.66*# 35.205 <0.001
对照组 49 58.39±7.06 95.69±12.04* 105.28±11.32*# 30.345 <0.001
F值   0.691 10.192 11.215    
P值   0.356 0.009 0.006    
表3 两组膝关节前交叉韧带损伤患者干预前后膝关节稳定性比较[例（%）]
组别 例数 Pivotshift试验阳性 Lachman试验3+
干预3月 干预6月 干预3月 干预6月
观察组 43 14（32.56） 34（79.07）* 21（48.84） 35（81.40）*
对照组 49 15（30.61） 26（53.06）* 16（32.65） 27（55.10）*
χ2值   0.040 6.829 2.495 7. 205
P值   0.841 0.009 0.114 0.007
表4 两组膝关节前交叉韧带损伤患者干预前后Lysholm评分比较（分，±s）
组别 例数 干预前 干预3月 干预6月 F值 P值
观察组 43 48.32±6.98 68.56±8.47* 82.53±10.36*# 25.365 <0.001
对照组 49 50.28±7.56 65.38±7.64* 75.28±9.34*# 22.845 <0.001
F值   0.892 3.323 7.671    
P值   0.329 0.046 0.007    
表5 两组膝关节前交叉韧带损伤患者干预前后步态特征比较（±s）
组别 例数 步长（cm） 步速（cm/s）
干预前 干预3月 干预6月 干预前 干预3月 干预6月
观察组 43 32.26±5.26 38.54±6.21*# 50.74±9.54*# 54.57±7.58 75.32±9.62*# 86.47±10.35*#
对照组 49 31.58±4.66 34.55±6.34* 43.69±7.25* 52.14±6.35 66.35±8.54* 75.62±9.68*
F值   0.773 3.446 5.691 0.491 7.672 8.329
P值   0.439 0.010 0.008 0.684 0.000 0.000
组别 例数 步频（步/min） 患侧触地时长（min）
干预前 干预3月 干预6月 干预前 干预3月 干预6月
观察组 43 69.58±10.25 78.25±9.37*# 95.63±11.08*# 1.65±0.54 1.02±0.56*# 0.74±0.62*#
对照组 49 67.23±8.92 75.25±8.64* 88.57±11.36* 1.70±0.85 1.35±0.52* 0.87±0.34*
F值   0.094 3.121 5.452 0.009 3.232 3.559
P值   0.776 0.032 0.000 0.956 0.041 0.035
组别 例数 健侧触地时长（min）
干预前 干预3月 干预6月
观察组 43 2.05±0.41 1.34±0.82*# 0.86±0.58*#
对照组 49 2.15±0.52 1.59±0.24* 1.06±0.54*
F值   0.084 4.434 3.982
P值   0.545 0.021 0.038
表6 两组膝关节前交叉韧带损伤患者干预前后MFES评分比较（分，±s）
组别 例数 干预前 干预3月 干预6月 F值 P值
观察组 43 4.06±0.85 7.62±1.06 9.58±10.33 19.632 <0.001
对照组 49 4.15±0.92 5.03±0.98 7.38±9.62 15.384 <0.001
F值   0.436 9.235 5.491    
P值   0.671 <0.001 <0.001    
表7 两组膝关节前交叉韧带损伤患者干预前后TSK-11评分比较（分，±s）
组别 例数 干预前 干预3月 干预6月 F值 P值
观察组 43 28.21±2.39 21.61±3.27 18.52±2.36 15.639 <0.001
对照组 49 29.54±3.64 25.31±4.06 21.35±3.06 10.348 <0.001
F值   0.658 8.510 7.365    
P值   0.231 0.015 0.032    
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