三维步态分析在早期前交叉韧带重建修复术后的临床康复应用研究

关键词：前交叉韧带损伤  运动生物力学评估  康复

Keywords:anterior cruciate ligament injury  application of biomechanical assessment  rehabilitation

摘要：

      摘要 目的：探讨基于三维步态分析的运动生物力学评估指导下膝前交叉韧带重建术后康复疗效。 方法：前瞻性连续将2020年7月—2022年6月在首都医科大学附属北京康复医院就诊的单侧膝关节前交叉韧带重建术后符合纳入标准的52例患者纳入研究，根据患者意愿，将其分为常规康复训练组和个性化康复训练组。对照组采用常规康复治疗方法，试验组在对照组的基础上通过生物力学评估和监测来指导康复治疗，两组患者每次治疗均包括徒手一对一训练30min、器械训练30min，每天1次，每周5天。通过本体感觉、步态、Lysholm量表对膝关节功能进行评估。 结果：两组患者术后6周各参数均无显著性差异，术后12周，试验组患者Lysholm膝关节评估量表的得分明显高于对照组（P<0.05），步频、步速明显大于对照组（P<0.05），跨步时间较对照组明显缩短（P<0.05），两组患者在术后12周与术后6周相比，髋、膝、踝关节在行走过程中的最大屈曲角度均有显著性差异（P<0.05），试验组患者术后12周行走过程中的膝关节最大屈曲角度、踝关节最大屈角度均明显大于对照组，本体感觉测试结果显示试验组45°重现差值低于对照组（P<0.05）。 结论：基于表面肌电和三维步态分析的运动生物力学评估指导康复训练方法可优化膝前交叉韧带重建术后患者的康复疗效。

Abstract:

      Abstract Objective： To investigate the effects of rehabilitation management for anterior cruciate ligament （ACL） injury, utilizing three-dimensional gait analysis. Method： This prospective study included 52 patients with unilateral ACL injuries who underwent reconstruction surgery between July 2020 and March 2022 at the Capital Medical University Affiliated Beijing Rehabilitation Hospital. Participants were divided into an experimental group (n=26) and a control group (n=26) according to the random number table method. The control group received routine rehabilitation treatment after ACL reconstruction， while the experimental group received rehabilitation treatment guided by biomechanical evaluation and monitoring on the basis of the control group. Both groups received rehabilitation treatment for 60 minutes once a day， 5 times a week， over a total of 12 weeks. Before and after treatment， knee function was evaluated by proprioception test， gait analysis， and the Lysholm Knee Scale （LKS）. Result： There was no significant difference between all parameters at six weeks after treatment. However, the experimental group demonstrated significantly higher LKS scores, cadence, and speed compared to the control group at 16 weeks after treatment（P<0.05）. Additionally, the stride time was significantly shorter than that of the control group （P<0.05）， and the proprioceptive test indicated that the 45° reproducibility difference of the experimental group was significantly lower than that of the control group （P<0.05）. Conclusion： Rehabilitation management guided by biomechanical evaluation based on surface electromyography and three-dimensional gait analysis can optimize the rehabilitation outcomes for patients following ACL reconstruction.