[1]李克军,刘水根,蒋拥军,等.反重力跑台训练在股骨干骨折加压钢板螺钉内固定术后康复治疗中的应用[J].中医正骨,2023,35(08):20-25,42.
　LI Kejun,LIU Shuigen,JIANG Yongjun,et al.Application of anti-gravity treadmill training to functional rehabilitation after compression plate and screw internal fixation for treatment of femoral shaft fracture[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(08):20-25,42.
点击复制

反重力跑台训练在股骨干骨折加压钢板螺钉内固定术后康复治疗中的应用()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期数:
2023年08期
页码:
20-25,42
栏目:
临床研究
出版日期:
2023-08-20

文章信息/Info

Title:
Application of anti-gravity treadmill training to functional rehabilitation after compression plate and screw internal fixation for treatment of femoral shaft fracture
作者:
李克军; 刘水根; 蒋拥军; 何梦凡; 秦健君
深圳平乐骨伤科医院/深圳市坪山区中医院,广东 深圳 518010
Author(s):
LI Kejun; LIU Shuigen; JIANG Yongjun; HE Mengfan; QIN Jianjun
Shenzhen Pingle Orthopedic Hospital(Shenzhen Pingshan District Hospital of Traditional Chinese medicine),Shenzhen 518010,Guangdong,China
关键词:
股骨骨折;  骨折固定术; 内;  康复;  反重力跑台;  临床试验
Keywords:
femoral fractures;  fracture fixation; internal;  rehabilitation;  anti-gravity treadmill;  clinal trial
摘要:
目的:探讨反重力跑台训练在股骨干骨折加压钢板螺钉内固定术后康复治疗中的应用价值。方法:将58例行加压钢板螺钉内固定术后4周的股骨干骨折患者随机分为常规康复组和联合康复组,每组29例。常规康复组采用手法、运动疗法和物理疗法进行康复治疗,联合康复组在常规康复组干预措施基础上采用反重力跑台训练; 均每周治疗5次,每次20 min,共治疗4周。记录并比较治疗前和治疗结束后2组患者N端骨钙素、Ⅰ型前胶原N端前肽(N-terminal propeptide of type Ⅰ procollagen,PINP)、β-Ⅰ型胶原羧基端肽(β-C-terminal telopeptide of typeⅠ collagen,β-CTX)血清含量及美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分和骨痂生长评分。结果:①N端骨钙素血清含量。治疗结束后,2组患者N端骨钙素血清含量均高于治疗前[(10.07±2.12)ng·mL-1,(13.10±1.23)ng·mL-1,t=-6.660,P=0.000;(9.69±2.11)ng·mL-1,(11.93±1.89)ng·mL-1,t=-4.267,P=0.000],联合康复组患者N端骨钙素血清含量高于常规康复组(t=-2.798,P=0.007)。②PINP血清含量。治疗结束后,2组患者PINP血清含量均高于治疗前[(43.79±7.79)ng·mL-1,(72.52±5.03)ng·mL-1,t=-16.673,P=0.000;(46.3±10.76)ng·mL-1,(65.76±9.37)ng·mL-1,t=-7.339,P=0.000],联合康复组患者PINP血清含量高于常规康复组(t=-3.421,P=0.001)。③β-CTX血清含量。治疗结束后,2组患者β-CTX血清含量均低于治疗前[(772.93±18.29)pg·mL-1,(727.76±16.19)pg·mL-1,t=9.930,P=0.000;(765.38±25.76)pg·mL-1,(744.07±25.29)pg·mL-1,t=3.179,P=0.002],联合康复组患者β-CTX血清含量低于常规康复组(t=2.925,P=0.005)。④HSS膝关节评分。治疗结束后,2组患者HSS膝关节评分均高于治疗前[(63.04±6.75)分,(85.20±7.72)分,t=-8.781,P=0.000;(66.86±8.12)分,(80.14±6.24)分,t=-10.015,P=0.000],联合康复组患者HSS膝关节评分高于常规康复组(t=-2.748,P=0.008)。⑤骨痂生长评分。治疗结束后,2组患者骨痂生长评分均高于治疗前[(0.72±0.45)分,(2.03±0.68)分,t=-0.821,P=0.000;(0.76±0.58)分,(1.55±0.51)分,t=-5.567,P=0.000],联合康复组患者骨痂生长评分高于常规康复组(t=-3.065,P=0.003)。结论:在股骨干骨折加压钢板螺钉内固定术后康复治疗中应用反重力跑台训练,可促进骨折愈合,有利于改善膝关节功能。
Abstract:
Objective:To explore the clinical applied values of anti-gravity treadmill(AlterG)training in postoperative rehabilitation of patients who underwent compression plate and screw internal fixation for treatment of femoral shaft fracture.Methods:Fifty-eight patients with femoral shaft fracture who underwent compression plate and screw internal fixation 4 weeks ago were randomly divided into conventional rehabilitation group and combination rehabilitation group,29 cases in each group.All patients in the 2 groups were treated with the same conventional rehabilitation therapies including manipulation,kinesitherapy and physiotherapy,moreover,the patients in combination rehabilitation group were further treated with AlterG training.All patients were treated five times a week,20 minutes at a time for consecutive 4 weeks.The serum levels of N-terminal osteocalcin(OC),N-terminal propeptide of typeⅠprocollagen(PINP)and β-C-terminal telopeptide of typeⅠcollagen(β-CTX),and Hospital for Special Surgery(HSS)knee score and bony callus growth score were recorded and compared between the 2 groups before the treatment and after the end of the treatment respectively.Results:①The serum level of N-terminal OC increased in the 2 groups after the end of the treatment compared to pre-treatment(10.07±2.12 vs 13.10±1.23 ng/mL,t=-6.660,P=0.000; 9.69±2.11 vs 11.93±1.89 ng/mL,t=-4.267,P=0.000),and it was higher in combination rehabilitation group compared to conventional rehabilitation group(t=-2.798,P=0.007).②The serum level of PINP increased in the 2 groups after the end of the treatment compared to pre-treatment(43.79±7.79 vs 72.52±5.03 ng/mL,t=-16.673,P=0.000; 46.3±10.76 vs 65.76±9.37 ng/mL,t=-7.339,P=0.000),and it was higher in combination rehabilitation group compared to conventional rehabilitation group(t=-3.421,P=0.001).③The serum level of β-CTX decreased in the 2 groups after the end of the treatment compared to pre-treatment(772.93±18.29 vs 727.76±16.19 pg/mL,t=9.930,P=0.000; 765.38±25.76 vs 744.07±25.29 pg/mL,t=3.179,P=0.002),and it was lower in combination rehabilitation group compared to conventional rehabilitation group(t=2.925,P=0.005).④The HSS knee score increased in the 2 groups after the end of the treatment compared to pre-treatment(63.04±6.75 vs 85.20±7.72 points,t=-8.781,P=0.000; 66.86±8.12 vs 80.14±6.24 points,t=-10.015,P=0.000),and it was higher in combination rehabilitation group compared to conventional rehabilitation group(t=-2.748,P=0.008).⑤The bony callus growth score increased in the 2 groups after the end of the treatment compared to pre-treatment(0.72±0.45 vs 2.03±0.68 points,t=-0.821,P=0.000; 0.76±0.58 vs 1.55±0.51 points,t=-5.567,P=0.000),and it was higher in combination rehabilitation group compared to conventional rehabilitation group(t=-3.065,P=0.003).Conclusion:Application of AlterG training to rehabilitation can promote fracture healing and improve knee function after compression plate and screw internal fixation for treatment of femoral shaft fracture.

参考文献/References:

[1] 朱明喜.闭合复位与切开复位交锁髓内钉内固定术治疗股骨干骨折的比较研究[J].现代中西医结合杂志, 2016,25(22):2451-2453.
[2] 康立恒,袁宝明,彭传刚,等.微创钢板内固定治疗股骨干多段骨折髓内钉内固定术后骨折延迟愈合1例[J].中国骨与关节损伤杂志,2018,33(12):1338-1339.
[3] MITCHNIK I Y,TALMY T,RADOMISLENSKY I,et al.Femur fractures and hemorrhagic shock:implications for point of injury treatment[J].Injury,2022,53(10):3416-3422.
[4] 赵唐永,任原,王志强.股骨干骨折内固定术后骨折愈合情况及其影响因素分析[J].中国骨与关节损伤杂志,2015,30(8):869-870.
[5] 高建华,邓江涛,李秋明,等.交锁髓内钉与锁定加压钢板内固定对股骨干骨折患者膝关节功能及创伤相关指标的影响[J].现代生物医学进展,2020,20(16):3100-3104.
[6] 曹克勇,方彩莲,叶积飞.不同强度的早期负重对股骨干骨折愈合的影响[J].中国康复,2014,29(6):458-459.
[7] ARAZI M,OGÜN T C,OKTAR M N,et al.Early weight-bearing after statically locked reamed intramedullary nailing of comminuted femoral fractures:is it a safe procedure?[J].J Trauma,2001,50(4):711-716.
[8] BRUMBACK R J,TOAL T R,MURPHY-ZANE M S,et al.Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intra-medullary nail[J].J Bone Joint Surg Am,1999,81(11):1538-1544.
[9] 陈孝平,汪建平,赵继宗.外科学[M].9版.北京:人民卫生出版社,2018:445.
[10] 徐伟龙,郝剑,郑升鹏,等.平乐郭氏荣肌揉筋法治疗膝关节置换术后下肢肿胀临床研究[J].河南中医,2022,42(5):773-776.
[11] KIM P,LEE H,CHOI W,et al.Effect of 4 weeks of anti-gravity treadmill training on isokinetic muscle strength and muscle activity in adults patients with a femoral fracture:a randomized controlled trial[J].Int J Environ Res Public Health,2020,17(22):8572.
[12] 王玉龙.康复功能评定学[M].北京:人民卫生出版社,2018:148-150.
[13] PEIR A,ANDRES F,FERNANDEZ-ESTEVE F.Acute Monteggia lesions in children[J].J Bone Joint Surg Am,1977,59(1):92-97.
[14] 金镇雄,舒冰,王乾,等.中医辨证分型治疗骨质疏松性骨折的研究进展[J].中国骨质疏松杂志,2020,26(12):1843-1846.
[15] ZHAO H Z,FAN T S,WANG S L,et al.Closed reduction for the treatment of grade Ⅳ supination-external rotation fracture of the ankle joint:a retrospective analysis[J].Orthop Surg,2021,13(7):2163-2169.
[16] 薛雷雷,武军龙,魏戎.腰椎骨折内固定术后影响骨折愈合的危险因素分析[J].中国医学工程,2022,30(3):79-82.
[17] 卢红信,陈笑天,叶龙飞,等.胫骨骨折髓内钉内固定患者术后早期与晚期负重的对比研究[J].中华解剖与临床杂志,2022, 27(8):563-567.
[18] BHANUSHALI A,KOVOOR J G,STRETTON B,et al.Outcomes of early versus delayed weight-bearing with intrame-dullary nailing of tibial shaft fractures:a systematic review and meta-analysis[J].Eur J Trauma Emerg Surg,2022,48(5):3521-3527.
[19] 中华医学会骨质疏松和骨矿盐疾病分会.骨转换生化标志物临床应用指南[J].中华内分泌代谢杂志,2021,37(10):863-874.
[20] 陈伟,李鹏,万永建,等.创伤性骨折延迟愈合患者血清骨转化标志物的表达水平及意义[J].东南大学学报(医学版),2021,40(2):225-229.
[21] 王首贵,段涛秀,刘丽芳,等.血栓通对股骨颈骨质疏松性骨折患者置换术后血液高凝状态、骨代谢和康复进程的影响[J].中国骨质疏松杂志,2019,25(9):1312-1316.
[22] 徐文,邹明,岳建彪.血清低Alb和低NMID-OC/β-CTX比值与老年女性骨质疏松性骨折的相关性[J].中国骨质疏松杂志,2022,28(6):825-829.
[23] 王福平,史世勤,任飞,等.不同髓内钉锁定方式对股骨干骨折患者术后恢复的影响[J].安徽医学,2017,38(10):1307-1310.
[24] 张敬飞.闭合复位交锁髓内钉内固定术治疗股骨干骨折患者的疗效及安全性分析[J].中国药物与临床,2021,21(8):1369-1371.
[25] 王斌,郭东哲,张远,等.低频体外冲击波联合红骨髓局部注射治疗骨折延迟愈合的临床疗效分析[J].中华急诊医学杂志,2020,29(6):873-875.
[26] CHAO E Y,INOUE N.Biophysical stimulation of bone fracture repair,regeneration and remodelling[J].Eur Cell Mater,2003,6:72-84.
[27] LIANG J,LANG S,ZHENG Y,et al.The effect of anti-gravity treadmill training for knee osteoarthritis rehabilitation on joint pain,gait,and EMG:case report[J].Medicine,2019,98(18):e15386.

相似文献/References:

[1]温超海,何忠,李永斌,等.闭合复位伽玛钉改良成锁定支架内固定治疗 老年股骨转子间骨折[J].中医正骨,2015,27(11):32.
[2]肖善富,张喜善,于凤珍.髌下小切口钢丝纽扣式内固定治疗胫骨髁间隆突骨折[J].中医正骨,2015,27(11):34.
[3]朱峰,宋相建,吴蔚,等.手法复位经皮克氏针内固定治疗 儿童闭合性肱骨远端全骨骺分离[J].中医正骨,2015,27(11):51.
[4]裘人华,胡培阳,裘天强,等.闭合复位外固定架固定治疗Colles骨折[J].中医正骨,2015,27(11):59.
[5]葛波涌,王玉波,王明太,等.交锁髓内钉内固定治疗胫骨干骨折的临床研究[J].中医正骨,2015,27(10):8.
　GE Boyong,WANG Yubo,WANG Mingtai,et al.Clinical study on the internal fixation with interlocking intramedullary nail for the treatment of tibial shaft fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(08):8.
[6]王 强.胫腓下联合骨牵引配合手法整复小夹板外固定治疗 儿童闭合移位性股骨干骨折[J].中医正骨,2015,27(10):15.
[7]邓红敏,刘志诚.转子间斜行截骨结合股骨近端防旋髓内钉固定治疗 股骨近端骨折术后髋内翻畸形[J].中医正骨,2015,27(10):17.
[8]孙群周,阮成群,李光明,等.股骨近端防旋髓内钉内固定治疗 老年不稳定型股骨转子间骨折[J].中医正骨,2015,27(10):20.
[9]方策,倪新宇,王宏伟,等.迟氏正骨手法复位单臂外固定支架固定治疗 老年股骨转子间骨折[J].中医正骨,2015,27(10):22.
[10]全先辉,万春友,刘磊,等.Taylor空间支架外固定治疗胫腓骨开放性骨折[J].中医正骨,2015,27(10):30.
[11]张振南,王爱国,白玉,等.保留原钉的单皮质锁定加压钢板内固定配合植骨治疗 股骨干骨折髓内钉固定术后骨折不愈合[J].中医正骨,2015,27(05):40.
[12]汤金城,谭旭仪,成传德.前外侧切口可吸收螺钉内固定治疗Hoffa骨折[J].中医正骨,2015,27(03):44.
[13]屠永刚,任绍东,周国新,等.双切口双钢板内固定治疗股骨下段粉碎性骨折[J].中医正骨,2016,28(01):51.
[14]周磊,陈柯,田可为,等.双钢板内固定结合自体髂骨植骨治疗股骨干骨折不愈合[J].中医正骨,2016,28(02):47.
[15]李文强.半环式组合外固定架外固定治疗儿童股骨远端骨折[J].中医正骨,2017,29(02):45.
[16]吴天然,陈夏平,王瑞雄,等.克氏针协助手法复位在股骨干骨折顺行髓内钉内固定术中的应用[J].中医正骨,2017,29(06):49.
[17]董根荣,尧彦青,沈卫东,等.微创锁定钢板内固定治疗股骨干粉碎性骨折[J].中医正骨,2017,29(08):60.
[18]杜贵强,张晓东,刘又文,等.髓内钉附加侧板联合自体髂骨植骨治疗股骨干骨折术后钢板断裂骨折不愈合[J].中医正骨,2017,29(09):54.
[19]张镇,沈金虎,惠正广,等.股骨远端微创内固定系统内固定配合抗骨质疏松药物口服治疗股骨近端防旋髓内钉内固定术后同侧股骨远端骨折[J].中医正骨,2017,29(10):73.
[20]章铁琦,陈金洪,王勇,等.重建锁定钢板联合微创内固定系统治疗复杂股骨远端骨折[J].中医正骨,2017,29(12):62.

备注/Memo

备注/Memo:
通讯作者:蒋拥军 E-mail:89556868@qq.com
更新日期/Last Update: 1900-01-01