角度波动式康复训练对肘关节活动受限的术后康复作用-中华老年骨科与康复电子杂志

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Title:: Application of Angle fluctuating rehabilitation training in postoperative rehabilitation of elbow joint limited by medial collateral ligament injury

作者:: 刘江; 杜俊炜; 徐征宇; 姜姚; 毕郑刚; 孙佳冰; 耿硕; 150001 哈尔滨医科大学附属第一医院骨科

Author(s):: Liu Jiang; Du Junwei; Xu Zhengyu; Jiang Yao; Bi Zhenggang; Sun Jiabing; Geng Shuo.; Department of Orthopedics, the First Affiliated Hospital of Harbin Medical University, Harbin150001, China

关键词:: 关节僵直; 尺侧副韧带重建; 康复训练; 关节支具

Keywords:: Ankylosis; Ulnar collateral ligament reconstruction; Rehabilitation; Brace

文献标志码:: A

摘要:: 目的采用回顾性队列研究，分析“角度波动式康复训练”在肘关节内侧副韧带损伤导致的陈旧性肘关节活动受限患者康复治疗中的效果。方法回顾性收集2014年9月至2021年7月收治的外翻试验不稳定患者104例，平均年龄（50±5）岁。男性46例，女性58例，均为单侧肢体发病，术前Mayo肘关节评分均小于60分。根据其康复方式的不同，分为试验组（n=53）和对照组（n=51），分别采用了“角度波动式康复训练”和“传统康复训练”。比较术前及术后6周、3个月、6个月肘关节功能，肘关节功能评估应用Mayo肘关节功能评分（MEPS）、改良的美国特种外科医院评分（改良HSS）、疼痛视觉模拟评分（VAS）、以及屈曲、伸直、内旋、外旋四个活动角度。结果随访时间为10~36个月，平均随访（21.3±7.2）个月，6个月随访率100%。在术后6个月随访时，试验组功能评分明显高于对照组，MEPS试验组为80（80，85）分，对照组70（70，75）分；改良HSS试验组为85（82，88）分，对照组79（75，82）分；VAS试验组为2（1，3）分，对照组3（3，4）分，三组数据均具有统计学意义（c2=118.907，52.847，60.904，P＜0.05）；试验组肘关节活动范围：屈曲120（115，130）°，伸直15（10，15）°，明显大于传统康复方式：屈曲100°（95，110）°，伸直：20°（15，20）°，且未出现因康复而造成的副损伤。结论角度波动式康复训练结合了肘关节可调节支具和静态拉伸支具（SPS）二者的优点，通过静态、动态训练相结合，非暴力地递进式增长训练角度，可达到满意的主被动活动度。康复过程中疼痛度更低，康复周期更短，提高了中远期随访功能评分优良率。

Abstract:: Objectives To retrospectively study the effect of the “angular fluctuation rehabilitation training” method in the rehabilitation of patients with old limitation of elbow joint motion due to medial collateral ligament injury. Methods We retrospectively collected 104 patients with unstable valgus test admitted from January 2014 to July 2021, with an average age of (50±5) years. There were 46 males and 58 females, all with unilateral limb onset, and all with preoperative Mayo elbow scores less than 60. The patients were divided into the experimental group (n=53) and the control group (n=51) according to the postoperative rehabilitation method, and the rehabilitation was carried out by two methods: "angular fluctuation rehabilitation training" and "traditional rehabilitation training", respectively. The Mayo Elbow Performance Score (MEPS), Modified Hospital for Special Surgery Score (Modified HSS), Visual Analogue Score (VAS) for pain, and four angles of movement: flexion, extension, internal rotation, and external rotation were used to evaluate the efficacy before and at 6 weeks, 3 months, and 6 months after surgery. Results The follow-up period ranged from 10 to 36 months, with a mean follow-up of (21.3±7.2) months and a 6-month follow-up rate of 100%. At the 6-month postoperative follow-up, the functional activity scores of patients in the trial group were significantly higher than those in the control group, with 80(80,85) points in the MEPS trial group and 70(70,75) points in the control group; 85(82,88) points in the modified HSS trial group and 79(75,82) points in the control group; 2(1,3) points in the VAS trial group and 3(3,4) points in the control group, and the data of all three groups were The range of motion of the elbow joint in the test group was 120°(115,130)° in flexion and 15°(10,15)° in extension, which was significantly greater than that in the traditional rehabilitation mode: 100°(95,110)° in flexion and 20°(15,20)° in extension, and there was no side injuries due to rehabilitation. Conclusions The angle fluctuation rehabilitation training combines the advantages of adjustable brace and static progressive stretch(SPS) brace of the elbow joint. By combining static and dynamic training and non-violently increasing the training angle progressively, satisfactory active and passive mobility can be achieved. The pain level during rehabilitation was within the tolerance range, the rehabilitation period was shortened, and the rate of excellent functional scores in the medium and long term follow-up was significantly increased.

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

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