摘要目的 探讨重复外周磁刺激(repetitive peripheral magnetic stimulation,rPMS)对前交叉韧带(anterior cruciate ligament,ACL)重建术后患者平衡功能和本体感觉的影响。方法 选取2021年9月至2022年6月联勤保障部队第九八三医院收治的60例ACL损伤患者为研究对象。采用常规康复方案的30例患者为对照组,男17例,女13例;年龄21~33岁,平均(26.11±5.46)岁。在对照组的基础上采用rPMS治疗的30例患者为实验组,男18例,女12例;年龄22~34岁,平均(25.32±5.61)岁。采用Lysholm膝关节功能评分、Holden步行功能分级(function classification,FAC)、膝关节活动度(range of motion,ROM)、疼痛视觉模拟评分(visual analogue scale,VAS)评估膝关节功能,测试伸肌峰力矩(extensor peak moment,EPT)、屈肌峰力矩(flexor peak moment,FPT)及膝关节屈/伸肌群峰力矩比值(hamstrings/quadriceps,H/Q)×100%,进行被动活动察觉阈值测试(threshold to detection of passive motion,TTDPM)评估患者本体感觉功能,使用Pro-Kin平衡测试与训练系统评估膝关节平衡状态,包括压力中心X/Y轴、覆盖90%椭圆区域面积、功能表面区域的轨迹长度指数(length in function of surface,LFS)以及全身动态平衡测试(whole-body dynamic balancing task,DBT)。结果 治疗后4周,实验组的Lysholm评分、FAC、ROM高于对照组,VAS低于对照组(P<0.05);实验组的EPT、FPT、ROM、H/Q均高于对照组(P<0.05);实验组两侧的本体感觉无差异(P>0.05),而对照组患侧的本体感觉较健侧仍有差异(P<0.05);实验组患者在睁眼及闭眼状态下的压力中心X/Y轴、覆盖90%椭圆区域面积和LFS均显著低于对照组(P<0.05)。治疗后6个月和12个月两组患者DBT均改善,且实验组优于对照组(P<0.05)。结论 rPMS可以改善ACL重建术后患者的本体感觉和平衡功能以及预后。
[1] Okoroha KR,Fidai MS,Tramer JS,et al.Length of time between anterior cruciate ligament reconstruction and return to sport does not predict need for revision surgery in national football league players[J].Arthroscopy,2019,35(1):158-162.
[2] 宋炎成,曹明德,许华亮,等.经颅直流电刺激前交叉韧带重建术后康复效果研究[J].广东药科大学学报,2021,37(4):96-100;144.
[3] Cheney S,Chiaia TA,de Mille P,et al.Readiness to return to sport after acl reconstruction:A combination of physical and psychological factors[J].Sports Med Arthrosc Rev,2020,28(2):66-70.
[4] JJeong J,Choi DH,Shin CS.Core strength training can alter neuromuscular and biomechanical risk factors for anterior cruciate ligament injury[J].Am J Sports Med,2021,49(1):183-192.
[5] 王艺伟,马玉宝,高维广,等.本体感觉训练对前交叉韧带重建术后功能恢复的影响[J].中国老年保健医学,2022,20(1):113-116.
[6] Kim T,Wright DL.Transcranial direct current stimulation of supplementary motor region impacts the effectiveness of interleaved and repetitive practice schedules for retention of motor skills[J].Neuroscience,2020(435):58-72.
[7] TThoma LM,Grindem H,Logerstedt D,et al.Coper classification early after anterior cruciate ligament rupture changes with progressive neuromuscular and strength training and is associated with 2-year success:The delaware-oslo acl cohort study[J].Am J Sports Med,2019,47(4):807-814.
[8] Blackburn JT,Pietrosimone B,Spang JT,et al.Somatosensory function influences aberrant gait biomechanics following anterior cruciate ligament reconstruction[J].J Orthop Res,2020,38(3):620-628.
[9] Angius L,Santarnecchi E,Pascual-Leone A,et al.Transcranial direct current stimulation over the left dorsolateral prefrontal cortex improves inhibitory control and endurance performance in healthy individuals[J].Neuroscience,2019(419):34-45.
[10] DDiermeier T,Rothrauff BB,Engebretsen L,et al. Panther symposium acl treatment consensus group.treatment after anterior cruciate ligament injury:Panther symposium acl treatment consensus group[J].Knee Surg Sports Traumatol Arthrosc,2020,28(8):2390-2402.
[11] Jeong J,Choi DH,Shin CS.Core Strength training can alter neuromuscular and biomechanical risk factors for anterior cruciate ligament injury[J].Am J Sports Med,2021,49(1):183-192.
[12] Okudera Y,Matsunaga T,Sato M,et al.The impact of high-frequency magnetic stimulation of peripheral nerves:Muscle hardness,venous blood flow,and motor function of upper extremity in healthy subjects[J].Biomed Res,2015,36(2):81-87.
[13] Baek J,Park N,Lee B,et al.Effects of repetitive peripheral magnetic stimulation over vastus lateralis in patients after hip replacement surgery[J].Ann Rehabil Med,2018,42(1):67-75.
[14] Yang SS,Jee S,Hwang SL,et al.Strengthening of quadriceps by neuromuscular magnetic stimulation in healthy subjects[J].PMR,2017,9(8):767-773.
[15] Dargo L,Robinson KJ,Games KE.Prevention of knee and anterior cruciate ligament injuries through the use of neuromuscular and proprioceptive training:An evidence-based review[J].J Athl Train,2017,52(12):1171-1172.
[16] 刘晓磊,张鸿悦,章耀华,等.前交叉韧带重建术后患者膝本体感觉与姿势控制的相关性[J].中国康复,2021,36(3):170-173.
[17] 何建华,杨振,万绍文,等.低频重复经颅磁刺激联合平衡仪训练对脑卒中患者平衡功能的影响[J].中国康复,2021,36(11):657-660.
[18] Chiarotto A,Roorda LD,Crins MH,et al.PROMIS physical function short forms display item-and scale-level characteristics at least as good as the roland morris disability questionnaire in patients with chronic low back pain[J].Arch Phys Med Rehabil,2020,101(2):297-308.
[19] Cavaleri R,Chipchase LS,Summers SJ,et al.Repetitive transcranial magnetic stimulation of the primary motor cortex expedites recovery in the transition from acute to sustained experimental pain:A randomised,controlled study[J].Pain,2019,160(11):2624-2633.
[20] Renner T,Sollmann N,Heinen F,et al.Alleviation of migraine symptoms by application of repetitive peripheral magnetic stimulation to myofascial trigger points of neck and shoulder muscles-A randomized trial[J].Sci Rep,2020,10(1):5954.