虚拟现实平衡训练对前交叉韧带重建术后膝关节本体感觉的效果

doi:10.3969/j.issn.1006-9771.2020.12.015

摘要/Abstract

摘要：

目的探讨虚拟现实平衡训练技术对前交叉韧带重建术后膝关节本体感觉功能的效果。方法 2016年1月至2018年12月,本院72例前交叉韧带重建术后患者随机分为对照组(n = 36)和观察组(n= 36)。两组在常规康复的基础上分别进行传统平衡训练和虚拟现实平衡训练,共8周。训练前后进行压力中心(COP)时间稳定性、闭眼压力中心速度(COPS)、单腿COPS、膝关节反应时间、极限包络面积(COPA)和主动关节角度重现偏差值评估。结果训练后,两组COP时间稳定性、闭眼COPS、单腿COPS、膝关节反应时间、COPA和主动关节角度重现偏差值均显著改善(|t| > 5.611, P < 0.001),且观察组COP时间稳定性、闭眼COPS、单腿COPS、膝关节反应时间和主动关节角度重现偏差值均明显优于对照组(| t| > 3.232, P < 0.01),两组COPA无显著性差异( t = 1.054, P = 0.296)。结论虚拟现实平衡训练可改善前交叉韧带重建术后膝关节的本体感觉,且较传统平衡训练效果更佳。

关键词: 前交叉韧带重建术, 本体感觉, 虚拟现实, 膝

Abstract:

Objective To investigate the effect of virtual reality balance training on knee proprioception after anterior cruciate ligament reconstruction (ACLR).Methods From January, 2016 to December, 2018, 72 patients after ACLR were randomly divided into control group (n = 36) and observation group (n = 36). On the basis of routine rehabilitation, they received routine balance training and balance training with virtual reality, respectively, for eight weeks. Before and after training, the center of pressure (COP) time stability, the COP speed (COPS) of closed eyes, the COPS of one leg, the knee joint reaction time, the center of pressure area (COPA) and the active joint angle recurrence deviation were measured.Results After training, the COP time stability, the COPS of closed eyes, the COPS of one leg, knee joint reaction time, COPA and active joint angle recurrence deviation improved in both groups (|t|>5.611,P < 0.001); and the COP time stability, the COPS of closed eyes, the COPS of one leg, the knee joint reaction time and active joint angle recurrence deviation were better in the observation group than in the control group (| t| > 3.232, P < 0.01), however, no significant difference was found in COPA between two groups ( t = 1.054, P = 0.296).Conclusion Virtual reality balance training can improve the proprioception of knee joint after ACLR, which is better than routine balance training.

Key words: anterior cruciate ligament reconstruction, proprioception, virtual reality, knee

中图分类号:

R684

施明,潘文平,曾明,林斯捷,李岩,吴华,王伟国. 虚拟现实平衡训练对前交叉韧带重建术后膝关节本体感觉的效果[J]. 《中国康复理论与实践》, 2020, 26(12): 1458-1463.

SHI Ming,PAN Wen-ping,ZENG Ming,LIN Si-jie,LI Yan,WU Hua,WANG Wei-guo. Effects of Virtual Reality Balance Training on Proprioception of Knee after Anterior Cruciate Ligament Reconstruction[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(12): 1458-1463.

图/表 8

表1

图1

表2

表3

表4

表5

表6

表7

参考文献 25

[1]	Nagai T, Schilaty N D, Strauss J D, et al. Analysis of lower extremity proprioception for anterior cruciate ligament injury prevention: current opinion[J]. Sports Med, 2018, 48(6):1303-1309. doi: 10.1007/s40279-018-0889-1
[2]	马燕红, 程安龙, 江澜, 等. 本体感觉训练在膝前交叉韧带重建术后康复中的应用[J]. 中华物理医学与康复杂志, 2005, 27(7):413-415.
	Ma Y H, Cheng A L, Jiang L, et al. Proprioception enhancement after anterior cruciate ligament reconstruction[J]. Chin J Phys Med Rehabil, 2005, 27(7):413-415.
[3]	Zhang L, Qi J, Zeng Y, et al. Proprioceptive changes in bilateral knee joints following unilateral anterior cruciate ligament injury in cynomolgus monkeys[J]. Med Sci Monit, 2018, 24:105-113. doi: 10.12659/MSM.905160
[4]	蒋拥军, 李克军, 王雪冰. 平衡促进训练对膝关节前交叉韧带损伤重建术后患膝本体感觉的影响[J]. 中国康复医学杂志, 2011, 26(3):251-253, 267.
	Jiang Y J, Li K J, Wang X B. Effect of balance promotion training on knee proprioception after reconstruction of knee anterior cruciate ligament injury[J]. Chin J Rehabil Med, 2011, 26(3):251-253, 267.
[5]	de Rooij I J, van de Port I G, Meijer J G. Effect of virtual reality training on balance and gait ability in patients with stroke: systematic review and meta-analysis[J]. Phys Ther, 2016, 96(12):1905-1918. doi: 10.2522/ptj.20160054
[6]	Lee Y, Choi W, Lee K, et al. Virtual reality training with three-dimensional video games improves postural balance and lower extremity strength in community-dwelling older adults[J]. J Aging Phys Act, 2017, 25(4):621-627.
[7]	康海燕, 许光旭. 虚拟现实技术对脑卒中患者平衡及步行能力康复效果的Meta分析[J]. 中国康复医学杂志, 2016, 31(5):554-557.
	Kang H Y, Xu G X. Chin J Rehabil Med, 2016, 31(5):554-557.
[8]	林志诚, 陈阿贞, 江一静, 等. 虚拟现实平衡游戏训练对帕金森病患者平衡功能的效果[J]. 中国康复理论与实践, 2016, 22(9):1059-1063.
	Lin Z C, Chen A Z, Jiang Y J, et al. Effects of virtual reality balance game on balance function for Parkinson's disease[J]. Chin J Rehabil Theory Pract, 2016, 22(9):1059-1063.
[9]	高凯, 王立德, 齐志明, 等. 前交叉韧带损伤的MRI诊断与临床诊断比较研究[J]. 中国运动医学杂志, 2005, 24(5):521-525.
	Gao K, Wang L D, Qi Z M, et al. Comparison of diagnoses of ACL tear by MRI and clinical examination[J]. Chin J Sports Med, 2005, 24(5):521-525.
[10]	吴华, 杨翼, 顾旭东, 等. 本体感觉强化训练对前交叉韧带重建后功能恢复的影响[J]. 中华物理医学与康复杂志, 2014, 36(4):291-294.
	Wu H, Yang Y, Gu X D, et al. Chin J Physl Med Rehabil, 2014, 36(4):291-294.
[11]	张磊, 扶世杰, 周鑫, 等. NT-3/TrkC信号通路在猴前交叉韧带本体感觉损伤中的作用[J]. 中国康复医学杂志, 2018, 33(5):513-519.
	Zhang L, Fu S J, Zhou X, et al. The changing of NT-3/TrkC proprioceptive signaling pathway after ACL injury[J]. Chin J Rehabil Med, 2018, 33(5):513-519.
[12]	Godinho P, Nicoliche E, Cossich V, et al. Proprioceptive deficit in patients with complete tearing of the anterior cruciate ligament[J]. Rev Bras Ortop, 2014, 49(6):613-618. doi: 10.1016/j.rbo.2013.08.010
[13]	Adachi N, Ochi M, Uchio Y, et al. Temporal change of joint position sense after posterior cruciate ligament reconstruction using multi-stranded hamstring tendons[J]. Knee Surg Sports Traumatol Arthrosc, 2007, 15(1):2-8. doi: 10.1007/s00167-006-0127-5
[14]	Roberts D, Ageberg E, Andersson G, et al. Clinical measurements of proprioception, muscle strength and laxity in relation to function in the ACL-injured knee[J]. Knee Surg Sports Traumatol Arthrosc, 2007, 15(1):9-16. doi: 10.1007/s00167-006-0128-4
[15]	孙凤龙, 郭恒冰, 郄淑燕, 等. 膝关节前交叉韧带重建术后运动觉的变化[J]. 中华骨与关节外科杂志, 2016, 9(3):225-228.
	Sun F L, Guo H B, Qie S Y, et al. Alteration of knee joint kinesthesia after anterior cruciate ligament reconstruction[J]. Chin J Bone Joint Surg, 2016, 9(3):225-228.
[16]	Hatton A L, Crossley K M, Clark R A, et al. Between-leg differences in challenging single-limb balance performance one year following anterior cruciate ligament reconstruction[J]. Gait Posture, 2017, 52:22-25. doi: S0966-6362(16)30641-5 pmid: 27855310
[17]	Xu J, Zhou X, Guo X, et al. Effects of unilateral electroacupuncture on bilateral proprioception in a unilateral anterior cruciate ligament injury model[J]. Med Sci Monit, 2018, 24:5473-5479. doi: 10.12659/MSM.909508
[18]	Dargo L, Robinson K J, Games K E. 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. doi: 10.4085/1062-6050-52.12.21
[19]	吴术红, 刘毅, 张亦南. 前交叉韧带重建后本体感觉的改变及康复[J]. 中国组织工程研究与临床康复, 2009, 13(50):9962-9965.
	Wu S H, Liu Y, Zhang Y N. Alternation and rehabilitation of proprioceptive sense following anterior cruciate ligament reconstruction[J]. J Clin Rehabil Tissue Engin Res, 2009, 13(50):9962-9965.
[20]	孙然, 张通. 虚拟现实技术在脑卒中患者平衡功能康复的应用[J]. 中国康复理论与实践, 2014, 20(1):37-40.
	Sun R, Zhang T. Application of virtual reality in balance rehabilitation for stroke (review)[J]. Chin J Rehabil Theory Pract, 2014, 20(1):37-40.
[21]	Kim J H, Jang S H, Kim C S, et al. Use of virtual reality to enhance balance and ambulation in chronic stroke: a double-blind, randomized controlled study[J]. Am J Phys Med Rehabil, 2009, 88(9):693-701. doi: 10.1097/PHM.0b013e3181b33350
[22]	Lloréns R, Gil-Gómez J A, Alcañiz M, et al. Improvement in balance using a virtual reality-based stepping exercise: a randomized controlled trial involving individuals with chronic stroke[J]. Clin Rehabil, 2015, 29(3):261-268. doi: 10.1177/0269215514543333
[23]	Cho K H, Lee W H. Virtual walking training program using a real-world video recording for patients with chronic stroke: a pilot study[J]. Am J Phys Med Rehabil, 2013, 92(5): 371-380; quiz 380-382, 458.
[24]	Hirjaková Z, Šingliarová H, Bzdúšková D, et al. Postural stability and responses to vibrations in patients after anterior cruciate ligament surgical reconstruction[J]. Physiol Res, 2016, 65(Suppl 3):S409-S416.
[25]	Gokeler A, Benjaminse A, van Eck C F, et al. Return of normal gait as an outcome measurement in ACL reconstructed patients. A systematic review[J]. Int J Sports Phys Ther, 2013, 8(4):441-451. pmid: 24175130

组别	n	性别(n)		年龄(岁)	身高(cm)	体质量(kg)
组别	n	男	女	年龄(岁)	身高(cm)	体质量(kg)
对照组	36	28	8	31.44±2.42	169.01±6.24	66.31±2.22
观察组	36	26	10	31.82±2.71	169.62±5.13	67.12±1.93
χ²/t值		0.586		0.606	0.453	1.652
P值		0.786		0.532	0.652	0.103

组别	n	训练前	训练后	t值	P值
对照组	36	2.75±0.50	2.33±0.41	7.197	< 0.001
观察组	36	2.73±0.50	1.78±0.34	9.499	< 0.001
t值		-0.175	6.216
P值		0.862	< 0.001

组别	n	训练前	训练后	t值	P值
对照组	36	3.92±0.31	2.38±0.31	18.435	< 0.001
观察组	36	3.90±0.46	1.89±0.30	22.486	< 0.001
t值		-0.165	-5.079
P值		0.869	< 0.001

组别	n	训练前	训练后	t值	P值
对照组	36	5.22±0.47	4.22±0.44	14.444	< 0.001
观察组	36	5.08±0.62	3.76±0.41	12.415	< 0.001
t值		-1.075	-4.590
P值		0.286	< 0.001

组别	n	训练前	训练后	t值	P值
对照组	36	1.75±0.21	1.24±0.41	8.252	< 0.001
观察组	36	1.72±0.33	0.94±0.26	11.033	< 0.001
t值		-0.404	-3.771
P值		0.687	< 0.001