外踝扭伤后本体感觉的恢复

doi:10.3969/j.issn.1006-9771.2023.07.015

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (7): 844-848.doi: 10.3969/j.issn.1006-9771.2023.07.015

外踝扭伤后本体感觉的恢复

徐仁杰¹^,², 李周¹, 郭雨亭³, 于喜勤¹, 马景明¹, 葛向阳⁴, 朱子昀¹, 张玉鑫⁵, 周峰¹()

1.昆山市康复医院，江苏昆山市 215300
2.南京医科大学，江苏南京市 210000
3.昆山市第一人民医院，江苏昆山市 215300
4.南通大学附属妇幼保健院，江苏南通市 226000
5.上海交通大学医学院附属第九人民医院，上海市 200011

收稿日期:2023-02-21 修回日期:2023-06-01 出版日期:2023-07-25 发布日期:2023-08-30
通讯作者: 周峰(1979-)，男，汉族，副主任医师。E-mail： zhoufeng4356@163.com
作者简介:徐仁杰(1993-)，男，汉族，江苏昆山市人，硕士研究生，主管技师，主要研究方向：肌骨系统疾患康复、运动损伤康复。
基金资助:
昆山市重点研发计划(社会发展)(KSF202121)

Recovery of proprioception after lateral ankle sprain

XU Renjie¹^,², LI Zhou¹, GUO Yuting³, YU Xiqin¹, MA Jingming¹, GE Xiangyang⁴, ZHU Ziyun¹, ZHANG Yuxin⁵, ZHOU Feng¹()

1. Kunshan Rehabilitation Hospital, Kunshan, Jiangsu 215300, China
2. Nanjing Medical University, Nanjing, Jiangsu 210000, China
3. The First People's Hospital of Kunshan, Kunshan, Jiangsu 215300, China
4. Maternal and Child Health Care Hospital Affiliated to Nantong University, Nantong, Jiangsu 226000, China
5. The Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China

Received:2023-02-21 Revised:2023-06-01 Published:2023-07-25 Online:2023-08-30
Contact: ZHOU Feng, E-mail: zhoufeng4356@163.com
Supported by:
Kunshan Key Research and Development Plan (Social Development)(KSF202121)

摘要/Abstract

摘要：

目的观察外踝扭伤常规康复后，患侧踝关节本体感觉随时间的恢复情况。

方法 2020年6月至2022年6月，昆山市康复医院外踝扭伤患者18例，均行常规康复训练12周。分别于治疗前、治疗4周、治疗8周和治疗12周时，采用等速肌力测试系统评估双侧踝关节主动位置觉和被动位置觉。

结果治疗后，患侧踝关节主动位置呈现差逐渐降低(F = 22.533, P < 0.001)，但均显著高于健侧同时间点(t > 4.419, P < 0.001)；患侧踝关节被动位置呈现差无显著变化(F = 1.175, P > 0.05)，与健侧同时间点无显著性差异(|t| < 0.646, P > 0.05)。

结论外踝扭伤后患侧踝关节本体感觉受损，康复训练后逐渐恢复，但训练3个月后仍未恢复到健侧水平。被动位置觉作为评价本体感觉的指标有待进一步研究。

关键词: 外踝, 扭伤, 位置觉, 本体感觉

Abstract:

Objective To observe the recovery of proprioception of the affected ankle over time after lateral ankle sprain accepting routine rehabilitation.

Methods From June, 2020 to June, 2022, 18 patients with lateral ankle sprain in Kunshan Rehabilitation Hospital underwent routine rehabilitation for twelve weeks. They were measured active and passive position sense of bilateral ankles using an isokinetic dynamometer before treatment, and four, eight and twelve weeks after treatment, respectively.

Results The active presentation difference of affected ankle reduced after treatment (F = 22.533, P < 0.001), but it was more than that of the healthy ankle at the same time (t > 4.419, P < 0.001). No significant improvement was found in passive presentation difference of affected ankle after treatment (F= 1.175, P > 0.05), and it was not significantly different from those of the healthy ankle at the same time (|t| < 0.646, P > 0.05).

Conclusion Proprioception of affected ankle has been impaired after lateral ankle sprain, and it can be recovered after rehabilitation, but cannot achieve the healthy level even after three months of training. Passive position sense as an index of proprioception needs more researches.

Key words: lateral ankle, sprain, position sense, proprioception

中图分类号:

R686

徐仁杰, 李周, 郭雨亭, 于喜勤, 马景明, 葛向阳, 朱子昀, 张玉鑫, 周峰. 外踝扭伤后本体感觉的恢复[J]. 《中国康复理论与实践》, 2023, 29(7): 844-848.

XU Renjie, LI Zhou, GUO Yuting, YU Xiqin, MA Jingming, GE Xiangyang, ZHU Ziyun, ZHANG Yuxin, ZHOU Feng. Recovery of proprioception after lateral ankle sprain[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 844-848.

图/表 2

参考文献 32

[1]	DELAHUNT E, REMUS A. Risk factors for lateral ankle sprains and chronic ankle instability[J]. J Athl Train, 2019, 54(6): 611-616. doi: 10.4085/1062-6050-44-18
[2]	CHANDRAN A, MOFFIT R E, DEJONG LEMPKE A F, et al. Epidemiology of lateral ligament complex tears of the ankle in National Collegiate Athletic Association (NCAA) Sports: 2014-15 through 2018-19[J]. Am J Sports Med, 2023, 51(1): 169-178. doi: 10.1177/03635465221138281 pmid: 36592020
[3]	SLATER K. Acute lateral ankle instability[J]. Foot Ankle Clin, 2018, 23(4): 523-537. doi: S1083-7515(18)30055-X pmid: 30414650
[4]	HERSHKOVICH O, TENENBAUM S, GORDON B, et al. A large-scale study on epidemiology and risk factors for chronic ankle instability in young adults[J]. J Foot Ankle Surg, 2015, 54(2): 183-187. doi: 10.1053/j.jfas.2014.06.001 pmid: 25135102
[5]	BĄCZKOWICZ D, FALKOWSKI K, MAJORCZYK E. Assessment of relationships between joint motion quality and postural control in patients with chronic ankle joint instability[J]. J Orthop Sports Phys Ther, 2017, 47(8): 570-577. doi: 10.2519/jospt.2017.6836
[6]	STEINBERG N, ADAMS R, TIROSH O, et al. Effects of textured balance board training in adolescent ballet dancers with ankle pathology[J]. J Sport Rehabil, 2019, 28(6): 584-592. doi: 10.1123/jsr.2018-0052 pmid: 30040016
[7]	施晓剑, 荣积峰, 蔡斌, 等. 物理治疗技术改善慢性踝关节不稳神经肌肉控制障碍的系统综述[J]. 中国康复理论与实践, 2022, 28(2): 132-143. doi: 10.3969/j.issn.1006-9771.2022.02.002
	SHI X J, RONG J F, CAI B, et al. Effect of physical therapy on neuromuscular control dysfunction for chronic ankle instability: a systematic review[J]. Chin J Rehabil Theory Pract, 2022, 28(2): 132-143.
[8]	MARTIN R L, DAVENPORT T E, FRASER J J, et al. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021[J]. J Orthop Sports Phys Ther, 2021, 51(4): CPG1-CPG80.
[9]	LIN C I, HOUTENBOS S, LU Y H, et al. The epidemiology of chronic ankle instability with perceived ankle instability: a systematic review[J]. J Foot Ankle Res, 2021, 14(1): 41. doi: 10.1186/s13047-021-00480-w
[10]	DE VASCONCELOS G S, CINI A, SBRUZZI G, et al. Effects of proprioceptive training on the incidence of ankle sprain in athletes: systematic review and meta-analysis[J]. Clin Rehabil, 2018, 32(12): 1581-1590. doi: 10.1177/0269215518788683 pmid: 29996668
[11]	VUURBERG G, HOORNTJE A, WINK L M, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline[J]. Br J Sports Med, 2018, 52(15): 956. doi: 10.1136/bjsports-2017-098106
[12]	D'HOOGHE P, CRUZ F, ALKHELAIFI K. Return to play after a lateral ligament ankle sprain[J]. Curr Rev Musculoskelet Med, 2020, 13(3): 281-288. doi: 10.1007/s12178-020-09631-1 pmid: 32377961
[13]	杨绯, 潘珏, 吴琼, 等. 踝扭伤后关节生物力学和本体感觉变化特征及相关性[J]. 中国康复理论与实践, 2019, 25(12): 1365-1369. doi: 10.3969/j.issn.1006-9771.2019.12.001
	YANG F, PAN Y, WU Q, et al. Biomechanics characteristics and its correlation with proprioception of ankle post sprain[J]. Chin J Rehabil Theory Pract, 2019, 25(12): 1365-1369.
[14]	张秋霞, 花秀琴, 施永健. 踝关节本体感觉的测量方法研究与应用[J]. 中国组织工程研究, 2011, 15(35): 6619-6623.
	ZHANG Q X, HUA X Q, SHI Y J. Development and application of measurement methods for ankle proprioception[J]. Chin J Tiss Eng Res, 2011, 15(35): 6619-6623.
[15]	MARINHO H V R, AMARAL G M, DE SOUZA MOREIRA B, et al. Influence of passive joint stiffness on proprioceptive acuity in individuals with functional instability of the ankle[J]. J Orthop Sports Phys Ther, 2017, 47(12): 899-905. doi: 10.2519/jospt.2017.7030
[16]	TASSIGNON B, VERSCHUEREN J, DELAHUNT E, et al. Criteria-based return to sport decision-making following lateral ankle sprain injury: a systematic review and narrative synthesis[J]. Sports Med, 2019, 49(4): 601-619. doi: 10.1007/s40279-019-01071-3 pmid: 30747379
[17]	YU R, YANG Z, WITCHALLS J, et al. Kinesiology tape length and ankle inversion proprioception at step-down landing in individuals with chronic ankle instability[J]. J Sci Med Sport, 2021, 24(9): 894-899. doi: 10.1016/j.jsams.2021.04.009 pmid: 34016535
[18]	KONRADSEN L, RAVN J B, SORENSEN A I. Proprioception at the ankle: the effect of anaesthetic blockade of ligament receptors[J]. J Bone Joint Surg Br, 1993, 75(3): 433-436.
[19]	SORENSEN K L, HOLLANDS M A, PATLA E. The effects of human ankle muscle vibration on posture and balance during adaptive locomotion[J]. Exp Brain Res, 2002, 143(1): 24-34. doi: 10.1007/s00221-001-0962-z pmid: 11907687
[20]	HUBBARD T J, KAMINSKI T W. Kinesthesia is not affected by functional ankle instability status[J]. J Athl Train, 2002, 37(4): 481-486.
[21]	GOKELER A, BENJAMINSE A, HEWETT T E, et al. Proprioceptive deficits after ACL injury: are they clinically relevant?[J]. Br J Sports Med, 2012, 46(3): 180-192. doi: 10.1136/bjsm.2010.082578
[22]	RIEMANN B L, LEPHART S M. The sensorimotor system, part II: the role of proprioception in motor control and functional joint stability[J]. J Athl Train, 2002, 37(1): 80-84.
[23]	RAUNEST J, SAGER M, BURGENER E. Proprioceptive mechanisms in the cruciate ligaments: an electromyographic study on reflex activity in the thigh muscles[J]. J Trauma, 1996, 41(3): 488-493. doi: 10.1097/00005373-199609000-00017
[24]	LEDRI L N, PINGEL J, HULTBORN H, et al. Immobilization leads to reduced stretch reflexes but increased central reflex gain in the rat[J]. J Neurophysiol, 2020, 124(3): 985-993. doi: 10.1152/jn.00748.2019 pmid: 32783594
[25]	SOUSA A S P, LEITE J, COSTA B, et al. Bilateral proprioceptive evaluation in individuals with unilateral chronic ankle instability[J]. J Athl Train, 2017, 52(4): 360-367. doi: 10.4085/1062-6050-52.2.08
[26]	LEE H, SON S J, KIM H, et al. Submaximal force steadiness and accuracy in patients with chronic ankle instability[J]. J Athl Train, 2021, 56(5): 454-460. doi: 10.4085/15-20
[27]	AZEVEDO J, RODRIGUES S, SEIXAS A. The influence of sports practice, dominance and gender on the knee joint position sense[J]. Knee, 2021, 28: 117-123. doi: 10.1016/j.knee.2020.11.013 pmid: 33348123
[28]	TERRIER P, PIOTTON S, PUNT I M, et al. Predictive factors of recovery after an acute lateral ankle sprain: a longitudinal study[J]. Sports (Basel), 2021, 9(3): 41.
[29]	TURVEY M T, FONSECA S T. The medium of haptic perception: a tensegrity hypothesis[J]. J Mot Behav, 2014, 46(3): 143-187. doi: 10.1080/00222895.2013.798252 pmid: 24628057
[30]	KIM K M. Higher visual reliance during single-leg balance bilaterally occurring following acute lateral ankle sprain: a potential central mechanism of bilateral sensorimotor deficits[J]. Gait Posture, 2020, 78: 26-29. doi: 10.1016/j.gaitpost.2020.03.003
[31]	DELAHUNT E, BLEAKLEY C M, BOSSARD D S, et al. Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium[J]. Br J Sports Med, 2018, 52(20): 1304-1310. doi: 10.1136/bjsports-2017-098885
[32]	章丽莉, 杨玉珊, 郑洁皎. 慢性踝关节不稳姿势稳定性的研究进展[J]. 中国康复理论与实践, 2019, 25(8): 908-912. doi: 10.3969/j.issn.1006-9771.2019.08.006
	ZHANG L L, YANG Y S, ZHENG J J. Advance in posture control for chronic ankle instability (review)[J]. Chin J Rehabil Theory Pract, 2019, 25(8): 908-912.

时间	n	患侧	健侧	t值	P值
治疗前	18	5.57±1.85	5.28±1.81	0.646	0.527
治疗4周	18	5.43±1.61	5.30±1.38	0.284	0.780
治疗8周	18	5.26±1.76	4.96±1.53	0.574	0.574
治疗12周	18	4.80±1.72	4.98±1.28	0.168	0.868
F值		1.175	0.810
P值		0.328	0.494

外踝扭伤后本体感觉的恢复

Recovery of proprioception after lateral ankle sprain

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时间	n	患侧	健侧	t值	P值
治疗前	18	5.59±1.71	2.45±0.89	14.931	< 0.001
治疗4周	18	4.91±1.23^a	2.41±0.88	11.234	< 0.001
治疗8周	18	4.22±1.44^a,b	2.50±0.99	6.607	< 0.001
治疗12周	18	3.46±1.24^a,b,c	2.43±0.85	4.419	< 0.001
F值		22.533	0.086
P值		< 0.001	0.967

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