开链和闭链训练治疗膝关节半月板损伤

背景:开链训练和闭链训练均可应用于膝关节半月板损伤,然而两种方法的机制不一样,临床未见两种训练方法改善膝关节半月板损伤的报道。目的:观察开链训练和闭链训练对青年人膝关节半月板损伤疗效的影响。方法:49例青年人膝关节半月板损伤采用康复保守治疗的患者,随机数字表法将入选患者分为2组,生物反馈开链组(n=25)采用基础治疗联合终末伸膝生物反馈训练,蹬踏闭链组(n=24)采用基础治疗联合单侧下肢蹬踏训练。其中基础治疗包括电针、手法治疗、徒手运动疗法;生物反馈开链训练采用加拿大Thought公司生产的Myotrac infiniti生物反馈仪进行刺激训练;蹬踏闭链训练采用德国GYM80智能力量训练系统蹬踏配件进行训练。1次/d,连续3周。使用膝关节屈、伸、全关节活动度,目测类比评定级法评分、改良Lysholm膝关节评分、日常生活活动能力评分进行疗效评价。研究方案的实施符合四川省骨科医院的相关伦理要求,患者对试验过程完全知情同意。结果与结论:①在关节活动度方面:生物反馈开链组屈、伸、全关节活动度优于治疗前(P<0.05);蹬踏闭链组伸、全关节活动度优于治疗前(P<0.05);生物反馈开链组较蹬踏闭链组改善关节活动度较好,但组间差异无显著性意义(P>0.05);②在疼痛和功能方面:2组治疗后目测类比评定级法评分、改良Lysholm膝关节评分、日常生活活动能力评分优于治疗前(P<0.05);蹬踏闭链组治疗后日常生活活动能力评分好于生物反馈开链组(P<0.05);2组在改善膝关节活动度、疼痛和功能方面均有效果;③结果说明,生物反馈开链组在改善关节活动度方面疗效较好;在控制疼痛的基础上,蹬踏闭链组在改善膝关节功能和日常生活活动能力方面疗效较好。

Open and closed kinetic chain exercises for meniscus lesions

BACKGROUND:Both open and closed kinetic chain exercises can be applied to meniscal lesions in the knee joint,but their mechanisms are different.There is still no clinical report on the improvement of meniscus lesions by the two exercise methods.OBJECTIVE:To observe the effects of open kinetic chain exercise and closed kinetic chain exercise on meniscus lesions in young patients.METHODS:Forty-nine young patients with meniscus lesions were treated with rehabilitation and conservative treatments.They were randomly divided into two groups using a random digital table method:a biofeedback open kinetic chain group(n=25)treated with basic therapy combined with terminal knee extension biofeedback training,and a leg press closed kinetic chain group(n=24)treated with basic therapy combined with single-leg press training.The basic treatment included electro-acupuncture,manipulation therapy and unarmed exercise therapy.Biofeedback open chain training was conducted with Myotrac infiniti biofeedback instrument produced by Thought,Canada.Closed chain training with leg press was conducted using pedal accessories of GYM80 intelligent strength training system,Germany.All the trainings were conducted once a day for 3 consecutive weeks.Curative effects were assessed by joint range of motion(ROM)during knee joint flexion and extension,total ROM,visual analogue scale score,modified Lysholm knee score,and activity of daily living score.The study protocol was implemented in line with the relevant requirements of Sichuan Provincial Orthopedic Hospital.All the patients were informed of the study procedures.requirements of Sichuan Provincial Orthopedic Hospital.All the patients were informed of the study procedures.RESULTS AND CONCLUSION:Assessment for ROM:After treatment,the ROM during joint flexion and extension and total ROM in the biofeedback open kinetic chain group were significantly better than the baseline(P<0.05),the ROM during joint extension and total ROM in the leg press closed kinetic chain group were significantly better than the baseline(P<0.05),and the ROM in the biofeedback open kinetic chain group was higher than that in the leg press closed kinetic chain group,but there was no significant difference between two groups(P>0.05).Assessment for pain and function:The two groups had statistically significant improvements on visual analogue scale score,modified Lysholm knee score,and activity of daily living score after treatment(P<0.05).Compared with the biofeedback open kinetic chain group,the activity of daily living score was higher in the leg press closed kinetic chain group(P<0.05).The two groups had satisfactory effects on the knee joint ROM,pain and functional performance.Therefore,biofeedback open kinetic chain exercise has a better improvement on the knee joint ROM,while the leg press closed kinetic chain exercise shows better outcomes in the improvement of knee functional performance and activity of daily living based on the basis of pain control.