平衡训练联合常规治疗对严重烧伤后下肢运动及平衡功能障碍患者影响的前瞻性随机对照研究

茹天峰; 李菲虹; 谢卫国; 陈佩; 袁林

doi:10.3760/cma.j.cn501120-20201018-00441

平衡训练联合常规治疗对严重烧伤后下肢运动及平衡功能障碍患者影响的前瞻性随机对照研究

doi: 10.3760/cma.j.cn501120-20201018-00441

1. 武汉大学同仁医院暨武汉市第三医院烧伤研究所 430060;
2. 湖北省直属机关医院康复科,武汉 430071

基金项目:

国家自然科学基金面上项目（81772097）

武汉市卫生健康委员会科研组（WG19B02）

湖北省卫生健康委员会科研项目（WJ2019M003）

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出版历程
- 收稿日期: 2020-10-18
- 网络出版日期: 2021-10-28
- 刊出日期: 2021-04-20

A prospective randomized controlled study of the effects of balance training combined with routine training on patients with lower limb motor and balance dysfunction after severe burns

1. Institute of Burns, Tongren Hospital of Wuhan University&Wuhan Third Hospital, Wuhan 430060, China;
2. Department of Rehabilitation, Hubei Provincial Organ Hospital, Wuhan 430071, China

摘要

摘要:
目的观察平衡训练对严重烧伤后下肢运动及平衡功能障碍患者的影响。方法采用前瞻性随机对照研究方法。2016年1月—2020年1月，武汉大学同仁医院暨武汉市第三医院收治符合入选标准的下肢运动及平衡功能障碍的严重烧伤患者64例。采用随机数字表法将患者分为常规训练组和联合训练组，每组32例，常规训练组中男22例、女10例，年龄40.5（35.5，52.8）岁；联合训练组中男24例、女8例，年龄37.0（30.0，44.0）岁。常规训练组患者进行膝关节牵伸、持续被动运动、下肢肌力训练以及压力治疗等常规治疗，联合训练组患者在常规治疗基础上辅以坐位平衡、重心转移、骨盆稳定、单腿站立交替和平衡垫站立的平衡训练，2组患者均治疗4个月。于治疗前和治疗4个月后分别采用Berg平衡量表、下肢功能量表、特异性活动平衡自信量表评估患者平衡功能、下肢功能、平衡活动自信心，对数据行独立样本
t
检验、配对样本
t
检验、Mann-Whitney
U
检验、Wilcoxon符号秩检验或
χ
²检验。结果治疗前，常规训练组及联合训练组患者Berg平衡评分分别为（25±9）、（25±7）分，2组评分相近（
t
=-0.154，
P
>0.05）；治疗4个月后，联合训练组患者Berg平衡评分为（43±6）分，明显高于常规训练组的（40±6）分（
t
=2.028，
P
<0.05）；常规训练组、联合训练组患者治疗4个月后Berg平衡评分均明显高于治疗前（
t
=-15.189、-26.200，
P
<0.01）。治疗前，常规训练组及联合训练组患者下肢功能评分分别为25.0（16.5，30.0）、23.0（10.3，28.8）分，2组评分相近（
Z
=-1.575，
P
>0.05）；治疗4个月后，联合训练组患者下肢功能评分为55.0（35.0，60.0）分，明显高于常规训练组的43.0（36.0，53.0）分（
Z
=-2.744，
P
<0.01）。常规训练组、联合训练组患者治疗4个月后下肢功能评分均显著高于治疗前（
Z
=-4.943、-4.955，
P
<0.01）。治疗前，2组患者平衡活动自信心评分相近（
t
=-0.966，
P
>0.05）；治疗4个月后，联合训练组患者平衡活动自信心评分明显高于常规训练组（
t
=3.343，
P
<0.01）。常规训练组、联合训练组患者治疗4个月后平衡活动自信心评分均明显高于治疗前（
t
=-19.611、-34.300，
P
<0.01）。结论对严重烧伤后下肢运动及平衡功能障碍患者进行常规治疗联合平衡训练能明显促进其下肢运动及平衡功能恢复。
- 烧伤 /
- 康复 /
- 平衡训练 /
- 平衡功能 /
- 下肢运动功能
Abstract:
Objective To observe the effects of balance training combined with routine training on patients with lower limb motor and balance dysfunctions after severe burns. Methods A prospective randomized controlled study was conducted. From January 2016 to January 2020, sixty-four patients with lower limb motor and balance dysfunction after severe burns who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University＆Wuhan Third Hospital. According to the random number table, the patients were divided into routine training (RT) group and combined training (CT) group. There were 32 cases in each group, 22 males and 10 females in RT group, aged 40.5 (35.5, 52.8) years, and 24 males and 8 females in CT group, aged 37.0 (30.0, 44.0) years. Patients in RT group performed conventional treatment including knee joint stretch, continuous passive motion, lower limb muscle strength training, and pressure therapy etc., while patients in CT group received balance training in addition to RT treatment including sitting balance, center of gravity transfer, pelvic stability, standing alternately on one leg, and standing on balance pad. Patients in both groups were treated for 4 months. Before treatment and after 4 months of treatment, the Berg Balance Scale, Lower Extremity Function Scale, and Activities-specific Balance Confidence Scale were used to evaluate the balance function, lower limb function, and balance activity self-confidence of patients respectively. Data were statistically analyzed with independent sample
t
test, paired sample
t
test, Mann-Whitney
U
test, Wilcoxon signed rank test or chi-square test. Results Before treatment, the Berg balance score of patients in RT group was (25±9) points, which was similar to (25±7) points in CT group (
t
=-0.154,
P
>0.05). After 4 months of treatment, the Berg balance score of patients in CT group was (43±6) points, which was significantly higher than (40±6) points in RT group (
t
=2.028,
P
<0.05). The Berg balance scores of patients in RT and CT groups after 4 months of treatment were obviously higher than those before treatment (
t
=-15.189, -26.200,
P
<0.01). Before treatment, the lower limb function score of patients in RT group was 25.0 (16.5, 30.0) points, which was similar to 23.0 (10.3, 28.8) points in CT group (
Z
=-1.575,
P
>0.05). After 4 months of treatment, the lower limb function score of patients in CT group was 55.0 (35.0, 60.0) points, which was significantly higher than 43.0 (36.0, 53.0) points in RT group (
Z
=-2.744,
P
<0.01). The lower limb function scores of patients in RT and CT groups after 4 months of treatment were obviously higher than those before treatment (
Z
=-4.943, -4.955,
P
<0.01). Before treatment, the balance activity self-confidence scores of patients in the two groups were similar (
t
=-0.966,
P
>0.05). After 4 months of treatment, the balance activity self-confidence scores of patients in CT group was significantly higher than that in RT group (
t
=3.343,
P
<0.01). The balance activity self-confidence scores of patients in RT and CT groups after 4 months of treatment were obviously higher than those before treatment (
t
=-19.611, -34.300,
P
<0.01). Conclusions Conventional treatment combined with balance training for patients with lower limb motor and balance dysfunctions after severe burns can effectively promote the recovery of their lower limb motor and balance function.
- Burns /
- Rehabilitation /
- Balance training /
- Balance function /
- Lower limb motor function