A prospective randomized controlled study on the effects of bicycle ergometer rehabilitation training on quadriceps and walking ability of patients with lower limb dysfunction caused by extensive burns
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摘要:
目的 探讨功率自行车康复训练对大面积烧伤致下肢功能障碍患者股四头肌和步行能力的影响。 方法 采用前瞻性随机对照研究方法。选择武汉大学同仁医院暨武汉市第三医院2017年12月—2020年12月收治的符合入选标准的40例大面积烧伤患者，将其按照随机数字表法分为常规训练组［男16例、女4例，年龄（45±10）岁］和联合训练组［男13例、女7例，年龄（39±8）岁］。对常规训练组患者进行关节松动、下肢力量训练、步行能力训练和压力治疗等常规康复治疗，联合训练组患者在常规康复治疗的基础上增加功率自行车康复训练。针对2组患者，于治疗前和治疗2个月后，采用超声诊断仪测量股四头肌厚度，采用便携式肌力测试仪测试股四头肌肌力，采用6 min和10 m步行测试检测步行能力，应用改良李克特量表评估患者对训练效果的满意度。对数据行独立样本或配对样本t检验、Mann-Whitney U检验、Wilcoxon符号秩和检验和χ2检验。 结果 治疗2个月后，联合训练组患者股四头肌厚度为（3.76±0.39）cm，明显大于常规训练组的（3.45±0.35）cm（t=2.67，P<0.05）；常规训练组和联合训练组患者治疗2个月后的股四头肌厚度均明显大于治疗前（t值分别为5.99、8.62，P<0.01）。治疗2个月后，联合训练组患者股四头肌肌力明显大于常规训练组（Z=2.69，P<0.01）；常规训练组和联合训练组患者治疗2个月后的股四头肌肌力均明显大于治疗前（Z值分别为3.92、3.92，P<0.01）。治疗2个月后，联合训练组患者6 min步行距离为（488±39）m，明显长于常规训练组的（429±25）m（t=5.66，P<0.01）；常规训练组和联合训练组患者治疗2个月后的6 min步行距离均明显长于治疗前（t值分别为13.16、17.92，P<0.01）。治疗2个月后，联合训练组患者10 m步行时长明显短于常规训练组（t=3.20，P<0.01）；常规训练组和联合训练组患者治疗2个月后的10 m步行时长均明显短于治疗前（t值分别为7.21、13.13，P<0.01）。治疗2个月后，联合训练组患者对治疗效果的满意度得分明显高于常规训练组（Z=3.14，P<0.01）；常规训练组和联合训练组患者治疗2个月后对治疗效果的满意度得分均明显高于治疗前（Z值分别为3.98、4.04，P<0.01）。 结论 功率自行车康复训练可以改善大面积烧伤致下肢功能障碍患者的股四头肌厚度、肌力以及步行能力，提高患者对治疗效果的满意度，值得推广。 Abstract:Objective To explore the effects of bicycle ergometer rehabilitation training on quadriceps and walking ability of patients with lower limb dysfunction caused by extensive burns. Methods A prospective randomized controlled study was conducted. A total of 40 patients with extensive burns who met the inclusion criteria and were admitted to Tongren Hospital of Wuhan University＆Wuhan Third Hospital from December 2017 to December 2020 were selected. According to the random number table, the patients were divided into conventional training group (16 males, 4 females, aged (45±10) years) and combined training group (13 males, 7 females, aged (39±8) years). Patients in conventional training group were given conventional rehabilitation therapy such as joint loosening, lower limb strength training, walking training, and pressure therapy, while patients in combined training group were given additional bicycle ergometer rehabilitation training on the basis of conventional rehabilitation. For patients in the 2 groups before and after a 2-month's treatment, the thickness of quadriceps was measured by ultrasonic diagnostic instrument, the muscle strength of quadriceps was measured by portable muscle strength tester, the walking ability was tested with a 6-min and a 10-meter walk tests, and the patients' satisfaction for treatment effects was assessed using the modified Likert scale. Data were statistically analyzed with independent or paired sample t test, Mann-Whitney U test, Wilcoxon signed rank test, or chi-square test. Results After 2-month's treatment, the quadriceps thickness of patients in combined training group was (3.76±0.39) cm, which was significantly thicker than (3.45±0.35) cm in conventional training group (t=2.67, P<0.05); quadriceps thickness of patients in conventional training group and combined training group after 2-month's treatment was significantly thicker than that before treatment (with t values of 5.99 and 8.62, respectively, P<0.01). After 2-month's treatment, the quadriceps muscle strength of patients in combined training group was significantly greater than that in conventional training group (Z=2.69, P<0.01); quadriceps muscle strength of patients in conventional training group and combined training group after 2-month's treatment was significantly greater than that before treatment (with Z values of 3.92 and 3.92, respectively, P<0.01). After 2-month's treatment, the 6-min walking distance of patients in combined training group was (488±39) m, which was significantly longer than (429±25) m in conventional training group (t=5.66, P<0.01); the 6-min walking distance of patients after 2-month's treatment in conventional training group and combined training group was significantly longer than that before treatment (with t values of 13.16 and 17.92, respectively, P<0.01). After 2-month's treatment, the 10-meter walking time of patients in combined training group was significantly shorter than that in conventional training group (t=3.20, P<0.01); and the 10-meter walking time in conventional training group and combined training group was significantly shorter than that before treatment (with t values of 7.21 and 13.13, respectively, P<0.01). The patients' satisfaction score for treatment effects in combined training group was significantly higher than that in conventional training group (Z=3.14, P<0.01), and the patients' satisfaction scores for treatment effects in conventional training group and combined training group after 2-month's treatment were significantly greater than those before treatment (with Z values of 3.98 and 4.04, respectively, P<0.01). Conclusions Bicycle ergometer rehabilitation training can be used to improve quadriceps thickness, muscle strength, and walking ability of patients with lower limb dysfunction caused by extensive burns. It can also improve the satisfaction of patients with the treatment outcome, and therefore is worthy of promotion. -
参考文献
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2 下肢股四头肌萎缩和步行能力障碍患者采用功率自行车联合常规康复训练治疗前后股四头肌厚度。2A.治疗前患者右下肢股四头肌厚度为2.66 cm；2B.治疗2个月后患者右下肢股四头肌厚度为4.15 cm
表1 大面积烧伤致股四头肌萎缩和/或步行能力障碍的2组患者临床资料比较
组别 例数 性别（例） 体重（kg， 年龄（岁， 烧伤总面积（%TBSA， 下肢烧伤面积（%TBSA， 下肢Ⅲ度烧伤面积［%TBSA，M（Q1，Q3）］ 创面基本愈合时间（d， 创面基本愈合后纳入本研究时间（d， 男 女 常规训练组 20 16 4 64±11 45±10 47±8 22±8 12（8，14） 56±7 14±6 联合训练组 20 13 7 63±11 39±8 44±9 20±6 13（9，16） 59±5 13±4 统计量值 χ2=1.13 t=0.37 t=1.96 t=1.17 t=0.89 Z=0.86 t=1.63 t=0.42 P值 0.288 0.711 0.057 0.248 0.380 0.392 0.112 0.675 注：联合训练组在常规训练组常规康复训练的基础上增加功率自行车康复训练；TBSA为体表总面积 
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表2 大面积烧伤致股四头肌萎缩和/或步行能力障碍的2组患者治疗前后股四头肌厚度比较（cm，
组别 例数 治疗前 治疗2个月后 t值 P值 常规训练组 20 2.94±0.15 3.45±0.35 5.99 <0.001 联合训练组 20 2.97±0.21 3.76±0.39 8.62 <0.001 t值 0.58 2.67 P值 0.607 0.011 注：联合训练组在常规训练组常规康复训练的基础上增加功率自行车康复训练
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表3 大面积烧伤致股四头肌萎缩和/或步行能力障碍的2组患者治疗前后股四头肌肌力比较[N，M（Q1，Q3）]
组别 例数 治疗前 治疗2个月后 Z值 P值 常规训练组 20 88.0（83.3，98.5） 146.0（134.3，164.0） 3.92 <0.001 联合训练组 20 94.0（77.0，97.0） 170.5（147.3，176.8） 3.92 <0.001 Z值 0.46 2.69 P值 0.645 0.007 注：联合训练组在常规训练组常规康复训练的基础上增加功率自行车康复训练
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表4 大面积烧伤致股四头肌萎缩和/或步行能力障碍的2组患者治疗前后6 min步行距离比较（m，
组别 例数 治疗前 治疗2个月后 t值 P值 常规训练组 20 290±36 429±25 13.16 <0.001 联合训练组 20 280±37 488±39 17.92 <0.001 t值 0.93 5.66 P值 0.357 <0.001 注：联合训练组在常规训练组常规康复训练的基础上增加功率自行车康复训练
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表5 大面积烧伤致股四头肌萎缩和/或步行能力障碍的2组患者治疗前后10 m步行时长比较（s，
组别 例数 治疗前 治疗2个月后 t值 P值 常规训练组 20 16.5±3.9 9.1±1.9 7.21 <0.001 联合训练组 20 15.9±2.7 7.6±0.8 13.13 <0.001 t值 0.58 3.20 P值 0.564 0.004 注：联合训练组在常规训练组常规康复训练的基础上增加功率自行车康复训练
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表6 大面积烧伤致股四头肌萎缩和/或步行能力障碍的2组患者治疗前后对训练效果的满意度得分比较[分，M（Q1，Q3）]
组别 例数 治疗前 治疗2个月后 Z值 P值 常规训练组 20 1（1，1） 3（3，3） 3.98 <0.001 联合训练组 20 1（0，1） 4（3，4） 4.04 <0.001 Z值 0.47 3.14 P值 0.637 0.002 注：联合训练组在常规训练组常规康复训练的基础上增加功率自行车康复训练
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