A prospective randomized controlled study on the effects of progressive core muscle group training combined with lower limb intelligent rehabilitation training for burn patients with lower limb dysfunction
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摘要:
目的 观察渐进式核心肌群训练联合下肢智能康复训练对烧伤患者下肢功能障碍的影响。 方法 采用前瞻性随机对照研究方法。2017年3月—2020年5月，空军军医大学第一附属医院收治60例符合入选标准的双下肢深Ⅱ度或Ⅲ度烧伤后运动及平衡功能障碍患者，按照随机数字表法分为单纯智能康复组［30例，男20例、女10例，年龄（40±3）岁］和联合康复组［30例，男16例、女14例，年龄（39±3）岁］。2组患者均于创面愈合后或散在残余创面面积<5%体表总面积时开始进行红光治疗。红光治疗2周后，联合康复组患者在单纯智能康复组下肢智能康复训练的基础上行渐进式核心肌群训练，训练时间均为6周。训练前及训练6周后，采用简易Fugl-Meyer量表评定下肢运动功能，采用Berg平衡量表评定平衡能力，采用Holden步行功能分级量表评定步行能力。训练6周后，自行设计调查表调查患者对治疗效果的满意度。治疗结束后6个月随访，观察患者屈曲位单脚站立的平衡稳定性及参与日常生活活动情况。对数据行独立样本t检验、配对样本t检验、χ²检验。 结果 训练前，单纯智能康复组患者下肢运动功能评分为（24.9±2.7）分，与联合康复组的（23.9±2.3）分相近（P>0.05）；训练6周后，联合康复组患者下肢运动功能评分为（29.6±3.9）分，明显高于单纯智能康复组的（27.3±3.8）分（t=-2.28，P<0.05）。联合康复组、单纯智能康复组患者训练6周后下肢运动功能评分均较训练前明显升高（t值分别为-6.50、-3.21，P<0.01）。训练6周后，联合康复组患者平衡能力评分为（41±7）分，明显高于单纯智能康复组的（36±5）分（t=-2.68，P<0.05）；联合康复组、单纯智能康复组患者训练6周后平衡能力评分均较训练前明显升高（t值分别为-8.72、-8.09，P<0.01）。训练6周后，联合康复组患者步行能力分级较单纯智能康复组明显提高（χ2=-2.14，P<0.05）；单纯智能康复组、联合康复组患者训练6周后的步行能力分级均较训练前明显提高（χ2值分别为-4.94、-5.26，P<0.01）。训练6周后，联合康复组患者对治疗效果的满意度评分为（13.7±1.2）分，明显高于单纯智能康复组的（7.8±1.4）分（t=22.84，P<0.01）。2组患者治疗结束后6个月，下肢屈曲位下可单脚站立保持平衡，日常生活活动不受影响。 结论 在常规康复治疗基础上，采用渐进式核心肌群训练联合下肢智能康复训练能明显促进烧伤患者下肢运动及平衡功能恢复。 Abstract:Objective To observe the effect of progressive core muscle group training combined with lower limb intelligent rehabilitation training on burn patients with lower limb dysfunction. Methods A prospective randomized controlled study was conducted. From March 2017 to May 2020, 60 patients with motor and balance dysfunction after deep partial-thickness burns or full-thickness burns of both lower extremities who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Military Medical University. They were divided into simple intelligent rehabilitation group (30 cases, 20 males and 10 females, aged (40±3) years) and combined rehabilitation group (30 cases, 16 males and 14 females, aged (39±3) years) according to the random number table method. The patients in both groups started red light treatment after the wound healing or when the scattered residual wound area was less than 5% total body surface area. After 2 weeks of red light treatment, patients in the combined rehabilitation group started progressive core muscle group training on the basis of lower limb intelligent rehabilitation training in simple intelligent rehabilitation group, and the training time was 6 weeks. Before and after 6 weeks of training, the lower limb motor function was evaluated with the simple Fugl-Meyer scale, the balance capacity was evaluated with the Berg balance scale, and the walking capacity was evaluated with the Holden walking ability rating scale. After 6 weeks of training, a self-designed questionnaire was used to investigate patients' satisfaction for the treatment effect. The patients were followed up for 6 months after the treatment to observe the balance stability of standing on one foot in the flexion position and their participation in activities of daily life. Data were statistically analyzed with independent sample t test, paired sample t test, and chi-square test. Results Before training, the lower limb motor function score of patients in simple intelligent rehabilitation group was 24.9±2.7, which was close to 23.9±2.3 in combined rehabilitation group (P>0.05). After 6 weeks of training, the lower limb motor function score of patients in combined rehabilitation group was 29.6±3.9, which was significantly higher than 27.3±3.8 in simple rehabilitation group (t=-2.28, P<0.05). The lower limb motor function scores of patients in combined rehabilitation group and simple intelligent rehabilitation group after 6 weeks of training were significantly higher than those before training (with t values of -6.50 and -3.21, respectively, P<0.01). After 6 weeks of training, the balance capacity score of patients in combined rehabilitation group was 41±7, which was significantly higher than 36±5 in simple intelligent rehabilitation group (t=-2.68, P<0.05); the balance capacity scores of patients in combined rehabilitation group and simple intelligent rehabilitation group after 6 weeks of training were significantly higher than those before training (with t values of -8.72 and -8.09, respectively, P<0.01). After 6 weeks of training, the walking capacity grading of patients in combined rehabilitation group was significantly improved compared with that in simple intelligent rehabilitation group (χ2=-2.14, P<0.05), and the walking capacity grading of patients in simple intelligent rehabilitation group and combined rehabilitation group after 6 weeks of training was significantly improved compared with that before treatment (with χ2 values of -4.94 and -5.26, respectively, P<0.01). After 6 weeks of training, the satisfaction score for the treatment effect of patients in combined rehabilitation group was 13.7±1.2, which was significantly higher than 7.8±1.4 in simple intelligent rehabilitation group (t=22.84, P<0.01). The patients in both groups could stand on one foot to maintain balance in the flexion position of lower limb, and their activities of daily life were not affected 6 months after treatment. Conclusions On the basis of conventional rehabilitation therapy, the combination of progressive core muscle group training and lower limb intelligent rehabilitation training can significantly promote the recovery of lower limb motor and balance function of burn patients. -
Key words:
- Burns /
- Rehabilitation /
- Lower extremity /
- Progressive core muscle group training /
- Motor function
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参考文献
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4 双下肢深度烧伤后下肢功能障碍患者的创面情况及康复训练方法。4A.入院后3 d，双下肢被覆黄色焦痂，表面可见栓塞血管网及多处切开减张；4B.伤后2个月余，创面基本愈合，足踝处残留少许小创面；4C.红光治疗2周后，行智能康复训练；4D.红光治疗2周后，行核心肌群训练（双桥式训练）
5 双下肢深度烧伤后下肢功能障碍患者行渐进式核心肌群训练联合下肢智能康复训练系统训练治疗后的效果。5A.训练6周后，能独自直立位单脚站立保持平衡；5B.训练6周后，能独自上下楼梯；5C.治疗结束后6个月，能屈曲位单脚站立保持平衡；5D.治疗结束后6个月，能驾驶小汽车
表1 2组深度烧伤后下肢功能障碍患者临床资料比较
组别 例数 性别（例） 年龄（岁， 烧伤总面积（%TBSA， 下肢深Ⅱ度烧伤面积（%TBSA， 下肢Ⅲ度烧伤面积（%TBSA， 伤后至开始康复治疗时间（d， 男 女 单纯智能康复组 30 20 10 40±3 44±6 19±7 20±6 49.0±2.9 联合康复组 30 16 14 39±3 45±7 19±8 19±7 48.5±3.6 统计量值 χ2=1.11 t=1.70 t=-0.04 t=0.69 t=0.63 t=0.67 P值 0.292 0.095 0.970 0.550 0.530 0.506 注：联合康复组在单纯智能康复组下肢智能康复训练基础上行渐进式核心肌群训练；TBSA为体表总面积 
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表2 2组深度烧伤后下肢功能障碍患者训练前后下肢运动功能评分比较（分，
组别 例数 训练前 训练6周后 t值 P值 单纯智能康复组 30 24.9±2.7 27.3±3.8 -3.21 0.003 联合康复组 30 23.9±2.3 29.6±3.9 -6.50 <0.001 t值 1.43 -2.28 P值 0.158 0.026 注：训练前为进行红光治疗2周后和进行康复训练前；联合康复组在单纯智能康复组下肢智能康复训练基础上行渐进式核心肌群训练
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表3 2组深度烧伤后下肢功能障碍患者训练前后平衡能力评分比较（分，
组别 例数 训练前 训练6周后 t值 P值 单纯智能康复组 30 27±6 36±5 -8.09 <0.001 联合康复组 30 25±8 41±7 -8.72 <0.001 t值 0.94 -2.68 P值 0.352 0.011 注：训练前为进行红光治疗2周后和进行康复训练前；联合康复组在单纯智能康复组下肢智能康复训练基础上行渐进式核心肌群训练
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