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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影响的前瞻性随机对照研究

赵海洋 刘佳琦 韩军涛 朱婵 周琴 徐婧 梁敏 张博文 齐宗师

赵海洋, 刘佳琦, 韩军涛, 等. 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影响的前瞻性随机对照研究[J]. 中华烧伤与创面修复杂志, 2022, 38(12): 1117-1125. DOI: 10.3760/cma.j.cn501225-20220616-00236.
引用本文: 赵海洋, 刘佳琦, 韩军涛, 等. 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影响的前瞻性随机对照研究[J]. 中华烧伤与创面修复杂志, 2022, 38(12): 1117-1125. DOI: 10.3760/cma.j.cn501225-20220616-00236.
Zhao HY,Liu JQ,Han JT,et al.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[J].Chin J Burns Wounds,2022,38(12):1117-1125.DOI: 10.3760/cma.j.cn501225-20220616-00236.
Citation: Zhao HY,Liu JQ,Han JT,et al.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[J].Chin J Burns Wounds,2022,38(12):1117-1125.DOI: 10.3760/cma.j.cn501225-20220616-00236.

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影响的前瞻性随机对照研究

doi: 10.3760/cma.j.cn501225-20220616-00236
基金项目: 

陕西省重点研发计划 2022SF-279

详细信息
    通讯作者:

    刘佳琦,Email:anlhw07@fmmu.edu.cn

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

Funds: 

Shaanxi Provincial Key Research and Development Plan 2022SF-279

More Information
  • 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。

     

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  • 1  渐进式核心肌群初级训练。1A.双桥式训练;1B.水平仰卧起坐训练;1C.屈膝摸踝训练

    2  渐进式核心肌群中级训练。2A.单桥式训练;2B.屈膝仰卧起坐训练;2C.平躺蹬车训练

    3  渐进式核心肌群高级训练。3A.平躺Bobath球支撑训练;3B.仰卧两头起训练;3C.侧身Bobath球支撑训练

    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,x¯±s烧伤总面积(%TBSA,x¯±s下肢深Ⅱ度烧伤面积(%TBSA,x¯±s下肢Ⅲ度烧伤面积(%TBSA,x¯±s伤后至开始康复治疗时间(d,x¯±s
    单纯智能康复组30201040±344±619±720±649.0±2.9
    联合康复组30161439±345±719±819±748.5±3.6
    统计量值χ2=1.11t=1.70t=-0.04t=0.69t=0.63t=0.67
    P0.2920.0950.9700.5500.5300.506
    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
    下载: 导出CSV

    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,x¯±s

    组别例数训练前训练6周后tP
    单纯智能康复组3024.9±2.727.3±3.8-3.210.003
    联合康复组3023.9±2.329.6±3.9-6.50<0.001
    t1.43-2.28
    P0.1580.026
    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
    下载: 导出CSV

    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,x¯±s

    组别例数训练前训练6周后tP
    单纯智能康复组3027±636±5-8.09<0.001
    联合康复组3025±841±7-8.72<0.001
    t0.94-2.68
    P0.3520.011
    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
    下载: 导出CSV
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