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发散式体外冲击波疗法改善膝关节挛缩角度及步态：一项随机临床试验研究
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Abstract:
目的：旨在探究膝关节挛缩患者在发散式体外冲击波治疗后行走时步态相关参数的变化和动态足底压力的分布规律。方法：选取安徽医科大学第二附属医院2022年9月至2024年2月诊治的40例单侧膝关节挛缩患者作为研究对象，将40例膝关节挛缩患者随机分为2组，20例行常规康复治疗(A组)，20例在常规康复治疗基础上行发散式体外冲击波治疗(B组)。另选取20例步态自然的健康人群(C组)。分别在行康复治疗前1天，治疗后第1、2周对患者进行足底压力系统检测及膝关节主动屈曲活动度测量。另对正常组同样进行足底压力系统检测。结果：冲击波组和常规治疗组在接受治疗后膝关节主动屈曲活动度均有显著提升，差异有统计学意义(P < 0.05)。与常规组相比，冲击波组治疗后膝关节主动屈曲活动度更具优势，差异有统计学意义(P < 0.05)。冲击波组膝关节挛缩患者治疗后的步幅长度和步速均明显提升，差异有统计学意义(P < 0.05)。冲击波组患者治疗后的足底分区压力占比对比治疗前无明显差异。膝关节挛缩患者的患侧T2区、MF区足底压力占比相较于正常人轻度升高，M4区、M5区足底压力占比相较于正常人显著升高，M1、M2区足底压力占比较正常人轻度降低，MH区、LH区足底压力占比相较于正常人显著降低，差异均有统计学意义(P < 0.05)。结论：康复治疗可以明显改善膝关节的主动屈曲活动度丧失，且体外冲击波疗法对改善膝关节主动活动度相较常规治疗有一定优势。体外冲击波治疗联合常规的康复治疗可以明显提升膝关节挛缩患者的步幅长度和步速，改善其步态，因此在临床上具有相当高的价值和应用前景。
Objective: The aim was to investigate the changes in gait-related parameters and the distribution pattern of dynamic plantar pressure during walking in patients with knee contracture after radial extracorporeal shockwave therapy. Methods: Forty cases of unilateral knee contracture patients treated in the Second Affiliated Hospital of Anhui Medical University from September 2022 to February 2024 were selected as the study subjects, and the 40 patients with knee contracture were randomly divided into 2 groups, 20 cases with conventional rehabilitation therapy (Group A), and 20 cases with radial extracorporeal shockwave therapy on the basis of conventional rehabilitation therapy (Group B). Another 20 healthy people with natural gait were selected (Group C). The plantar pressure system and active knee flexion mobility were measured 1 day before and 1 and 2 weeks after the rehabilitation treatment, respectively. The plantar pressure system was also measured in the normal group. Results: The active flexion activity of the knee joint in both the shock wave group and the conventional treatment group was significantly improved after treatment, and the difference was statistically significant (P < 0.05). Compared with the conventional group, the active flexion activity of the knee joint in the shockwave group was more advantageous after treatment, and the difference was statistically significant (P < 0.05). The step length and step speed of patients with knee contracture in the shockwave group were significantly improved after treatment, and the difference was statistically significant (P < 0.05). There was no significant difference in the plantar zonal pressure percentage of patients in the shockwave group after treatment compared to before treatment. In patients with knee joint contracture, the ratio of plantar pressure in the T2 and MF zones
| [1] | Zhou, Y., Zhang, Q.B., Zhong, H.Z., et al. (2020) Rabbit Model of Extending Knee Joint Contracture: Progression of Joint Motion Restriction and Subsequent Joint Capsule Changes after Immobilization. Journal of Knee Surgery, 33, 15-21. https://doi.org/10.1055/s-0038-1676502 |
| [2] | Yi, X., Wang, Z., Ren, J., Zhuang, Z., Liu, K., Wang, K., et al. (2019) Overexpression of Chaperonin Containing T-Complex Polypeptide Subunit Zeta 2 (CCT6b) Suppresses the Functions of Active Fibroblasts in a Rat Model of Joint Contracture. Journal of Orthopaedic Surgery and Research, 14, Article No. 125. https://doi.org/10.1186/s13018-019-1161-6 |
| [3] | James, S.E.F.M. (2001) Contractures in Orthopaedic and Neurological Conditions: A Review of Causes and Treatment. Disability and Rehabilitation, 23, 549-558. https://doi.org/10.1080/09638280010029930 |
| [4] | Usuba, M., Miyanaga, Y., Miyakawa, S., Maeshima, T. and Shirasaki, Y. (2006) Effect of Heat in Increasing the Range of Knee Motion after the Development of a Joint Contracture: An Experiment with an Animal Model. Archives of Physical Medicine and Rehabilitation, 87, 247-253. https://doi.org/10.1016/j.apmr.2005.10.015 |
| [5] | Hildebrand, K.A., Zhang, M., Germscheid, N.M., Wang, C. and Hart, D.A. (2008) Cellular, Matrix, and Growth Factor Components of the Joint Capsule Are Modified Early in the Process of Posttraumatic Contracture Formation in a Rabbit Model. Acta Orthopaedica, 79, 116-125. https://doi.org/10.1080/17453670710014860 |
| [6] | Furia, J.P., Willis, F.B., Shanmugam, R. and Curran, S.A. (2013) Systematic Review of Contracture Reduction in the Lower Extremity with Dynamic Splinting. Advances in Therapy, 30, 763-770. https://doi.org/10.1007/s12325-013-0052-1 |
| [7] | Abdel, M.P., Morrey, M.E., Barlow, J.D., Kreofsky, C.R., An, K., Steinmann, S.P., et al. (2011) Myofibroblast Cells Are Preferentially Expressed Early in a Rabbit Model of Joint Contracture. Journal of Orthopaedic Research, 30, 713-719. https://doi.org/10.1002/jor.21588 |
| [8] | Unterhauser, F.N., Bosch, U., Zeichen, J. and Weiler, A. (2004) α-Smooth Muscle Actin Containing Contractile Fibroblastic Cells in Human Knee Arthrofibrosis Tissue. Archives of Orthopaedic and Trauma Surgery, 124, 585-591. https://doi.org/10.1007/s00402-004-0742-x |
| [9] | Kim, H.Y., Kim, K.J., Yang, D.S., Jeung, S.W., Choi, H.G. and Choy, W.S. (2015) Screw-Home Movement of the Tibiofemoral Joint during Normal Gait: Three-Dimensional Analysis. Clinics in Orthopedic Surgery, 7, 303-309. https://doi.org/10.4055/cios.2015.7.3.303 |
| [10] | El Naggar, T.E.D.M., Maaty, A.I.E. and Mohamed, A.E. (2020) Effectiveness of Radial Extracorporeal Shock-Wave Therapy versus Ultrasound-Guided Low-Dose Intra-Articular Steroid Injection in Improving Shoulder Pain, Function, and Range of Motion in Diabetic Patients with Shoulder Adhesive Capsulitis. Journal of Shoulder and Elbow Surgery, 29, 1300-1309. https://doi.org/10.1016/j.jse.2020.03.005 |
| [11] | Kuroda, R., Hoshino, Y., Kubo, S., Araki, D., Oka, S., Nagamune, K., et al. (2011) Similarities and Differences of Diagnostic Manual Tests for Anterior Cruciate Ligament Insufficiency. The American Journal of Sports Medicine, 40, 91-99. https://doi.org/10.1177/0363546511423634 |
| [12] | 周云, 王锋, 张全兵, 等. Motomed功能训练对创伤性膝关节挛缩患者关节功能恢复的疗效观察[J]. 中华临床医师杂志(电子版), 2016, 10(24): 3711-3715. |
| [13] | Ozawa, J., Kaneguchi, A., Minamimoto, K., Tanaka, R., Kito, N. and Moriyama, H. (2017) Accumulation of Advanced-Glycation End Products (AGEs) Accelerates Arthrogenic Joint Contracture in Immobilized Rat Knee. Journal of Orthopaedic Research, 36, 854-863. https://doi.org/10.1002/jor.23719 |
| [14] | Abdul, N., Dixon, D., Walker, A., Horabin, J., Smith, N., Weir, D.J., et al. (2015) Fibrosis Is a Common Outcome Following Total Knee Arthroplasty. Scientific Reports, 5, Article No. 16469. https://doi.org/10.1038/srep16469 |
| [15] | Lee, S., Sakurai, T., Ohsako, M., Saura, R., Hatta, H. and Atomi, Y. (2010) Tissue Stiffness Induced by Prolonged Immobilization of the Rat Knee Joint and Relevance of AGEs (Pentosidine). Connective Tissue Research, 51, 467-477. https://doi.org/10.3109/03008201003686941 |
| [16] | Lubiatowski, P., ？l？zak, M., Wa？ecka, J., Br？borowicz, M. and Romanowski, L. (2018) Prospective Outcome Assessment of Arthroscopic Arthrolysis for Traumatic and Degenerative Elbow Contracture. Journal of Shoulder and Elbow Surgery, 27, e269-e278. https://doi.org/10.1016/j.jse.2018.02.068 |
| [17] | Monument, M.J., Hart, D.A., Befus, A.D., Salo, P.T., Zhang, M. and Hildebrand, K.A. (2010) The Mast Cell Stabilizer Ketotifen Fumarate Lessens Contracture Severity and Myofibroblast Hyperplasia. The Journal of Bone and Joint Surgery, 92, 1468-1477. https://doi.org/10.2106/jbjs.i.00684 |
| [18] | Campbell, T.M., Trudel, G., Wong, K.K. and Laneuville, O. (2014) Genome Wide Gene Expression Analysis of the Posterior Capsule in Patients with Osteoarthritis and Knee Flexion Contracture. The Journal of Rheumatology, 41, 2232-2239. https://doi.org/10.3899/jrheum.140079 |
| [19] | Fehring, T.K., Odum, S.M., Griffin, W.L., McCoy, T.H. and Masonis, J.L. (2007) Surgical Treatment of Flexion Contractures after Total Knee Arthroplasty. The Journal of Arthroplasty, 22, 62-66. https://doi.org/10.1016/j.arth.2007.03.037 |
| [20] | De la Corte-Rodríguez, H., Román-Belmonte, J.M., Rodríguez-Damiani, B.A., Vázquez-Sasot, A. and Rodríguez-Merchán, E.C. (2023) Extracorporeal Shock Wave Therapy for the Treatment of Musculoskeletal Pain: A Narrative Review. Healthcare, 11, Article 2830. https://doi.org/10.3390/healthcare11212830 |
| [21] | Moya, D., Ramón, S., Schaden, W., Wang, C., Guiloff, L. and Cheng, J. (2018) The Role of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders. Journal of Bone and Joint Surgery, 100, 251-263. https://doi.org/10.2106/jbjs.17.00661 |
| [22] | Wang, C., Sun, Y., Wong, T., Hsu, S., Chou, W. and Chang, H. (2012) Extracorporeal Shockwave Therapy Shows Time-Dependent Chondroprotective Effects in Osteoarthritis of the Knee in Rats. Journal of Surgical Research, 178, 196-205. https://doi.org/10.1016/j.jss.2012.01.010 |
| [23] | Wang, C., Wang, F., Yang, K.D., Weng, L., Hsu, C., Huang, C., et al. (2003) Shock Wave Therapy Induces Neovascularization at the Tendon-Bone Junction. A Study in Rabbits. Journal of Orthopaedic Research, 21, 984-989. https://doi.org/10.1016/s0736-0266(03)00104-9 |
| [24] | Abe, Y., Ito, K., Hao, K., Shindo, T., Ogata, T., Kagaya, Y., et al. (2014) Extracorporeal Low-Energy Shock-Wave Therapy Exerts Anti-Inflammatory Effects in a Rat Model of Acute Myocardial Infarction. Circulation Journal, 78, 2915-2925. https://doi.org/10.1253/circj.cj-14-0230 |
| [25] | Ujiie, N., Nakano, T., Yamada, M., Sato, C., Nakanishi, C., Fujishima, F., et al. (2020) Low-Energy Extracorporeal Shock Wave Therapy for a Model of Liver Cirrhosis Ameliorates Liver Fibrosis and Liver Function. Scientific Reports, 10, Article No. 2405. https://doi.org/10.1038/s41598-020-58369-w |
| [26] | 杨杰华, 冼晓琪, 区大明, 等. 脊椎矫正枪技术修复骨骼组织细胞产生拉应力及压应力的作用[J]. 中国组织工程研究, 2014, 18(51): 8212-8216. |
| [27] | Sanford, B.A., Zucker-Levin, A.R., Williams, J.L., Mihalko, W.M. and Jacobs, E.L. (2012) Principal Component Analysis of Knee Kinematics and Kinetics after Anterior Cruciate Ligament Reconstruction. Gait & Posture, 36, 609-613. https://doi.org/10.1016/j.gaitpost.2012.06.003 |
| [28] | Northon, S., Boivin, K., Laurencelle, L., Hagemeister, N. and de Guise, J.A. (2018) Quantification of Joint Alignment and Stability during a Single Leg Stance Task in a Knee Osteoarthritis Cohort. The Knee, 25, 1040-1050. https://doi.org/10.1016/j.knee.2018.08.011 |
