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影响的前瞻性随机对照研究

吴坤平; 陈佩; 茹天峰; 袁林; 罗皓; 谢卫国

doi:10.3760/cma.j.cn501120-20210221-00060

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影响的前瞻性随机对照研究

doi: 10.3760/cma.j.cn501120-20210221-00060

武汉大学同仁医院暨武汉市第三医院烧伤科,武汉　　430060

基金项目:

武汉市卫生和健康委员会科研项目 WG19B02, WG18Q10

详细信息

通讯作者:
谢卫国，Email：wgxie@hotmail.com

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出版历程
- 收稿日期: 2021-02-21
- 网络出版日期: 2022-07-20
- 刊出日期: 2022-05-20

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

Department of Burns, Tongren Hospital of Wuhan University＆Wuhan Third Hospital, Wuhan 430060, China

Funds:

Scientific Research Project of Health Commission of Wuhan WG19B02, WG18Q10

More Information

Corresponding author: Xie Weiguo, Email: wgxie@hotmail.com

摘要

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。
- 烧伤 /
- 下肢 /
- 康复研究 /
- 步行试验 /
- 肌肉厚度 /
- 功率自行车康复训练
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.
- Burns /
- Lower extremity /
- Rehabilitation research /
- Walk test /
- Muscle thickness /
- Bicycle ergometer rehabilitation training
吴坤平：研究方案制订、实施，数据采集、整理、分析，论文撰写；陈佩、茹天峰、袁林、罗皓：参与数据采集、论文修改；谢卫国：研究指导、论文修改、经费支持

所有作者均声明不存在利益冲突

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1 大面积烧伤致股四头肌萎缩和步行能力障碍患者股四头肌肌力测试

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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

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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， $\bar{x} \pm s$ ）	年龄（岁， $\bar{x} \pm s$ ）	烧伤总面积（%TBSA， $\bar{x} \pm s$ ）	下肢烧伤面积（%TBSA， $\bar{x} \pm s$ ）	下肢Ⅲ度烧伤面积［%TBSA，M（Q₁，Q₃）］	创面基本愈合时间（d， $\bar{x} \pm s$ ）	创面基本愈合后纳入本研究时间（d， $\bar{x} \pm s$ ）
组别	例数	男	女	体重（kg， $\bar{x} \pm s$ ）	年龄（岁， $\bar{x} \pm s$ ）	烧伤总面积（%TBSA， $\bar{x} \pm s$ ）	下肢烧伤面积（%TBSA， $\bar{x} \pm s$ ）	下肢Ⅲ度烧伤面积［%TBSA，M（Q₁，Q₃）］	创面基本愈合时间（d， $\bar{x} \pm s$ ）	创面基本愈合后纳入本研究时间（d， $\bar{x} \pm s$ ）
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， $\bar{x} \pm s$ ）

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， $\bar{x} \pm s$ ）

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， $\bar{x} \pm s$ ）

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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