神经肌肉再教育对全髋关节置换术后患者髋关节力学及功能表现的影响：病例系列研究
Effects of neuromuscular reeducation on hip mechanics and functional performance in patients after total hip arthroplasty: A case series.
作者信息
Judd Dana L, Winters Joshua D, Stevens-Lapsley Jennifer E, Christiansen Cory L
机构信息
University of Colorado Anschutz Medical Campus, Physical Therapy Program, 13121 E. 17th Ave, Mail Stop C244, Aurora, CO 80045, USA.
University of Colorado Anschutz Medical Campus, Physical Therapy Program, 13121 E. 17th Ave, Mail Stop C244, Aurora, CO 80045, USA.
出版信息
Clin Biomech (Bristol). 2016 Feb;32:49-55. doi: 10.1016/j.clinbiomech.2015.12.008. Epub 2015 Dec 31.
BACKGROUND
Following total hip arthroplasty, patients demonstrate compensatory movement strategies during activities of daily living such as walking and stair climbing. Movement compensations are important markers of functional decline in older adults and are related to poor functional capacity. Despite increased utilization of hip arthroplasty, persistent movement compensation, and functional performance deficits, no consensus on postoperative rehabilitation exists. Neuromuscular reeducation techniques offer a strategy to improve movement quality by emphasizing hip abductor performance and pelvic stability. This case series illustrates changes in movement strategy around the hip in response to targeted neuromuscular reeducation techniques after hip arthroplasty.
METHODS
Five participants received an 8-week exercise program following total hip arthroplasty, emphasizing targeted neuromuscular reeducation techniques hallmarked by specific, weight-bearing exercise to improve hip abductor performance and pelvic stability. Five additional participants were supervised and followed for comparison.
FINDINGS
Participants in the neuromuscular reeducation program improved their internal hip abductor moments and vertical ground reaction forces during walking and stair climbing. They also improved their functional performance and hip abductor strength outcomes.
INTERPRETATION
Targeted neuromuscular reeducation techniques after total hip arthroplasty provided a positive effect on biomechanical outcomes, functional performance, and muscle strength. Through focused use of the hip abductor muscles, increased internal hip abductor moments were observed. This intervention potentially promotes pelvic stability, and may contribute to improved performance on tasks such as stair climbing, fast walking, and balance. The results suggest that neuromuscular reeducation offers a unique effect on movement strategy and function for patients following total hip arthroplasty.
背景
全髋关节置换术后，患者在诸如行走和爬楼梯等日常生活活动中表现出代偿性运动策略。运动代偿是老年人功能衰退的重要标志，且与功能能力差有关。尽管髋关节置换术的应用增加，但持续的运动代偿和功能表现缺陷仍然存在，术后康复尚无共识。神经肌肉再教育技术提供了一种通过强调髋外展肌表现和骨盆稳定性来改善运动质量的策略。本病例系列阐述了髋关节置换术后针对神经肌肉再教育技术，髋关节周围运动策略的变化。
方法
五名参与者在全髋关节置换术后接受了为期8周的运动计划，重点是针对性的神经肌肉再教育技术，其特点是进行特定的负重运动以改善髋外展肌表现和骨盆稳定性。另外五名参与者接受监督和随访以作比较。
结果
神经肌肉再教育计划的参与者在行走和爬楼梯时改善了髋内收肌力矩和垂直地面反作用力。他们还改善了功能表现和髋外展肌力量结果。
解读
全髋关节置换术后针对性的神经肌肉再教育技术对生物力学结果、功能表现和肌肉力量产生了积极影响。通过集中使用髋外展肌，观察到髋内收肌力矩增加。这种干预可能促进骨盆稳定性，并可能有助于改善爬楼梯、快走和平衡等任务的表现。结果表明，神经肌肉再教育对全髋关节置换术后患者的运动策略和功能具有独特作用。
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