Department of Orthopedics, University Hospital Duesseldorf, Duesseldorf, Germany.
Faculty of Sport Sciences, Goethe University Frankfurt, Frankfurt, Germany.
Med Hypotheses. 2018 Jan;110:53-59. doi: 10.1016/j.mehy.2017.10.029. Epub 2017 Oct 31.
Osteoarthritis of the knee is one of the most commonly diagnosed joint ailments and responsible for increased rates of total knee arthroplasty surgeries worldwide. Whereas the surgical approach is able to diminish the perceived knee pain of concerned patients', the postoperative recovery is often accompanied by persistent skeletal muscle dysfunctions and atrophy, which is responsible for functional deficits for up to several years. Recent findings indicate that surgery induced adverse effects on skeletal muscles are largely associated with the use of pneumatic tourniquets, wherefore several studies try to reduce tourniquet use in orthopedic surgery. However, due to comparable incidence of muscle impairment and increased surgical challenge, the most frequently applied surgical technique in TKA is still associated with the use of tourniquets. When attenuating TKA induced adverse effects, the preoperative preparation of patients by specific exercises (called prehabilitation) was able to enhance preoperative overall fitness through associated accelerated recovery. Based on patients' limited functional activity, prehabilitation techniques have to be particularly designed to allow regular adherence. The present paper is based on a narrative review of current literature, and provides a novel hypothesis by which blood flow restriction exercises (BFR) are able to improve patients' compliance to prehabilitation. BFR training is characterized by the application of low-resistance exercise with similar intensities as daily living tasks in association with a suppression of venous blood flow in an extremity, achieving significant morphological and neuromuscular adaptations in skeletal muscles. In addition, preoperative enhancements in muscle health with corresponding benefits in overall fitness, BFR induced molecular alterations could also be able to interfere with TKA induced pathological signaling. Therefore, based on the known major impact of BFR on skeletal muscle physiology, the present paper aims to illustrate the potential beneficial impact of BFR training as a prehabilitation concept to promote patients regular adherence to preoperative exercises and thus achieve an accelerated recovery and increases in patients' satisfaction.
膝关节骨关节炎是最常见的关节疾病之一，也是导致全球全膝关节置换手术增加的原因。虽然手术方法能够减轻患者的膝关节疼痛，但术后恢复常常伴有持续的骨骼肌肉功能障碍和萎缩，这会导致患者在数年内出现功能缺陷。最近的研究结果表明，手术对骨骼肌肉的不良影响主要与使用气压止血带有关，因此，一些研究试图减少骨科手术中止血带的使用。然而，由于肌肉损伤的发生率相当，手术难度增加，全膝关节置换术最常用的手术技术仍然与止血带的使用有关。在减轻全膝关节置换术引起的不良影响时，通过特定的锻炼（称为康复前准备）对患者进行术前准备，可以通过相关的加速恢复来提高术前整体健康水平。由于患者的功能活动有限，康复前准备技术必须特别设计，以允许定期坚持。本文基于对当前文献的叙述性综述，提出了一个新的假说，即血流限制训练（BFR）能够提高患者对康复前准备的依从性。BFR 训练的特点是在四肢中应用低阻力运动，其强度与日常生活任务相似，并抑制静脉血流，从而在骨骼肌肉中实现显著的形态和神经肌肉适应性。此外，术前肌肉健康的增强和整体健康的相应改善，BFR 引起的分子改变也可能干扰全膝关节置换术引起的病理信号。因此，基于 BFR 对骨骼肌肉生理学的已知重大影响，本文旨在说明 BFR 训练作为康复前准备概念的潜在有益影响，以促进患者定期坚持术前锻炼，从而实现加速恢复和提高患者满意度。
