Salas-Gómez Diana, Fernández-Gorgojo Mario, Sanchez-Juan Pascual, Bercero Esther Laguna, Isabel Perez-Núñez M, Barbado David
Gimbernat-Cantabria Research Unit (SUIGC), University Schools Gimbernat-Cantabria, Attached to the University of Cantabria, 39300, Torrelavega, Spain; University Schools Gimbernat-Cantabria, Attached to the University of Cantabria, 39300, Torrelavega, Spain.
Gimbernat-Cantabria Research Unit (SUIGC), University Schools Gimbernat-Cantabria, Attached to the University of Cantabria, 39300, Torrelavega, Spain; Service of Neurology, University Hospital "Marqués de Valdecilla", University of Cantabria (UC), CIBERNED, IDIVAL, Santander, 39008, Cantabria, Spain.
Gait Posture. 2022 Jun;95:249-255. doi: 10.1016/j.gaitpost.2020.10.037. Epub 2020 Nov 6.
Ankle fractures are among the most common traumatic fractures and have a great socio-economic impact. Consequences of an ankle fracture requiring surgical treatment (e.g. pain, reduced ankle range of motion (ROM), muscle weakness, etc.) lead to balance deterioration, which has a profound impact on activities of daily living. However, to the best of the authors' knowledge, no reliable clinical tests are available to monitor balance in patients after ankle surgery.
To quantify single-leg dynamic balance in patients with bimalleolar ankle fracture through the Y-Balance test (YBT). The second objective was to analyze the impact of ankle dorsiflexion ROM and hip strength on balance to optimize balance rehabilitation programs.
Cross-sectional study.
22 participants, who had undergone surgery after bimalleolar ankle fractures, were assessed for ankle ROM, hip strength, and dynamic balance six-months after the surgical intervention. The within-session reliability of YBT was calculated through the intraclass correlation coefficient (ICC) and the standard error of measurement (SEM). Student's t-tests were used to assess leg differences. A multiple regression analysis was performed to evaluate the role of ankle dorsiflexion ROM and hip abductor and adductor strength in predicting balance performance.
YBT showed high-to-excellent within-session relative reliability (Healthy leg: 0.85 ≤ ICC≤0.96; Operated leg: 0.84 ≤ ICC≤0.96). SEM values were below 3.3 %. The operated leg showed significant lower YBT scores for anterior reach direction (-9.0 %; g=-0.70) and composite score (-4.5 %; g=-0.34). Multiple regression analysis showed that both, ankle dorsiflexion and hip abductor and adductor strength explained 66 % of the variance in the YBT anterior direction of the operated leg.
The YBT is a reliable tool that allows the quantification of single-leg dynamic balance impairments from 6-months after surgery in patients with bimalleolar ankle fracture. Between-leg YBT differences in the anterior direction can be used as reference scores (3.3 %) for balance restoration. Balance rehabilitation programs should focus on improving ankle functionality and reducing hip muscle weakness with specific hip strength exercises and balance exercises with similar demands to the reaching tasks of the YBT to promote a faster recovery.
踝关节骨折是最常见的创伤性骨折之一,具有重大的社会经济影响。需要手术治疗的踝关节骨折的后果(如疼痛、踝关节活动范围(ROM)减小、肌肉无力等)会导致平衡能力下降,这对日常生活活动有深远影响。然而,据作者所知,尚无可靠的临床测试可用于监测踝关节手术后患者的平衡能力。
通过Y平衡测试(YBT)量化双踝骨折患者的单腿动态平衡。第二个目的是分析踝关节背屈ROM和髋部力量对平衡的影响,以优化平衡康复计划。
横断面研究。
对22名双踝骨折后接受手术的参与者在手术干预6个月后进行踝关节ROM、髋部力量和动态平衡评估。通过组内相关系数(ICC)和测量标准误差(SEM)计算YBT在测试期间的可靠性。采用学生t检验评估双腿差异。进行多元回归分析,以评估踝关节背屈ROM以及髋外展肌和内收肌力量在预测平衡表现中的作用。
YBT在测试期间显示出高至优秀的相对可靠性(健侧:0.85≤ICC≤0.96;患侧:0.84≤ICC≤0.96)。SEM值低于3.3%。患侧在前伸方向的YBT评分显著较低(-9.0%;g=-0.70),综合评分也较低(-4.5%;g=-0.34)。多元回归分析表明,踝关节背屈以及髋外展肌和内收肌力量共同解释了患侧YBT前伸方向66%的差异。
YBT是一种可靠的工具,可用于量化双踝骨折患者术后6个月单腿动态平衡障碍。双腿在前伸方向的YBT差异可作为平衡恢复的参考评分(3.3%)。平衡康复计划应侧重于通过特定的髋部力量训练和与YBT伸展任务要求相似的平衡训练来改善踝关节功能和减少髋部肌肉无力,以促进更快恢复。