Cincinnati SportsMedicine & Orthopaedic Center, Cincinnati, Ohio, U.S.A.; Mercy Health, Cincinnati, Ohio, U.S.A.; Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, U.S.A.; Noyes Knee Institute, Cincinnati, Ohio, U.S.A.
Noyes Knee Institute, Cincinnati, Ohio, U.S.A..
Arthroscopy. 2021 Sep;37(9):2860-2869. doi: 10.1016/j.arthro.2021.03.040. Epub 2021 Mar 31.
To report a prospective study of patients who underwent blood flow restriction training (BFRT) for marked quadriceps or hamstring muscle deficits after failure to respond to traditional rehabilitation after knee surgery.
The BFRT protocol consisted of 4 low resistance exercises (30% of 1 repetition maximum): leg press, knee extension, mini-squats, and hamstring curls with 60% to 80% limb arterial occlusion pressure. Knee peak isometric muscle torque (60° flexion) was measured on an isokinetic dynamometer.
Twenty-seven patients (18 females, 9 males; mean age, 40.1 years) with severe quadriceps and/or hamstrings deficits were enrolled from April 2017 to January 2020. They had undergone a mean of 5.3 ± 3.5 months of outpatient therapy and 22 ± 10 supervised therapy visits and did not respond to traditional rehabilitation. Prior surgery included anterior cruciate ligament reconstruction, partial or total knee replacements, meniscus repairs, and others. All patients completed 9 BFRT sessions, and 14 patients completed 18 sessions. The mean quadriceps and hamstrings torque deficits before BFRT were 43% ± 16% and 38% ± 14%, respectively. After 9 BFRT sessions, statistically significant improvements were found in muscle peak torque deficits for the quadriceps (P = .003) and hamstring (P = .02), with continued improvements after 18 sessions (P = .004 and P = .002, respectively). After 18 BFRT sessions, the peak quadriceps and hamstring peak torques increased > 20% in 86% and 76% of the patients, respectively. The failure rate of achieving this improvement in peak quadriceps and hamstring torque after 18 BFRT sessions was 14% and 24%, respectively.
BFRT produced statistically significant improvements in peak quadriceps and hamstring torque measurements after 9 and 18 sessions in a majority of patients with severe quadriceps and hamstring strength deficits that had failed to respond to many months of standard and monitored postoperative rehabilitation.
Level IV therapeutic case series.
报告一项前瞻性研究，研究对象为膝关节手术后传统康复治疗失败后出现明显股四头肌或腘绳肌缺陷的患者，他们接受了血流限制训练（BFRT）。
BFRT 方案包括 4 项低阻力运动（1 次重复最大的 30%）：腿推、膝关节伸展、迷你深蹲和腘绳肌卷曲，同时施加 60%至 80%的肢体动脉闭塞压力。在等速测力计上测量膝关节等速峰值等长肌肉扭矩（60°屈曲）。
2017 年 4 月至 2020 年 1 月，共纳入 27 例（女性 18 例，男性 9 例；平均年龄 40.1 岁）严重股四头肌和/或腘绳肌缺陷患者。他们平均接受了 5.3±3.5 个月的门诊治疗和 22±10 次监督治疗，且对传统康复治疗没有反应。既往手术包括前交叉韧带重建、部分或全膝关节置换、半月板修复等。所有患者均完成了 9 次 BFRT 治疗，14 例患者完成了 18 次治疗。BFRT 前股四头肌和腘绳肌扭矩缺陷的平均值分别为 43%±16%和 38%±14%。9 次 BFRT 治疗后，股四头肌（P=0.003）和腘绳肌（P=0.02）的肌肉峰值扭矩缺陷均有统计学显著改善，18 次治疗后仍有持续改善（P=0.004 和 P=0.002）。18 次 BFRT 治疗后，86%的患者股四头肌和 76%的患者腘绳肌峰值扭矩增加超过 20%。18 次 BFRT 治疗后，股四头肌和腘绳肌峰值扭矩未达到改善的失败率分别为 14%和 24%。
BFRT 在多数严重股四头肌和腘绳肌力量缺陷患者中，在 9 次和 18 次治疗后，股四头肌和腘绳肌峰值扭矩测量值均有统计学显著改善，这些患者在接受了数月的标准和监测术后康复治疗后仍未得到改善。
IV 级治疗性病例系列研究。
