发散式体外冲击波疗法改善膝关节挛缩角度及步态：一项随机临床试验研究

Radial Extracorporeal Shockwave Therapy Improves Knee Contracture Angle and Gait: A Randomised Clinical Trial Study

摘要: 目的：旨在探究膝关节挛缩患者在发散式体外冲击波治疗后行走时步态相关参数的变化和动态足底压力的分布规律。方法：选取安徽医科大学第二附属医院2022年9月至2024年2月诊治的40例单侧膝关节挛缩患者作为研究对象，将40例膝关节挛缩患者随机分为2组，20例行常规康复治疗(A组)，20例在常规康复治疗基础上行发散式体外冲击波治疗(B组)。另选取20例步态自然的健康人群(C组)。分别在行康复治疗前1天，治疗后第1、2周对患者进行足底压力系统检测及膝关节主动屈曲活动度测量。另对正常组同样进行足底压力系统检测。结果：冲击波组和常规治疗组在接受治疗后膝关节主动屈曲活动度均有显著提升，差异有统计学意义(P < 0.05)。与常规组相比，冲击波组治疗后膝关节主动屈曲活动度更具优势，差异有统计学意义(P < 0.05)。冲击波组膝关节挛缩患者治疗后的步幅长度和步速均明显提升，差异有统计学意义(P < 0.05)。冲击波组患者治疗后的足底分区压力占比对比治疗前无明显差异。膝关节挛缩患者的患侧T2区、MF区足底压力占比相较于正常人轻度升高，M4区、M5区足底压力占比相较于正常人显著升高，M1、M2区足底压力占比较正常人轻度降低，MH区、LH区足底压力占比相较于正常人显著降低，差异均有统计学意义(P < 0.05)。结论：康复治疗可以明显改善膝关节的主动屈曲活动度丧失，且体外冲击波疗法对改善膝关节主动活动度相较常规治疗有一定优势。体外冲击波治疗联合常规的康复治疗可以明显提升膝关节挛缩患者的步幅长度和步速，改善其步态，因此在临床上具有相当高的价值和应用前景。

Abstract: Objective: The aim was to investigate the changes in gait-related parameters and the distribution pattern of dynamic plantar pressure during walking in patients with knee contracture after radial extracorporeal shockwave therapy. Methods: Forty cases of unilateral knee contracture patients treated in the Second Affiliated Hospital of Anhui Medical University from September 2022 to February 2024 were selected as the study subjects, and the 40 patients with knee contracture were randomly divided into 2 groups, 20 cases with conventional rehabilitation therapy (Group A), and 20 cases with radial extracorporeal shockwave therapy on the basis of conventional rehabilitation therapy (Group B). Another 20 healthy people with natural gait were selected (Group C). The plantar pressure system and active knee flexion mobility were measured 1 day before and 1 and 2 weeks after the rehabilitation treatment, respectively. The plantar pressure system was also measured in the normal group. Results: The active flexion activity of the knee joint in both the shock wave group and the conventional treatment group was significantly improved after treatment, and the difference was statistically significant (P < 0.05). Compared with the conventional group, the active flexion activity of the knee joint in the shockwave group was more advantageous after treatment, and the difference was statistically significant (P < 0.05). The step length and step speed of patients with knee contracture in the shockwave group were significantly improved after treatment, and the difference was statistically significant (P < 0.05). There was no significant difference in the plantar zonal pressure percentage of patients in the shockwave group after treatment compared to before treatment. In patients with knee joint contracture, the ratio of plantar pressure in the T2 and MF zones on the affected side was mildly increased compared with that of normal people, the ratio of plantar pressure in the M4 and M5 zones was significantly increased compared with that of normal people, the ratio of plantar pressure in the M1 and M2 zones was mildly decreased compared with that of normal people, and the ratio of plantar pressure in the MH and LH zones was significantly decreased compared with that of normal people, and the differences were statistically significant (P < 0.05). Conclusion: Rehabilitation therapy can significantly improve the loss of active flexion mobility of the knee joint, and extracorporeal shock wave therapy has certain advantages over conventional therapy in improving active mobility of the knee joint. The combination of extracorporeal shock wave therapy and conventional rehabilitation therapy can significantly improve the stride length and stride speed of patients with knee joint contracture, and improve their gait, so it has a high value and application prospect in clinical practice.