【摘要】 目的 分析全膝关节置换术后患者应用下肢康复机器人辅助训练联合早期路径式训练对膝关节功能、下肢肌力及平衡能力的影响。方法 选取2020-09-10-2021-12-10郑州市骨科医院东院区收治的膝骨性关节炎全膝关节置换术后患者90例作为研究对象，根据性别、年龄、体质量及手术部位组间均衡原则分组。对照组45例给予早期路径式训练，观察组45例增加下肢康复机器人辅助训练。术后3个月，以中文版牛津膝关节功能评分表(HSS)、膝关节活动度评估患者膝关节功能；术后3个月，isoforce多关节等速肌力测定测试系统评估患者下肢肌力；术后1、3个月，采用Breg平衡量表(BBS)评分评估患者平衡能力。研究数据由收集临床相关登记资料、检查与检验、问卷调查取得，采用单因素协方差检测、重复测量方差分析。结果 2组患者术后3个月膝关节活动度、被动膝关节活动、HSS评分、屈肌及伸肌总功、单次最大做功量、峰力矩均高于术后1 d,差异有统计学意义，均P<0.05。术后3个月，观察组的主动膝关节活动度为(101.20±10.22)°,高于对照组的(90.09±10.55)°,差异有统计学意义，F=32.131,P<0.001;被动膝关节活动度为(105.16±12.13)°,高于对照组的(95.73±10.75)°,差异有统计学意义，F=14.944,P<0.001;HSS评分为(74.42±6.32)分，高于对照组的(67.29±6.66)分，差异有统计学意义，F=26.670,P<0.001。术后3个月，观察组屈肌峰力矩为(53.24±8.06) N·m,高于对照组的(46.10±7.92) N·m,差异有统计学意义，F=17.474,P<0.001;屈肌总功为(409.67±47.12) J,高于对照组(363.13±48.98) J,差异有统计学意义，F=21.117,P<0.001;屈肌单次最大做功量为(35.81±6.32) J,高于对照组的(30.97±5.89)J,差异有统计学意义，F=13.978,P<0.001。术后3个月，观察组伸肌峰力矩为(105.23±14.97) N·m,高于对照组的(95.63±11.24) N·m,差异有统计学意义，F=11.089,P<0.001;伸肌总功为(568.70±87.82) J,高于对照组的(493.36±87.30) J,差异有统计学意义，F=17.264,P<0.001;伸肌单次最大做功量为(30.33±5.50) J,高于对照组(26.07±5.53) J,差异有统计学意义，F=13.616,P<0.001。术后1、3个月，观察组Breg平衡量表(BBS)评分分别为(39.67±4.63)、(50.27±3.01)分，对照组分别为(35.98±4.73)、(43.71±4.74)分，均高于术后1 d,且观察组高于对照组，差异有统计学意义，F=36.200,P<0.001。结论 膝骨性关节炎全膝关节置换术后患者应用下肢康复机器人辅助训练联合早期路径式训练可有效提高下肢肌力水平，促进膝关节功能恢复，增强平衡能力。更多还原

【Abstract】 Objective To analyze the effects of lower limb rehabilitation robot-assisted training combined with early path training on knee joint function,lower limb muscle strength and balance ability in patients after total knee arthroplasty.Methods A total of 90patients with knee osteoarthritis after total knee replacement treated in the East Ward of Zhengzhou Orthopedics Hospital from 2020-09-10to 2021-12-10were selected as the research objects,and they were grouped according to the balance principle of gender,age,body weight and surgical site.The control group was given early path training,and the observation group was given lower limb rehabilitation robot training.Three months after surgery,the Chinese version of the Oxford Knee Function Rating Scale(HSS)and knee range of motion were used to assess the knee function of patients.Three months after surgery,the isoforce multi-joint isokinetic muscle strength measurement system was used to evaluate the lower extremity muscle strength of patients.Breg Balance Scale(BBS)score was used to evaluate patients’balance ability in 1and 3months after surgery.The study data were collected from clinical registration data,examination and test,and questionnaire survey.Univariate covariance test and repeated measurement analysis of variance were used.Results Knee range of motion,passive knee activity,HSS score,total work of flexor and extensor muscles,single maximum work amount and peak moment in these two groups were higher 3months after surgery than 1day after surgery,with statistical significance(P<0.05).Three months after surgery,the active knee motion of the observation group was(101.20±10.22）°，higher than that of the control group(90.09±10.55）°，the difference was statistically significant,F=32.131,P<0.001;The range of motion of passive knee joint was(105.16±12.13）°，higher than that of control group(95.73±10.75）°，the difference was statistically significant,F=14.944,P<0.001;The HSS score was(74.42±6.32)points,higher than that of the control group(67.29±6.66)points,the difference was statistically significant,F=26.670,P<0.001.Three months after surgery,the flexor peak moment of the observation group was(53.24±8.06)N·m,higher than that of the control group(46.10±7.92)N·m,and the difference was statistically significant(F=17.474,P<0.001).The total work of flexor muscle was(409.67±47.12)J,higher than that of control group(363.13±48.98)J,the difference was statistically significant,F=21.117,P<0.001;The single maximum work amount of flexor muscle was(35.81±6.32)J,higher than that of control group(30.97±5.89)J,and the difference was statistically significant(F=13.978,P<0.001).Three months after surgery,the peak moment of the extensor muscle in the observation group was(105.23±14.97)N·m,higher than that in the control group(95.63±11.24)N·m,the difference was statistically significant(F=11.089,P<0.001).The total work of extensor muscle was(568.70±87.82)J,higher than that of control group(493.36±87.30)J,the difference was statistically significant,F=17.264,P<0.001;The maximum work amount of extensor muscle was(30.33±5.50)J,which was higher than that of control group(26.07±5.53)J,and the difference was statistically significant,F=13.616,P<0.001.One and three months after surgery,the Breg Balance Scale(BBS)scores of the observation group were(39.67±4.63)points and (50.27±3.01)points,respectively,while those of the control group were(35.98±4.73)points and(43.71±4.74)points,both higher than 1day after surgery,and the difference was statistically significant.F=36.200,P<0.001.Conclusion The application of lower limb rehabilitation robot-assisted training combined with early path training in patients with knee osteoarthritis after total knee arthroplasty can effectively improve the level of lower limb muscle strength,promote the recovery of knee function,and enhance the balance ability.更多还原