目的 探讨体外冲击波治疗(ESWT)对慢性髂胫束摩擦综合征(ITBS)患者髋膝关节运动学参数的影响,并通过三维步态分析验证其生物力学改善效应。方法 纳入30例符合纳入标准的ITBS患者,接受2次/周、连续4周的ESWT(能量密度2 bar,频率10 Hz)。于治疗前、治疗结束及结束后4周,采用视觉模拟量表(VAS)、下肢功能量表(LEFS)评估症状和功能,并通过三维步态分析系统量化髋膝关节运动学部分参数(髋内收角、髋内旋角、膝关节屈曲角、膝关节内旋角)。结果 治疗后,VAS评分由基线5.20±1.00降至2.53±1.25(P<0.001),LEFS评分由45.10±6.47提升至55.33±8.72(P<0.001),疗效持续至结束后4周(VAS=1.53±1.38,LEFS=69.87±8.03,均P<0.001)。三维步态分析显示:髋内收角从14.60°±1.19°降低至治疗结束时的9.87°±0.97°,并在4周随访时进一步优化至12.63°±2.11°(均P<0.001);髋内旋角由7.17°±1.66°降至5.90°±2.09°,维持于6.17°±1.88°,差异有统计学意义(均P<0.05);膝关节屈曲角在初始接触阶段从15.27°±0.83°增至16.53°±2.00°,支撑峰阶段从43.70°±3.35°提升至46.93°±3.70°,差异有统计学意义(均P<0.005);膝关节内旋角由8.57°±0.77°降至6.77°±1.59°,差异有统计学意义(P<0.001)。结论 ESWT可显著缓解慢性ITBS患者疼痛,改善下肢功能,并通过优化髋膝关节运动学参数修复异常步态模式。
Abstract
Objective To investigate the effects of extracorporeal shock wave therapy(ESWT) on the kinematic parameters of hip and knee joints in patients with chronic iliotibial band friction syndrome(ITBS), and to verify its biomechanical improvement effect through three-dimensional gait analysis. Methods A total of 30 patients meeting the inclusion criteria were enrolled and received ESWT twice a week for 4 weeks(energy density: 2 bar; frequency: 10 Hz). Symptoms and functions were evaluated using the Visual Analogue Scale(VAS) and the Lower Extremity Functional Scale(LEFS), before treatment, immediately after treatment and 4 weeks after treatment. A three-dimensional gait analysis system was used to quantify selected hip and knee kinematic parameters, including hip adduction angle, hip internal rotation angle, knee flexion angle, and knee internal rotation angle. Results After treatment, the VAS score decreased from 5.20±1.00 at baseline to 2.53±1.25 (P<0.001), and the LEFS score increased from 45.10±6.47 to 55.33±8.72 (P<0.001), and the improvements persisted at the 4-week follow-up (VAS: 1.53±1.38; LEFS: 69.87±8.03; both P<0.001). Three-dimensional gait analysis showed that the hip adduction angle decreased from 14.60°±1.19° to 9.87°±0.97° immediately after treatment and further improved to 12.63°±2.11° at 4-week follow-up (P<0.001). The hip internal rotation angle decreased from 7.17°±1.66° to 5.90°±2.09° and was maintained at 6.17°±1.88°(P<0.05). For knee flexion angle, values increased during initial contact from 15.27°±0.83° to 16.53°±2.00° and during peak stance from 43.70°±3.35° to 46.93°±3.70°(both P<0.005). The knee internal rotation angle decreased from 8.57°±0.77° to 6.77°±1.59°(P<0.001). Conclusions ESWT can significantly alleviate pain, improve lower-limb function, and help correct abnormal gait patterns by optimizing hip and knee kinematic parameters in patients with chronic ITBS.
关键词
髂胫束摩擦综合征 /
体外冲击波 /
步态 /
疼痛 /
康复
Key words
iliotibial band friction syndrome /
extracorporeal shock wave therapy /
gait /
pain /
rehabilitation
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基金
浙江省医药卫生科研项目(2021432378);浙江省中医药科技项目(2021ZB236)
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