臀中肌核心鍛煉(2)：漸進(jìn)式臀中肌抗阻力康復(fù)訓(xùn)練，髖臼發(fā)育不良DDH/股骨頭壞死——保髖截骨術(shù)后康復(fù)

臀中肌鍛煉(2)：漸進(jìn)式臀中肌抗阻力康復(fù)訓(xùn)練，髖臼發(fā)育不良DDH/股骨頭壞死——保髖截骨術(shù)后康復(fù)指導(dǎo)

作者：Jay R Ebert, Peter K Edwards, Daniel P Fick, Gregory C Janes.

作者單位: School of Sport Science, Exercise and Health, University of Western Australia, Crawley, Perth, Western Australia.

譯者：陶可（北京大學(xué)人民醫(yī)院骨關(guān)節(jié)科）

摘要

背景：鑒于臀中肌在骨盆和下肢穩(wěn)定性中的作用，以及臀中肌無力與許多下肢疾病之間已知的聯(lián)系，臀中肌康復(fù)至關(guān)重要。

目的：系統(tǒng)地回顧文獻(xiàn)并提出一系列循證的漸進(jìn)式臀中肌負(fù)荷練習(xí)。

證據(jù)獲?。?016年1月進(jìn)行了系統(tǒng)文獻(xiàn)檢索，以確定報(bào)告康復(fù)鍛煉期間臀中肌活動(dòng)占最大等長收縮(MVIC)百分比的研究。其中包括調(diào)查無受傷參與者的研究。對(duì)鍛煉的類型或方式?jīng)]有限制，但排除了無法在獨(dú)立環(huán)境中準(zhǔn)確復(fù)制或進(jìn)行的鍛煉。未將肌電活動(dòng)標(biāo)準(zhǔn)化為側(cè)臥MVIC的研究被排除。根據(jù)運(yùn)動(dòng)類型和%MVIC對(duì)運(yùn)動(dòng)進(jìn)行分層：低（0%至20%）、中（21%至40%）、高（41%至60%）和極高（＞61%）。

證據(jù)綜合：本次綜述納入了20項(xiàng)研究，報(bào)告了33項(xiàng)練習(xí)（以及同一練習(xí)的一系列變體）的結(jié)果。俯臥、四足和雙側(cè)橋式練習(xí)通常產(chǎn)生低或中等負(fù)荷。據(jù)報(bào)告，特定的髖部外展/旋轉(zhuǎn)練習(xí)為中等、高或極高負(fù)荷。存在對(duì)側(cè)肢體運(yùn)動(dòng)的單側(cè)站立練習(xí)通常是高負(fù)荷或極高負(fù)荷的活動(dòng)，而一系列功能性負(fù)重練習(xí)則存在高變異性。

結(jié)論：這篇綜述概述了康復(fù)環(huán)境中常用的一系列練習(xí)，根據(jù)運(yùn)動(dòng)類型和臀中肌激活程度進(jìn)行分層。這將有助于臨床醫(yī)生從術(shù)后早期到康復(fù)后期為患者量身定制臀中肌負(fù)荷方案。

A Systematic Review of Rehabilitation Exercises to Progressively Load the Gluteus Medius

Abstract

Context: Gluteus medius rehabilitation is of critical importance given its role in pelvic and lower limb stability, and the known link between gluteus medius weakness and many lower limb conditions.

Objective: To systematically review the literature and present an evidence-based graduated series of exercises to progressively load gluteus medius.

Evidence acquisition: A systematic literature search was conducted in January 2016 to identify studies reporting gluteus medius muscle activity as a percentage of maximal volitional isometric contraction (MVIC), during rehabilitation exercises. Studies that investigated injury free participants were included. No restrictions were placed on the type or mode of exercise, though exercises that could not be accurately replicated or performed within an independent setting were excluded. Studies that did not normalize electromyographic activity to a side lying MVIC were excluded. Exercises were stratified based on exercise type and %MVIC: low (0% to 20%), moderate (21% to 40%), high (41% to 60%), and very high (＞ 61%).

Evidence synthesis: 20 studies were included in this review, reporting outcomes in 33 exercises (and a range of variations of the same exercise). Prone, quadruped, and bilateral bridge exercises generally produced low or moderate load. Specific hip abduction/rotation exercises were reported as moderate, high, or very high load. Unilateral stance exercises in the presence of contralateral limb movement were often high or very high load activities, while high variability existed across a range of functional weight-bearing exercises.

Conclusions: This review outlined a series of exercises commonly employed in a rehabilitation setting, stratified based on exercise type and the magnitude of gluteus medius muscular activation. This will assist clinicians in tailoring gluteus medius loading regimens to patients, from the early postoperative through to later stages of rehabilitation.

Jiànjìn shì tún zhōng jī fùhè kāngfù xùnliàn

文獻(xiàn)出處：Jay R Ebert, Peter K Edwards, Daniel P Fick, Gregory C Janes. A Systematic Review of Rehabilitation Exercises to Progressively Load the Gluteus Medius. Review J Sport Rehabil. 2017 Sep;26(5):418-436. doi: 10.1123/jsr.2016-0088.

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