Effects of preoperative lower extremity muscle exercise on prognosis improvement following closed tibial shaft fractures and changes of gastrocnemius muscle average electromyography
Objective To explore the effect of preoperative lower limb muscle exercise on improving the progno-sis of closed tibial shaft fractures,and to monitor the changes of gastrocnemius muscle average electromyography(AEMG)based on wearable surface electromyography(sEMG)technology.Methods A prospective study was conducted on 60 patients with tibial shaft fractures who underwent intramedullary nail fixation in our hospital from May 2021 to Jan.2023.Patients were randomly divided into study group and control group(n=30 for each).There were 22 males and 8 females in the study group,who aged 38-59 years,mean 45.8 years;there were 21 males and 9 females in the control group,who aged 40-58 years,mean 44.9 years.Among the 60 cases,35 were injured in road traffic incidents,17 hit by heavy objects,and 8 due to falls from height.After admission,patients in both groups received wearable sEMG to measure the AEMG of gastrocnemius muscles during isometric contraction of calf muscles before and after surgery.Patients in the study group underwent preoperative ankle pump exercise,while those in the control group did not.VAS before and 1,3 and 7 d after surgery were compared between the two groups,together with the risk of developing lower extremity venous thrombosis during postoperative hospitalization.The long-term functional recovery parameters,including full weight-bearing activity time,range of motion(ROM),ankle extension-plantarflexion ROM,Johner-Wruhs score,tibial alignment and bilateral tibial length difference were also evaluated.At the same time,according to the wearable sEMG records of patients,the gastrocnemius AEMG was analyzed at 1,3,and 5 d after fracture(before surgery),and 1 d,3 d,1 week,1 month,3 months and 6 months after surgery be-tween the two groups.Results The postoperative VAS scores in both groups were largely decreased(all P＜0.05 compared with before surgery),but there was no statistically significant difference between the two groups in a short time(all P＞0.05 at the time points of 1,3,and 7 d).Within 3-7 d after surgery,both groups showed varying de-grees of D-dimer elevation,but the elevation percent in the study group was much lower than that in the control group(16.7％vs.43.3％,P＜0.05).Compared with the control group,the study group showed a much quicker complete weight-bearing activity(d,55.90±8.85 vs.60.28±9.33),and much larger knee joint extension-flexion ROM at 1 and 3 months after surgery,and much higher gastrocnemius muscle AEMG at 5 d day after fracture,and 1 d,3 d,1 week,l month,and 3 months after surgery(all P＜0.05).Conclusion Preoperative lower limb muscle exercise can accelerate the postoperative recovery process of patients with closed tibial shaft fractures,and its impact on the AMEG changes recorded in sEMG is more apparent.This also indicates that monitoring and quantifying AEMG based on wearable sEMG technology is expected to have good application value in guiding lower limb muscle exercise in patients with closed tibial shaft fractures to improve their prognosis.
万方数据
维普
