Effect Of Blood Flow Restriction Combined With Traditional Rehabilitation Training On Wrist Function In Middle-Aged And Elderly Female Colles Fracture Patients

Purpose:Distal radius fractures are one of the most common surgical fractures with a high incidence in clinical practice today.The most common of these fractures is Colles-type fracture,accounting for more than 90%of the cases.Plaster fixation is the common treatment for Colles fracture patients.Due to prolonged joint braking,it is easy to cause tissue adhesions and scar tissue formation at the fracture site,resulting in sequelae such as muscle atrophy and stiffness of the wrist joint,decreased mobility and impaired function,which seriously affect the work and quality of life of patients.Blood flow restriction training is a new type of rehabilitation training tool,which has been widely used in the rehabilitation after sports injuries.However,the differences in the effects of blood flow restriction combined with traditional rehabilitation training and traditional rehabilitation training alone on wrist muscle strength,mobility,muscle stiffness,and function in patients with Colles fractures are not clear.Therefore,the purpose of this study was to compare the differences in the effects of blood flow restriction combined with traditional rehabilitation training and traditional rehabilitation training alone on wrist joint muscle strength,mobility,muscle stiffness,and function in Colles fracture patients,and to provide an experimental basis and theoretical support for the promotion and application of blood flow restriction combined with traditional rehabilitation training in the field of rehabilitation.Methods:Twenty-one middle-aged and elderly female Colles fracture patients were recruited as subjects.They were then randomly divided into a blood flow restriction training group(BFR group,n=11)and a traditional rehabilitation training group(non-BFR group,n=10).The traditional rehabilitation training consisted of grasping and squeezing,wrist palm flexion and dorsiflexion in the forearm rotation position,wrist palm flexion and dorsiflexion in the forearm rotation position,prayer wrist palm flexion and dorsiflexion,and forearm resistance to anterior and posterior rotation.At the same time point,the non-BFR group performed only traditional rehabilitation training(4 groups,30 reps in group 1,15 reps in groups 2-4,and 45 s interval between groups).Before and after the intervention,grip strength,pinch strength(finger-side pinch,three-finger pinch,two-finger pinch),wrist mobility(wrist flexion,palmar extension,ulnar deviation,radial deviation,anterior rotation,posterior rotation),muscle stiffness,and the Patient-rated wrist evaluation(PRWE)scale on the affected side were assessed in all patients.Data were tested for normal distribution and chi-square using the Shapiro Wilk and Levene’s test.Independent samples t-test was used to analyze pre-test as well as imaging indices to determine if there was any variability between the two groups.A two-factor repeated measures ANOVA was used to examine the effect of time and group as factors on the indexes of interest.If there was an interaction effect between time and group,a simple effects analysis was performed.If there was no interaction effect between time and group,the time and group main effects were analyzed separately.Results:1.Muscle strength:The results of the two-factor repeated measures ANOVA showed that there was a significant interaction effect of grip strength on time and group(F=5.445,p=0.031,η_p~2=0.223),with a more significant increase in grip strength in patients in the BFR group(BFR group:160.594%,non-BFR group:120.482%).There was no significant interaction in time and group for finger-side pinch strength(F=0.019,p=0.348,η_p~2=0.046),three-finger pinch strength(F=0.079,p=0.889,η_p~2=0.001)and two-finger pinch strength(F=0.000,p=0.943,η_p~2=0.000),but there was no significant interaction in time and group for both groups for finger-side pinch strength(BFR group:79.530%,non-BFR group:82.437%),three-finger pinch force(BFR group:104.186%,non-BFR group:101.442%)and two-finger pinch force(BFR group:102.577%,non-BFR group:117.751%)in both groups;2.Wrist mobility:two-factor repeated measures ANOVA found There was a significant interaction between time and group for ulnar deviation(F=7.856,p=0.004,η_p~2=0.383),with a more significant improvement in ulnar deviation mobility in the BFR group(BFR group:84.980%,non-BFR group:33.965%).Palmar flexion(F=1.78,p=0.255,η_p~2=0.068),dorsiflexion(F=1.284,p=0.385,η_p~2=0.040),radial deviation(F=3.044,p=0.082,η_p~2=0.151),anterior rotation(F=1.286,p=0.211,η_p~2=0.081),and posterior rotation(F=0.299,p=0.580,η_p~2=0.016)did not have significant interactions in time or group,but both groups had significant interactions for palmar flexion(BFR group:108.302%,non-BFR group:91.078%),dorsal extension(BFR group:152.313%non-BFR group:150.060%),radial deviation(BFR group:130.999%,non-BFR-BFR group:58.007%),anterior rotation(BFR group:56.548%,non-BFR group:87.513%),and posterior rotation(BFR group:89.474%,non-BFR group:124.229%)showed an increasing trend in mobility;3.Muscle stiffness:a two-factor repeated measures ANOVA found brachioradialis stiffness(F=1.56,p=0.905,η_p~2=0.001)and thumb short abductor stiffness(F=0.022,p=0.510,η_p~2=0.023)had no significant interaction over time or group,but there was a decreasing trend in both brachioradialis stiffness(BFR group:-2.531%,non-BFR group:-8.288%)and thumb short abductor stiffness in both groups(BFR group:-12.038%,non-BFR group:-12.727%);4.PRWE scores:the results of the two-factor repeated measures ANOVA showed that there was an interaction between PRWE scores over time and group(F=25.452,p=0.003,η_p~2=0.373),with a more significant degree of improvement in wrist function in the BFR group(BFR group-77.235%,non-BFR group:-58.887%);5.Imaging results:independent sample t-test showed no significant differences in palmar inclination angle(t=0.074,p=0.981,d=0.80)and ulnar deviation angle(t=0.038,p=0.815,d=0.55)between the two groups before the intervention.There were no significant differences in palmar inclination(t=-2.240,p=0.986,d=0.90)and ulnar declination angle(t=-0.759,p=0.917,d=0.30)between the two groups after the intervention.Conclusions:1.6-week blood flow restriction combined with conventional rehabilitation significantly improved grip strength,wrist ulnar deviation mobility and reduced PRWE scores in middle-aged and elderly female Colles fracture patients compared with conventional rehabilitation alone.2.Both rehabilitation protocols improved pinch strength,wrist palmar flexion,dorsiflexion,radial deviation,anterior rotation,and posterior rotation mobility in patients,but the difference in effect between the two groups was not significant.