髋关节肌训练治疗膝骨关节炎的短期效果

doi:10.3969/j.issn.1006-9771.2021.02.014

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (2): 203-207.doi: 10.3969/j.issn.1006-9771.2021.02.014

髋关节肌训练治疗膝骨关节炎的短期效果

安丙辰,郑洁皎(),周甜甜,汤雨婷,连洁

复旦大学附属华东医院康复医学科，上海市 200040

收稿日期:2019-12-16 修回日期:2020-02-03 出版日期:2021-02-25 发布日期:2021-02-26
通讯作者: 郑洁皎 E-mail:zjjcss@163.com
作者简介:安丙辰(1976-)，男，汉族，河北邢台市人，博士，主任医师，研究生导师，主要研究方向：骨关节疾病康复|郑洁皎(1953-)，女，汉族，上海市人，主任医师，主要研究方向：老年康复。
基金资助:
上海市科学技术委员会医学引导项目(16411964000);上海市卫生和计划生育委员会科研基金项目(2014LP006A);上海市高级中西医结合人才培养项目(ZY3-RCPY-4-2005)

Short-term Effect of Hip Muscles Strengthening on Knee Osteoarthritis

Bing-chen AN,Jie-jiao ZHENG(),Tian-tian ZHOU,Yu-ting TANG,Jie LIAN

Department of Rehabilitation, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, ChinaCorresponding to ZHENG Jie-jiao, E-mail: zjjcss@163. com

Received:2019-12-16 Revised:2020-02-03 Published:2021-02-25 Online:2021-02-26
Contact: Jie-jiao ZHENG E-mail:zjjcss@163.com
Supported by:
Shanghai Science and Technology Commission Project(16411964000);Scientific Research Fund of Shanghai Health and Family Planning Commission(2014LP006A);Shanghai High Level Talents Plan of Integrated Traditional and Western Medicine(ZY3-RCPY-4-2005)

摘要/Abstract

摘要： 目的

比较髋关节肌与股四头肌等长肌力训练治疗膝骨关节炎的短期疗效，探讨髋关节肌训练治疗膝骨关节炎的优势。

方法

2015年10月至2016年5月，招募膝骨关节炎老年女性患者42例，分为股四头肌训练组(n = 21)和髋关节肌训练组(n = 21)，分别训练2周。训练前后采用西安大略及麦克马斯特大学骨关节炎指数(WOMAC)评分、等速肌力测试和6分钟步行测试进行评价，并在2个月时随访。

结果

训练前，两组WOMAC评分，膝关节伸、屈肌群等速峰力矩值以及6分钟步行距离均无显著性差异(P > 0.05)。训练2周后，股四头肌训练组膝关节屈肌群的等速峰力矩值(t = -4.038, P = 0.001)和6分钟步行测试(t = -2.474, P = 0.022)较训练前改善；髋关节肌训练组WOMAC评分的疼痛项、僵硬项和功能障碍项(t > 2.487, P < 0.05)，膝关节伸、屈肌群等速峰力矩值(|t| > 6.370, P < 0.001)，6分钟步行距离(t = -2.241, P = 0.037)均较训练前改善；且髋关节肌训练组WOMAC评分各项均低于股四头肌训练组(t > 2.087, P < 0.05)，膝关节伸肌群等速峰力矩值显著高于股四头肌训练组(t = -5.028, P < 0.001)。2个月随访时，髋关节肌训练组的脱落率显著低于股四头肌训练组(χ² = 13.480, P < 0.001)。

结论

髋关节肌训练治疗膝骨关节炎的短期疗效优于股四头肌训练，无股四头肌训练时诱发膝关节疼痛的副作用，是膝骨关节炎运动治疗的较好选择。

关键词: 膝骨关节炎, 髋关节肌训练, 股四头肌训练, 等长肌力训练

Abstract: Objective

To compare the short-term effects of hip muscles strengthening and quadriceps strengthening on knee osteoarthritis (KOA), and discuss the advantages of hip muscles strengthening.

Methods

From October, 2015 to May, 2016, 42 old females with KOA were divided into two groups equally. They received hip strengthening (HS group) and quadriceps strengthening (QS group) for two weeks, respectively. The pain, stiffness and physical function scores of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were measured. Isokinetic strength peak torque (PT) was assessed for knee extensors and flexors, and 6-minute Walk Test was also evaluated. They were followed up two months later.

Results

Before exercise, there was no significant difference in all the indexes between two groups (P > 0.05). Two weeks after exercise, the knee flexor PT (t = -4.038, P = 0.001) and 6-minute walk distance (t = -2.474, P = 0.022) increased in QS group; the pain, stiffness and physical function scores of WOMAC (t > 2.487, P < 0.05), the knee extensor and flexor PT (|t| > 6.370, P < 0.001), and 6-minute walk distance (t = -2.241, P = 0.037) improved in HS group; the scores of WOMAC were lower (t > 2.087, P < 0.05) and the knee extensor PT was higher (t = -5.028, P < 0.001) in HS group than in QS group. At two-months' follow-up, the drop-out rate was significantly lower in HS group than in QS group (χ² = 13.480, P < 0.001).

Conclusion

Hip muscles strengthening is a good choice for KOA in the early stage of treatment, which could avoid the pain in quadriceps training, increase quadriceps strength and improve physical function.

Key words: knee osteoarthritis, hip muscles strengthening, quadriceps strengthening, isometric strengthening

中图分类号:

R684.3

安丙辰,郑洁皎,周甜甜,汤雨婷,连洁. 髋关节肌训练治疗膝骨关节炎的短期效果[J]. 《中国康复理论与实践》, 2021, 27(2): 203-207.

Bing-chen AN,Jie-jiao ZHENG,Tian-tian ZHOU,Yu-ting TANG,Jie LIAN. Short-term Effect of Hip Muscles Strengthening on Knee Osteoarthritis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(2): 203-207.

图/表 6

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参考文献 25

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组别	n	年龄 (岁)	体质量（kg）	体质量指数（kg/m²）
股四头肌训练组	21	68.57±7.17	62.33±7.17	25.36±2.20
髋关节肌训练组	21	68.71±7.14	61.44±9.41	24.90±2.40
t值		-0.065	0.347	0.648
P值		0.949	0.731	0.521

组别	n	疼痛		僵硬		功能障碍
组别	n	训练前	2周后	训练前	2周后	训练前	2周后
股四头肌训练组	21	134.19±88.07	103.05±113.78^a	55.90±48.96	45.79±48.06^b	351.63±274.69	425.71±381.91^c
髋关节肌训练组	21	135.36±74.99	46.45±41.05^d	57.06±54.82	19.93±30.24^e	368.74±311.31	172.12±215.14^f
t值		-0.046	2.144	-0.072	2.087	-0.189	2.651
P值		0.963	0.042	0.943	0.045	0.851	0.012

组别	n	膝关节伸肌群		膝关节屈肌群
组别	n	训练前	2周后	训练前	2周后
股四头肌训练组	21	38.76±12.66	37.77±13.39^a	20.81±12.82	30.24±9.93^b
髋关节肌训练组	21	42.21±19.64	73.70±29.88^c	20.78±11.86	36.32±14.89^d
t值		-0.678	-5.028	0.009	0.143
P值		0.502	<0.001	0.993	0.127

组别	n	训练前	2周后	t值	P值
股四头肌训练组	21	540.71±126.02	574.00±127.84	-2.474	0.022
髋关节肌训练组	21	563.81±93.85	592.33±97.98	-2.241	0.037
t值		-0.674	-0.522
P值		0.504	0.605

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髋关节肌训练治疗膝骨关节炎的短期效果

Short-term Effect of Hip Muscles Strengthening on Knee Osteoarthritis

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