离心运动训练对髌股疼痛综合征患者膝关节功能和神经肌肉控制的效果

doi:10.3969/j.issn.1006-9771.2021.11.015

摘要/Abstract

摘要：

目的探讨离心运动训练对髌股疼痛综合征患者膝关节功能及神经肌肉控制的影响。方法 2016年9月至2019年9月,本院门诊髌股疼痛综合征患者39例,随机分为对照组(n = 19)和试验组(n = 20)。两组均接受常规康复训练,试验组加用股四头肌离心运动训练,共8周。治疗前后采用疼痛视觉模拟评分(VAS)、膝关节Lysholm评分进行评定,采用等速测试与训练系统测量加速时间,平衡测试仪测量稳定指数。结果治疗后,两组VAS评分,各肌肉加速时间,总体、左右和前后稳定指数均降低(t > 2.521, P < 0.05),Lysholm评分显著提高(|t| > 13.628, P < 0.001)。试验组VAS评分、各肌肉加速时间、总体及前后稳定指数低于对照组(|t| > 2.174, P < 0.05),Lysholm评分显著高于对照组(t = 11.947, P < 0.001)。结论股四头肌离心运动训练可缓解髌股疼痛综合征患者膝关节疼痛,提高膝关节功能和神经肌肉控制能力。

关键词: 髌股疼痛综合征, 离心运动, 膝, 神经肌肉控制

Abstract:

Objective To investigate the effect of eccentric exercise training on knee function and neuromuscular control in patients with patellofemoral pain syndrome.Methods From September, 2016 to September, 2019, 39 outpatients with patellofemoral pain syndrome visiting our hospital were randomly divided into control group (n = 19) and experimental group (n = 20). Both groups received routine rehabilitation, while the experimental group received eccentric training of quadriceps femoris in addition, for eight weeks. They were assessed with Visual Analogue Scale (VAS) of pain, Lysholm score, while the acceleration time was measured with Isokinetic Testing and Training System, and stability index with Dynamic Balance Tester.Results The VAS score, acceleration time of all the muscles, and overall, anterior-posterior and medial-lateral stability indexes decreased (t > 2.521, P < 0.05), and the Lysholm score increased (|t| > 13.628, P < 0.001) in both groups after treatment, while the VAS score, acceleration time of all the muscles, overall and anterior-posterior stability indexes were less (|t| > 2.174, P < 0.05), and the Lysholm score was more (t = 11.947, P < 0.001) in the experimental group than in the control group.Conclusion Eccentric exercise training of quadriceps femoris is effective on pain, knee function and neuromuscular control for patients with patellofemoral pain syndrome.

Key words: patellofemoral pain syndrome, eccentric contraction, knee, neuromuscular control

刘晓磊,李强,章耀华,张鸿悦,刘文辉,李佳,董明,杨云,杨华清. 离心运动训练对髌股疼痛综合征患者膝关节功能和神经肌肉控制的效果[J]. 《中国康复理论与实践》, 2021, 27(11): 1334-1339.

LIU Xiao-lei,LI Qiang,ZHANG Yao-hua,ZHANG Hong-yue,LIU Wen-hui,LI Jia,DONG Ming,YANG Yun,YANG Hua-qing. Effect of Eccentric Exercises on Knee Function and Neuromuscular Control of Patellofemoral Pain Syndrome[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(11): 1334-1339.

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组别	n	性别(男/女, n)	年龄(岁)	身高(cm)	体质量(kg)	病程(周)
对照组	19	7/12	38.57±7.99	168.21±5.19	71.39±10.98	22.07±7.48
试验组	20	7/13	36.35±6.32	168.71±6.68	69.04±10.58	21.71±7.77
χ²/t值		0.014	-0.813	0.221	-0.578	-0.124
P值		0.908	0.173	0.091	0.811	0.895

评价工具		ICF编码	类目名称
VAS		b28016	关节疼痛
		b28015	下肢疼痛
Lysholm评分	跛行	b28016	关节疼痛
		b28015	下肢疼痛
	支撑	b7603	手臂或腿部的支撑功能
		d420	移动自身
		d450	步行
		d455	到处移动
		d465	利用设备到处移动
	绞索	b7100	单关节活动
	不稳定	b7300	单一肌肉和肌群力量
	(打软腿)	b7400 b7150	单一肌肉耐力单关节的稳定
	疼痛	b28016	关节疼痛
		b28015	下肢疼痛
	肿胀	b7100	单关节活动
	上下楼梯	b7603	手臂或腿部的支撑功能
		d415	保持一种身体姿势
		d420	移动自身
		d450	步行
		d455	到处移动
	下蹲	d4101	蹲下
肌肉加速时间		b7300	单一肌肉和肌群力量
		b7400	单一肌肉耐力
稳定指数		b7601	复杂自主运动控制
		b7603	手臂或腿部的支撑功能
		b7100	单关节活动
		b7101	多关节活动
		b7203	跗骨的灵活性
		b7201	骨盆的灵活性
		b7151	多关节稳定性
		d415	保持一种身体姿势

组别	n	治疗前	治疗后	t值	P值
对照组	19	6.81±0.94	3.93±0.82	16.687	< 0.001
试验组	20	6.64±1.08	2.92±0.73	16.873	< 0.001
t值		-0.557	-3.380
P值		0.380	0.002

组别	n	治疗前	治疗后	t值	P值
对照组	19	59.42±3.96	76.43±2.73	-13.628	< 0.001
试验组	20	59.71±4.79	89.64±3.10	-19.869	< 0.001
t值		0.172	11.947
P值		0.442	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组	19	71.67±20.38	55.83±13.79	4.710	0.001
试验组	20	67.50±15.47	44.17±12.40	6.205	< 0.001
t值		-0.564	-2.179
P值		0.578	0.040