神经肌肉电刺激对前交叉韧带重建术后患者股四头肌肌力和步行功能的效果

doi:10.3969/j.issn.1006-9771.2025.02.015

摘要/Abstract

摘要：

目的探讨神经肌肉电刺激(NMES)对前交叉韧带重建术(ACLR)后患者股四头肌肌力和步行功能的影响。

方法选取2022年7月至2023年10月首都医科大学附属北京康复医院ACLR术后患者34例，随机分为对照组(n = 17)和试验组(n = 17)。两组均接受常规康复训练和功能性训练，功能性训练期间，试验组接受股内侧肌和股外侧肌NMES，对照组接受伪NMES，共8周。干预前后，测量患侧股四头肌峰力矩体重比、单腿支撑相和步行时足底冲量。

结果对照组脱落2例，试验组脱落3例。干预后，两组股四头肌峰力矩体重比均显著提高(|t| > 17.578, P < 0.001)，试验组显著大于对照组(t = 4.714, P < 0.001)；两组患侧单腿支撑相和患侧单腿支撑相与健侧单腿支撑相比值均显著改善(|t| > 16.882, P < 0.001)，试验组明显优于对照组(t > 3.234, P < 0.01)；两组各分区足底冲量均显著优化(t > 9.221, P < 0.001)，试验组改善程度优于对照组(|t| > 2.852, P < 0.01)。

结论 NMES能有效提升ACLR术后患者股四头肌肌力，改善步行时足底压力分布，提高单腿支撑能力。

关键词: 前交叉韧带重建术, 神经肌肉电刺激, 肌力, 步行

Abstract:

Objective To investigate the effect of neuromuscular electrical stimulation (NMES) on quadriceps muscle strength and walking for patients after anterior cruciate ligament reconstruction (ACLR).

Methods Thirty-four patients after ACLR were selected at Beijing Rehabilitation Hospital of Capital Medical University from July, 2022 to October, 2023, and randomly divided into control group (n = 17) and experimental group (n = 17). Both groups received routine rehabilitation and functional training, and the experimental group received NMES during the functional training, while the control group received sham NMES, for eight weeks. Quadriceps peak torque-to-weight ratio, single-leg support phase and plantar impulses during walking were measured before and after intervention.

Results Two cases in the control group and three in the experimental group dropped down. Quadriceps peak torque-to-weight ratio improved in both groups after intervention (|t| > 17.578, P< 0.001), and improved more in the experimental group than in the control group (t= 4.714, P< 0.001); while the affected single-leg support phase and the affected/unaffected single-leg support phase ratio improved in both groups (|t| > 16.882, P< 0.001), and improved more in the experimental group than in the control group (t> 3.234, P< 0.01); and plantar impulses of all zones optimized in both groups (t> 9.221, P< 0.001), and were better in the experimental group than in the control group(|t| > 2.852, P< 0.01).

Conclusion NMES may further improve quadriceps muscle strength, plantar pressure distribution during walking and single-leg support in patients after ACLR.

Key words: anterior cruciate ligament reconstruction, neuromuscular electrical stimulation, muscle strength, walking

中图分类号:

R622

樊志娇, 靳岚琦, 黄志彬, 李依格, 姚思含, 马玉宝. 神经肌肉电刺激对前交叉韧带重建术后患者股四头肌肌力和步行功能的效果[J]. 《中国康复理论与实践》, 2025, 31(2): 242-248.

FAN Zhijiao, JIN Lanqi, HUANG Zhibin, LI Yige, YAO Sihan, MA Yubao. Effect of neuromuscular electrical stimulation on quadriceps muscle strength and walking for patients after anterior cruciate ligament reconstruction[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(2): 242-248.

图/表 4

表1

表2

Comparison of quadriceps peak torque-to-weight ratio between two groups pre- and post-treatment 单位：%"

组别	n	测试	$x - ± s$	t值	P值
对照组	15	前测	70.80±4.60	-50.636	< 0.001
		后测	104.27±5.60
试验组	14	前测	71.29±6.34	-17.578	< 0.001
		后测	115.43±7.11
治疗前两组均值差			0.48±6.17	0.237	0.814
治疗后两组均值差			11.16±7.08	4.714	< 0.001

表2

表3

Comparison of single-leg support phase between two groups pre- and post-treatment 单位：%"

项目	组别	n	测试	$x - ± s$	t值	P值
患侧单足支撑相	对照组	15	前测	32.22±1.23	-125.149	< 0.001
			后测	35.79±1.27
	试验组	14	前测	32.36±1.58	-53.391	< 0.001
			后测	37.53±1.60
	治疗前两组均值差			0.14±1.44	0.258	0.799
	治疗后两组均值差			1.74±1.59	3.243	0.003
患侧/健侧单足支撑相比	对照组	15	前测	74.00±1.68	-16.882	< 0.001
			后测	86.74±1.04
	试验组	14	前测	73.98±1.18	-37.683	< 0.001
			后测	94.58±2.40
	治疗前两组均值差			-0.02±1.62	-0.058	0.954
	治疗后两组均值差			7.84±2.20	11.254	< 0.001

表3

表4

Comparison of plantar impulse between two groups pre- and post-treatment 单位：%"

项目	组别	n	测试	$x - ± s$	t值	P值
前足区	对照组	15	前测	57.62±1.67	36.568	< 0.001
			后测	54.30±1.42
	试验组	14	前测	57.39±2.47	21.214	< 0.001
			后测	51.30±2.52
	治疗前两组均值差			-0.23±2.18	-0.294	0.771
	治疗后两组均值差			-0.29±2.35	-3.996	< 0.001
中足区	对照组	15	前测	13.58±1.43	27.624	< 0.001
			后测	11.56±1.45
	试验组	14	前测	13.33±0.9	17.009	< 0.001
			后测	10.19±1.10
	治疗前两组均值差			-0.25±1.35	-0.541	0.593
	治疗后两组均值差			-1.37±1.43	-2.852	0.008
足跟区	对照组	15	前测	28.80±1.70	24.123	< 0.001
			后测	34.13±2.07
	试验组	14	前测	29.29±2.60	9.221	< 0.001
			后测	38.51±2.78
	治疗前两组均值差			0.49±2.47	0.588	0.562
	治疗后两组均值差			4.38±2.72	4.834	< 0.001

表4

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组别	n	性别 (男/女)/n	年龄/岁	身高/cm	体质量/kg	BMI/(kg·m^-2)	患侧 (左/右)/n	病程/周
对照组	15	8/7	30.70±1.74	170.87±7.70	65.13±8.94	22.19±1.25	10/5	7.1±0.11
试验组	14	6/8	31.16±1.63	169.50±8.20	62.79±8.91	21.73±1.44	8/6	7.0±0.16
t值			0.192	-0.463	-0.708	-0.924		-0.378
P值		0.720^a	0.848	0.647	0.485	0.364	0.710^a	0.709