目的 观察膝关节屈伸肌等速肌力训练对膝骨关节炎(KOA)患者步行能力的影响。方法 2016年12月至2017年6月,将本院收治的120例KOA患者随机分为空白组、对照组和观察组,各40例。三组均采用关节腔内注射玻璃酸钠与关节松动术治疗。对照组在此基础上增加常规肌力训练,包括膝关节周围肌肉等张训练和等长静蹲练习。观察组在此基础上增加膝关节等速肌力训练,训练模式为普通等速向心/向心模式。治疗前后分别测量膝关节屈伸肌峰力矩(PT)、疼痛视觉模拟量表(VAS)评分、Lysholm评分、10米步行时间及6分钟步行距离。结果 治疗4周后,三组膝关节屈伸肌峰力矩、VAS评分、Lysholm评分、10米步行时间及6分钟步行距离明显改善(P<0.05),且观察组优于对照组和空白组(P<0.05)。结论 等速肌力训练有助于改善KOA患者步行能力。
Objective To observe the effect of isokinetic training of knee flexors and extensors on walking ability in patients with knee osteoarthritis (KOA). MethodsFrom December, 2016 to June, 2017, 120 patients with KOA in our hospital were randomly divided into blank group (n=40), control group (n=40) and observation group (n=40). All the groups were injected with sodium hyaluronate intraluminally, and received joint mobilization. The control group added conventional strength training, including isotonic and isometric static squat exercise of muscles around the knee. The observation group received knee isokinetic training additionally, the training mode was ordinary isokinetic/centripetal mode. Before and four weeks after treatment, the peak torque (PT), the Lysholm score and Visual Analogue Scale (VAS) for pain, ten-meter walking time and six-minute walking distance were tested. ResultsAfter treatment, the PT value of knee flexors and extensors, the scores of VAS and Lysholm, ten-meter walking time and six-minute walking distance significantly improved in all groups (P<0.05), among which the observation group was the best (P<0.05).ConclusionIsokinetic muscle strength training of knee flexors and extensors can improve the walking ability of patients with KOA.
[1] 中华医学会风湿病学分会. 骨关节炎诊断及治疗指南[J]. 中华风湿病学杂志, 2010, 14(6): 416-419.
[2] 顾明士,张申岳,王萍,等. 中老年人膝骨关节炎患病趋势十年前后对照分析[J]. 上海医药, 2013, 34(4): 57-59.
[3] Felson DT, Naimark A, Anderson J, et al.The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study[J]. Arthritis Rheum, 1987, 30(8): 914-918.
[4] Turkiewicz A, Gerhardsson de verdier M, Engstrom G, et al. Prevalence of knee pain and knee OA in southern Sweden and the proportion that seeks medical care[J]. Rheumatology, 2014, 54(5): 827-835.
[5] 刘强,洪加源,胡维界. 膝骨性关节炎治疗进展[J]. 医学综述,2015, 21(3): 474-476.
[6] 王剑雄,周谋望,宫萍,等. 膝骨关节炎患者膝屈伸肌群等速肌力及其与功能的相关性[J]. 中国康复理论与实践, 2014, 20(12): 1105-1108.
[7] 刘宁,王维,王中莉,等. 膝关节骨性关节炎肌力训练疗效的临床研究[J]. 中国误诊学杂志, 2011, 11(15): 3546-3548.
[8] 谷爱武,白玉龙,吴毅,等. 等速离心肌力训练治疗膝关节骨关节炎的研究[J]. 中国康复医学杂志, 1997, 12(5): 197-198.
[9] 徐远红,王俊华,谢谨,等. 等速肌力训练结合Maitland手法对早中期膝骨关节炎疗效研究[J]. 中国临床保健杂志, 2015, 18(6): 593-597.
[10] 孟庆莹,王一洲,赵强. 膝骨性关节炎的生物力学研究进展[J]. 河南中医, 2014, 34(4): 676-678.
[11] van Baar ME, Dekker J, Oostendorp RA, et al. The effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized clinical trial[J]. J Rheumatol, 2008, 25(2): 2432-2439.
[12] 曹龙军,章礼勤,周石,等. 膝关节骨性关节炎患者股四头肌动员能力和肌力储备改变的研究[J]. 中国康复医学杂志, 2012, 27(1): 30-34.
[13] Tang B, Fan XL, Wu SD.Effects of tail suspension on electrophysiological characteristics of muscle spindles in isolated rat soleus muscle[J]. Space Med Med Eng, 2004, 17(1): 1-6.
[14] 李放,范振华,屠丹云,等. 膝关节骨关节炎的肌力状态和疼痛的关系[J]. 中国运动医学杂志, 2000, 19(1): 17-18.
[15] 徐远红,王俊华,万超,等. 等速运动训练结合Maitland手法对创伤性膝关节僵直的疗效观察[J]. 中国康复, 2015, 21(1): 31-34.
[16] Yildirim A, Surucu GD, Karamercan A, et al.Short-term effects of upper extremity circuit resistance training on muscle strength and functional independence in patients with paraplegia[J]. J Back Musculoskelet Rehabil, 2016, 5(18): 2667-2669.
[17] 张金龙,雷中杰,林海丹,等. 关节松动术在膝骨关节炎中的应用[J]. 华西医学, 2009, 24(2): 507-508.
[18] 袁淑娟,梁英,薛燕萍,等. 感觉运动训练治疗膝关节骨性关节炎的疗效观察[J]. 中华物理医学与康复杂志, 2011, 33(4): 290-291.
[19] 雒晓甜,梁英,张继峰. 不同治疗时间以等速肌力训练为主的综合疗法对膝骨关节炎的疗效对比[J]. 中国当代医药, 2014, 21(18): 52-55.
[20] 雒晓甜,梁英,李鹏,等. 等速肌力训练联合关节腔内注射及关节松动术治疗膝骨性关节炎的疗效观察[J]. 中华物理医学与康复杂志, 2014, 3(6): 440-444.
[21] 黄志平,尹彦,刘敏,等. 等速肌力测试与训练技术的研究进展[J]. 体育科技, 2011, 32(4): 52-58.
[22] 沈良册,吴立红,朱江军,等. 等速-平衡-减重综合康复训练对老年人髋关节置换术后疗效分析[J]. 中国康复理论与实践, 2010, 16(11): 1008-1009.
[23] 王垚,张序,郁冰,等. 等速肌力训练对前交叉韧带重建术后功能恢复的影响[J]. 中国煤炭工业医学杂志, 2015, 18(9): 1452-1456.
[24] Frontera WR, Hughes VA, Dallal GE, et al.Reliability of isokinetic muscle strength testing in 45-to 78-year-old men and women[J]. Arch Phys Med Rehabil, 1993, 74(11): 1181-1185.
[25] Nogueira FR, Libardi CA, Vechin FC, et al.Comparison of maximal muscle strength of elbow flexors and knee extensors between younger and older men with the same level of daily activity[J]. Clin Interv Aging, 2013, 8: 401-407.
[26] Meeteren Jv, Roebroeck ME, Stam HJ.Test-retest reliability in isokinetic muscle strength measurements of the shoulder[J]. J Rehabil Med, 2002, 34(2): 91-95.
[27] 杨俊兴,袁颖嘉,李田珂,等. 等速向心肌力训练对膝关节骨性关节炎患者关节功能水平的影响[J]. 中国康复医学杂志, 2012, 27(7): 631-634.
[28] 何柳,胡龙,余航. 等速离心运动对膝骨性关节炎患者平衡与步行能力的影响[J]. 广东医学, 2016, 37(21): 3248-3250.
