多角度等速肌力训练对膝关节置换术后膝关节活动度及本体感觉恢复效果

doi:10.6040/j.issn.1671-7554.0.2024.0840

摘要/Abstract

摘要： 目的探讨不同角度等速肌力训练对膝关节置换术(total knee arthroplasty, TKA)后膝关节活动度及本体感觉的影响。方法选择2021年1月至2022年6月在井冈山大学附属医院行TKA手术患者96例,48~74岁,平均(62.92±4.36)岁,其中男49例,女47例。在等速肌力训练中,根据不同膝关节屈曲范围分为0°~30°组、31°~60°组和61°~90°组,每组32例。对比3组患者治疗前和治疗2个月后肌力指标、临床指标及本体感觉相关指标,并分析不同角度等速肌力训练后膝关节膝关节活动度(range of motion, ROM)与本体感觉之间的相关性。结果 3组患者治疗2个月后股四头肌、小腿三头肌各项肌力指标均显著高于治疗前(P<0.05),治疗2个月后31°~60°组患者股四头肌各项肌力相关指标均显著高于0°~30°组和61°~90°组,而0°~30°组小腿三头肌各项肌力相关指标均显著高于31°~60°组和61°~90°组(P<0.05)。3组患者治疗后ROM、“起立-行走”计时(time “ up and go” test, TUGT)时间、视觉模拟评分法(visual analogue scale, VAS)评分、Berg平衡量表(Berg balance scale, BBS)评分及美国特种外科医院膝关节功能(hospital for special surgery, HSS)评分均有显著改善(P<0.05),0°~30°组治疗后ROM、HSS评分显著高于31°~60°组和61°~90°组,31°~60°组TUGT时间则显著低于0°~30°组和61°~90°组(P<0.05);0°~30°组和31°~60°组治疗后BBS评分均高于61°~90°组(P<0.05);3组患者治疗后VAS评分差异无统计学意义(P>0.05)。治疗后被动运动阈值测量(threshold to detection of passive movement, TDPM)和主动角度重现(active angle reproduction, AAR)得到显著改善(P<0.05);31°~60°组治疗后TDPM(30°、45°、60°)和AAR(30°、45°、60°)均显著低于0°~30°组和61°~90°组(P<0.05)。Pearson分析结果显示,等速肌力训练角度为0°~30°时,治疗后膝关节ROM与AAR 30°(r=-0.50,P=0.03)存在相关性;等速肌力训练角度为31°~60°时,治疗后膝关节ROM与TDPM 30°(r=-0.49,P=0.04)、TDPM 45°(r=-0.52,P=0.03)、AAR 45°(r=-0.62,P=0.00)及AAR 60°(r=-0.59,P=0.01)存在相关性。结论不同角度的股四头肌等速肌力训练,均有助于加速TKA术后患者的康复进程,其中训练范围为31°~60°可以更好地改善患者术后本体感觉和股四头肌肌力,0°~30°范围内的股四头肌等速训练对患者小腿三头肌肌力、ROM、HSS评分改善效果最为显著。

关键词: 等速肌力训练, 膝关节置换术, 膝关节活动度, 本体感觉

Abstract: Objective To investigate the effect of different angle isokinetic muscle strength training on knee joint motion and proprioception after total knee arthroplasty(TKA). Methods A total of 96 patients who underwent TKA in Affiliated Hospital of Jinggangshan University from January 2021 to June 2022 were selected, aged 37-74 years, with a mean age of 52.72±5.37 years. The patients were divided into group 0°-30°, group 31°-60° and group 61°-90° according to the range of knee flexion during isokinetic training. Muscle strength index, clinical index and proprioceptive index were compared before and after treatment in the three groups. The correlation between knee ROM and proprioception was analysed after isokinetic strength training at different angles. Results After treatment, the muscle strength indexes of the quadriceps femoris and triceps crus were significantly higher in the three groups than those before treatment(P<0.05). After treatment, the muscle strength related indexes of quadriceps femoris in group 31°-60° were significantly higher than those in group 0°-30° and group 31°-60°, while the muscle strength related indexes of triceps crus in group 0°-30° were significantly higher than those in group 31°-60° and group 31°-60°(P<0.05). After treatment, range of motion(ROM), time “ up and go” test(TUGT), visual analogue scale(VAS), Berg balance scale(BBS)score and hospital for special surgery(HSS)score were significantly improved in the three groups(P<0.05). The ROM and HSS scores of group 0°-30° were significantly higher than those in group 31°-60° and group 31°-60°, and the TUGT time of group 31°-60° was significantly lower than that of group 0°-30° and group 31°-60°(P<0.05). The BBS scores of group 0°-30° and group 31°-60° were higher than those of group 31°-60° after treatment(P<0.05). There was no significant difference in VAS score between the three groups after treatment(P>0.05). TDPM and AAR were significantly improved after treatment(P<0.05). After treatment, TDPM(30°, 45°, 60°)and AAR(30°, 45°, 60°)in group 31°-60° were significantly lower than those in group 0°-30° and group 31°-60°(P<0.05). When the training angle of isokinetic muscle strength was 0°-30°, there was a correlation between knee ROM and AAR 30° after treatment(r=-0.50, P=0.03). When the training angle of isokinetic muscle strength was 31°-60°, the knee joint ROM after treatment was correlated with TDPM 30°(r=-0.49, P=0.04), TDPM 45°(r=-0.52, P=0.03), AAR 45°(r=-0.62, P=0.00)and AAR 60°(r=-0.59, P=0.03). Conclusion Isokinetic quadriceps muscle strength training at different angles can effectively promote the rehabilitation of patients after TKA, among which isokinetic quadriceps muscle strength training in the range of 31°-60° can better improve the postoperative proprioception and quadriceps muscle strength of patients. In the range of 0°-30°, quadriceps isometric training has the most significant improvement effect on the muscle strength, ROM and HSS scores of patients calf triceps.

Key words: Isokinetic muscle strength training, Knee replacement, Knee joint motion, Proprioception

中图分类号:

R687.409

张彭,杨鹏,赵菁,钟俊桥,万绍勇. 多角度等速肌力训练对膝关节置换术后膝关节活动度及本体感觉恢复效果[J]. 山东大学学报 (医学版), 2025, 63(3): 36-43.

ZHANG Peng, YANG Peng, ZHAO Jing, ZHONG Junqiao, WAN Shaoyong. Effect of multi-angle isokinetic muscle strength training on the recovery of knee motion and proprioception after knee arthroplasty[J]. Journal of Shandong University (Health Sciences), 2025, 63(3): 36-43.

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