离心性肌肉训练改善髌腱末端病患者疼痛的效果

Effect of eccentric muscle exercises on the amelioration of pain in patients with patellar tendon enthesiopathy

目的:观察离心性肌肉训练对髌腱末端病患者疼痛的疗效,并与常用的理疗相比较。方法:选择2004-10/2005-08复旦大学附属华山医院收治髌腱末端病患者29例,随机分为两组:①理疗组(n=13):以微波+激光治疗,微波温热(输出功率100W),15min/(次·d);半导体激光治疗仪,以局部有舒适感为宜,15min/(次·d)。②离心训练组(n=16):以自行设计的离心性训练动作(单腿伸直位站立,在能承受的疼痛范围内缓慢平稳下蹲至屈膝90°,然后双手扶住栏杆,双侧下肢同时负重,负重0～15kg,缓慢站起)治疗,2次/d,15min/次。在治疗前和治疗后12周采用澳大利亚维多利亚运动学院评分法(0～100,分数越高症状越轻,100为无痛)和目测类比评分法(0～100,分数越高症状越重,100为剧痛)评估疼痛程度。结果:29例全部进入结果分析。①澳大利亚维多利亚运动学院评分:理疗组治疗前后差异不显著(P>0.05);离心训练组治疗后显著高于治疗前(68.5±15.8,38.3±13.2,P<0.05);治疗前后差值离心训练组大于理疗组(30.2±6.5,7.4±2.7,P<0.05)。②目测类比评分:理疗组治疗前后差异不显著(P>0.05);离心训练组治疗后显著低于治疗前(20.1±12.3,52.9±9.7,P<0.05);治疗前后差值离心训练组大于理疗组(32.4±5.3,9.3±4.9,P<0.05)。结论:离心性肌力训练可以显著减轻髌腱末端病患者的疼痛,效果优于传统理疗方法。

AIM： To investigate the curative effect of eccentric muscle exercises on pain in patients with patellar tendon enthesiopathy and compare with frequently used physiotherapy. METHODS： Totally 29 patients with patellar tendon enthesiopathy, who were treated at the Huashan Affiliated Hospital, Fudan University from October 2004 to August 2005, were enrolled and they were assigned randomly into 2 groups： ①physical therapy group （n=13）： microwave ＋ laser therapy, lukewarm of microwave （100 W output power）, 15 minutes every time per day. Semiconductor laser therapeutic device, it was better to have comfortable feeling at local part, 15 minutes every time per day. ② Eccentric exercises group （n=16）： They were treated with self-made eccentric training movement （standing with single leg straight, and squatted slowly and steadily in endurable ache range at 90°, and then held baluster, with over-weight of 0-15 kg at lower limb of double side, and then standing slowly）, twice per day, 15 minutes every time. Before treatment and 12 weeks after treatment, Australian Victorian Institute of Sport Assessment （VISA） score （0-100, the higher the score, the lower the symptom was, 100 as painless） and Visual Analogue Scale （VAS） （0-100, the higher the score, the severer the symptom was, 100 as exquisite pain） were used to assess pain degree. RESULTS： Totally 29 cases were involved in the result analysis. ①VISA score： There was insignificant difference before and after treatment in the physical therapy group （P 〉 0.05）. It was higher dramatically after treatment than that before treatment in the eccentric exercises group （68.5 ±15.8,38.3 ±13.2,P 〈 0.05）. The difference value in the eccentric exercises group was larger than that of the physical therapy group before and after treatment （30.2±65,7.4±2.7,p 〈 0.05）. ②VAS score： There was insignificant difference before and after treatment in the physical therapy group （P〉 0.05）. It was lower dramatically after treatment than that before treatment in the eccentric exercises group （20.1 ±123,52.9±9.7,P 〈 0.05）. The difference value in the eccentric exercises group was larger than that of the physical therapy group before and after treatment （32.4±5.3,9.3±4.9,P 〈 0.05 ）. CONCLUSION： The eccentric muscle exercises can obviously relieve the pain of patients with patellar tendon enthesiopathy, and its effect is better than that of traditional physiotherapy.