等速肌力训练对全膝关节置换术后髌骨轨迹异常的影响

A clinical evaluation of isokinetic training for correcting patellar tracking after total knee replacement

目的 探讨股四头肌不同角度等速肌力训练对全膝关节置换术后髌骨轨迹异常者的影响.方法 入选全膝关节置换术患者52例,共66个膝关节,其中男9例10膝,女43例56膝,平均年龄58.3岁.按接诊顺序分为3组,即0～30°组、30～60°组和60～90°组进行股四头肌训练,每组22个膝关节.采用德国lsomed 2000型等速肌力训练系统对各组（膝关节屈曲范围分别为0～30°、30～60°及60～90°）进行3个月的股四头肌向心性收缩训练,测试速度为30°/s.治疗前、后拍摄膝关节负重正侧位及屈膝45°轴位片,测量髌骨指数、外侧髌骨角及髌骨协调角;记录每个膝关节的峰力矩、总功率及平均功率;治疗前、后采用美国特种外科医院（HSS）膝关节功能评分评定膝关节功能.结果 0～30°组治疗前、后的髌骨指数、外侧髌骨角及髌骨协调角比较,差异有统计学意义（P＜0.01）,30～60°组及60～90°组治疗前、后相关指标差异无统计学意义（P＞0.05）;治疗后,各组峰力矩、总功率及平均功率均较治疗前增大（P＜0.05）.治疗前后反映髌骨轨迹的指标,即髌骨指数、外侧髌骨角及髌骨协调角差值均与0～30°组股四头肌肌力指标,即峰力矩、总功率及平均功率的差值呈正相关（P＜0.05）,但与30～60°组及60～90°组的各项肌力指标差值无相关性（P＞0.05）.治疗后0～30°组HSS评分与治疗前比较,差异有统计学意义,而30～60°组及60～90°组治疗前、后HSS评分差异无统计学意义.结论 膝关节屈曲范围0～30°的股四头肌等速训练可有效改善全膝关节置换术后髌骨轨迹异常,提高膝关节功能.

Objective To evaluate the effects of isokinetic quadriceps training with different ranges of motion for improving mal-patellar tracking after total knee replacement （TKR）. Methods Isokinetic quadriceps training was administered to 52 TKR cases, involving 66 knee joints with poor patellar tracking. The subjects were randomly allocated into 3 groups for isokinetic training with ranges of 0-30°, 30-60° or 60-90°, with 22 knee joints in each group. The angular velocity was set at 30°/second. X-rays with loading and with 45° knee flexion were taken before and after the training. The lateral patello-femoral angle,the patella index and the patello-femoral index were recorded along with the maximum torque （ MT）, the total work （ TW ）, and the average work（AW） in the three different ranges of motion. Hospital for Special Surgery （HSS） scores were also recorded. Results After 3 months of training, the average lateral patello-femoral angle, patella index, and patello-femoral index in the 0-30° training group were all significantly better than before the training. However, there was no significant difference in these measures for the 30-60° and 60-90° groups. After training average MT, TW and AW increased significantly in all groups, but the improvements were significantly correlated with the differences in lateral patello-femoral angles, patella indices and patello-femoral indices only for the 0-30°group. When compared with the baseline values, a statistically significant difference in HSS score after training was observed only in the 0-30° training group. Conclusions Isokinetic quadriceps training with a 0-30° range of motion can best realign patellar tracking after TKR, and best improve knee function.