神经肌肉电刺激股四头肌对全膝关节置换术后功能康复的影响

Influence of neuromuscular electrical stimulation of musculi quadriceps femoris on motor function rehabilitation after total knee replacement

目的:了解神经肌肉电刺激股四头肌对全膝关节置换术(TKR)后运动功能康复的影响。方法:TKR术后患者104例,按分层随机法分为两组,治疗组52例,用神经肌肉电刺激股四头肌,要求患者随电流刺激同时进行主动伸膝;对照组52例,用经皮神经电刺激模式,两组电极分别置于膝部痛点。同时所有患者参与常规康复治疗,平均治疗(14.89±3.65)d出院。出院前行视觉模拟评分法(VAS)、膝关节活动度和膝关节损伤和骨关节炎评分量表(KOOS)评定。出院后随访平均间隔9.5月,随访时行美国膝关节协会评分(KSS)和KOOS量表评定。结果:出院时治疗组和对照组VAS评分分别为(18.11±9.66)和(16.13±4.25)、膝关节主动活动范围(AROM)分别为(103.21°±15.44°)和(99.21°±15.19°),两组的差异均无显著性(P>0.05);治疗组主动伸膝受限为(1.93°±3.47°),明显小于对照组(6.26°±4.28°),差异非常显著(P<0.01);治疗组KOOS评分为(71.52±10.97),明显高于对照组(65.02±10.26),两组差异显著(P<0.01)。随访时,两组KSS评分均达优水平,差异无显著性(P>0.05);治疗组KOOS评分(96.16±2.96)高于对照组(94.04±4.80),两组差异非常显著(P<0.01)。结论:TKR术后早期配合神经肌肉电刺激股四头肌的康复治疗,有助于早期提高伸膝装置的功能和加速功能康复。

Objective： To observe the influence of neuromuscular electrical stimulation（NMES） of musculs quadriceps femoris on motor function rehabilitation after total knee replacement （TKR）. Method： One hundred and four patients who underwent TKR were randomized into treatment group NMES musculus quadriceps femoris sombined with active extension of knee and control group treated with transcutaneous electrical nerve stimulation （TENS） on the pain points of knee, while all patients also received standard physiotherapy about 2 weeks. All patients were assessed with both subjective and objective clinical scales about 2 weeks postoperatively. Average duration of follow-up for the 104 patients was 9.5 months （range 4—16 months）. Result： There was no significant difference in visual analogue scale （VAS） pain scores and knee active range of motion （AROM） between the two groups （P0.05）. The limited knee extension angle was significantly less in treatment group （1.93°±3.47°） than that in control group （6.26°±4.28°） （P0.01） and the knee injury and osteoarthritis outcome score （KOOS） score was significantly higher in treatment group （71.52±10.97） than that in control group （65.02±10.26） （P0.01） at 2 weeks postoperatively. However, at follow-up there was no significant difference in the knee society score （KSS） of both groups were at excellent level, but （P0.05）. The KOOS scorein treatment group （96.16±2.96） was significantly higher than that in control one （94.04±4.80） （P0.01）. Conclusion： NMES stimulation on musalus quadriceps femoris in addition to conventional physiotherapy can improve functional recovery and accerelate early motor function rehabilitation after TKR.