肌力训练对人工全髋置换术患者髋关节的生物力学影响

Effects of muscle strengthening exercise on biomechanics of hip function in patients after total hip replacement

目的：采用等速肌力测试和Ｈａｒｒｉｓ功能评价人工全髋关节置换术后患者髋关节屈伸肌力与其功能之间的关系，证明肌力训练对促进髋关节功能改善的重要性。方法：患者１６例，１０例右髋、６例左髋接受全髋关节置换术。术后２个月内进行日常活动能力训练；术后平均２个月开始进行患髋屈伸肌的肌力训练；均以手术侧髋与健侧髋进行对照；观察患者术后２个月、１４个月的髋关节肌力及功能变化。评定指标：手术前、后Ｈａｒｒｉｓ髋关节评分；术后Ｃｙｂｅｘ－６０００型等速肌力测试仪评定。结果：①髋关节置换术后患髋屈伸肌的峰力矩（ＰＴ）比健侧明显减低（Ｐ＜０．０１）， 患髋的屈髋ＰＴ／伸髋ＰＴ比值明显高于健侧（Ｐ＜０．０１）；②肌力训练后双侧髋关节屈伸肌ＰＴ均有显著性提高（Ｐ＜０．０１），尤以患侧改善更为明显。③患者Ｈａｒｒｉｓ总分较术前明显提高，但术后２－１２个月期间Ｈａｒｒｉｓ总分变化不大；结论：单纯Ｈａｒｒｉｓ评分不能很好地反映全髋关节置换术后髋周肌群的生物力学改变，需配合等速肌力检测作为评价全髋关节置换术后髋关节功能变化的重要指标；术后除进行日常的功能活动为主的训练外，应加强髋关节周围肌群的力量训练。

Objective: The relationship between the hip function and strength of hip muscle after total hip replacement (THR) was study using isokinetic muscle testing and Harris functional evaluation the evidence the importance of hip muscle strengthening exercise. Method: Sixteen patients receiving unilateral THR (10 right hip and 6 left hip) were enrolled in this study. ADL training and strengthening exercise of flexor and extensors muscle of the involved hip were carried out in 1 week and 2 month postoperatively. Each patient underwent the Harris hip evaluation and isokinetic hip strength by the Cybex-6000 isokentic dynamometer at 15°/s in the concentric mode while performing flexion-extension movements with both legs. Result: The peak torque values (PT) for both flexor and extensor of the involved hip were lower than those of the uninvolved hip (P<0.01) postoperatively. The PTFLX/PTEXT values of involved hip was higher than those of uninvolved hip (P<0.01). PT for both flexors and extensors of the involved hip have been markedly improved. The Harris hip scores significantly increased postoperatively. Conclusion: Harris evaluation showed mainly change of clinical function of hip joint. Isokinetic muscle testing can be regard as an important parameter in evaluating hip function after THR. Strengthening exercise of hip muscles should be encouraged in addition to ADL training.