膝关节骨性关节炎患者股四头肌肌力相关指标变化及其与疼痛程度的关系

Changes of relative parameters of muscle strength of quadriceps femoris and their relations to the degrees of pain for patients with knee osteoarthritis

目的分析膝关节骨性关节炎(KOA)患者股四头肌肌力相关指标变化情况及其与不同疼痛程度之间的关系,为康复治疗提供临床依据。方法选取2013年6月至2014年6月广州医科大学附属第二医院收治的30例KOA患者作为观察组,将同期体检中心随机选取的30例健康志愿者作为正常对照组。使用电刺激与随意收缩叠加法对研究对象的股四头肌最大随意等长收缩相对肌力(rMVC)、肌肉动员能力(MA)和肌力储备能力(RCMS)进行测量,按照视觉模拟量表(VAS)评分评估KOA患者的疼痛程度,分析不同水平VAS评分股四头肌肌力相关指标的变化。结果观察组患者股四头肌rMVC、MA明显低于对照组,而RCMS明显高于对照组,两组比较,差异均有统计学意义(P<0.05)。不同水平VAS评分患者股四头肌rMVC、MA及RCMS比较,差异均有统计学意义(P<0.05)。结论与正常人比较,KOA患者股四头肌肌力降低,肌肉动员能力减弱,但其储备能力有所提高;患者疼痛程度与股四头肌肌力关系密切。提示可通过针对性康复训练提升KOA患者神经-肌肉交联系统的控制能力,增强股四头肌肌力,以实现缓解疼痛、提高关节稳定性、改善临床疗效的目的。

Objective To analyze the changes of relative parameters of muscle strength of quadriceps femoris,and to explore their relations to the degrees of pain for patients with knee osteoarthritis（KOA）,so as to provide clinical evidences for rehabilitation.Methods Total of 30 KOA patients treated from June 2013 to June 2014 in the Second Affiliated Hospital of Guangzhou Medical College were included in observation group,at the same time,30 healthy volunteers in physical examination center in the hospital were selected as control group randomly.Electrical stimulation with voluntary contraction superposition method was used to examine the relative maximal voluntary isometric contraction（rMVC）,muscle activation（MA） and reserve capacity of muscle strength（RCMS） of quadriceps.Degrees of pain in KOA patients were evaluated by visual analogue scale（VAS） scoring,and the changes of the above parameters in different VAS score groups were also analyzed.Results MA and rMVC of quadriceps in observation group were lower than those in control group,while RCMS of quadriceps was higher than that in control group,the differences between two groups had statistical significance（P〈0.05）.Also,there were statistical differences of rMVC,MA and RCMS among different VAS score groups（P〈0.05）.Conclusions Compared to healthy volunteers,muscle strength and muscle activation capacity of quadriceps in KOA patients presented weak,on the contrary,RCMS of quadriceps increased significantly.Degree of pain is closely relative to the parameters of muscle strength of quadriceps for KOA patients.The results indicates that we should enhance the control of nerve-muscle crosslinking system and increase muscle strength of quadriceps by rehabilitation exercises,so as to relieve pain symptom,promote the stability of joint and improve the clinical efficacy.