限弧等速肌力训练对于髌股关节炎髌骨轨迹的影响

Effect of arc limitation isokinetic muscle strength training on the mal-patellar tracking of patients with patellofemoral arthritis

目的:探讨不同限弧等速肌力训练对髌股关节炎患者髌骨轨迹的影响。方法:诊断为髌股关节炎患者60例,按接诊顺序分为A组(0°~30°)、B组(30°~60°)和C组(60°~90°)不同角度限弧运动训练组,每组各20例,采用德国ISOMED 2000等速肌力训练系统按分组对患者膝关节周围肌肉进行4周的限弧等速肌力训练。训练前、后拍摄膝关节负重正侧位及屈膝45°轴位片,测量髌骨轨迹参数(即髌股指数、外侧髌股角、髌骨合适角);记录每个膝关节的等速肌力测定值,即峰力矩(PT)、总功(TW)及平均功率(AP);采用西安大略和麦克马斯特大学骨关节炎指数(WOMAC)(包括疼痛、僵硬、日常功能)评定膝关节功能。结果:训练4周后,A组髌股指数、髌骨合适角较训练前明显降低,外侧髌股角较训练前明显提高(P<0.05);A、B、C组峰力矩PT、总功TW及平均功率AP值均较训练前明显提高(P<0.05);WOMAC评分比较,A组疼痛、日常功能评分较训练前明显降低(P<0.05)。训练后,髌骨轨迹参数比较:髌股指数、髌骨合适角A组明显低于B、C组(P<0.05),外侧髌股角明显高于B、C组(P<0005);等速肌力测定值比较:A组PT值明显高于B、C组(P<0.05);WOMAC评分比较:疼痛评分A组明显低于B、C组(P<0.05)。B组与C组间各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髌股关节炎髌骨轨迹,提高膝关节功能。

Objective:To evaluate the effects of different quadrants of isokinetic quadriceps training on the mal-patellar tracking of patients with patellofemoral osteoarthritis.Methods:Isokinetic quadficeps training was administered to 60 cases of patellofemoral osteoarthritis.The subjects were allocated into 3 groups for 4-week isokinetie training with ranges of A(0-30°),B(30-60°)or C(60-90°)according to priority,with 20 knee joints in each group.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 patella-femoral index were recorded along with the peak torque(PT),the total work(TW),and the average work(AW)in the three different ranges of motion.WOMAC scores were also recorded.Results:After 4-week training,the patellofemoral index and patellar proper angle in group A were significantly lower than those before training,and the lateral patellofemoral angle was significantly higher than before training.The difference was statistically significant(P<0.05);PT,TW and AW values in groups A,B,and C were significantly higher than before training(P<0.05);For WOMAC score comparison,the pain and daily function scores in group A were significantly lower than before training(P<0.05).After training,for the mal-patellar tracking parameters comparison,the patellofemoral index and the appropriate patellar angle in group A were significantly lower than those in groups B and C(P<0.05),and the lateral patellofemoral angle was significantly greater than that in groups B and C(P<0.05);For comparison of measured values of isokinetic muscle strength,the PT in group A was significantly higher than that in groups B and C(P<0.05);For the comparison of WOMAC score,the pain score in group A was significantly lower than that in groups B and C(P<0.05).Conclusion:Isokinetic quadriceps training with 0°~30°range of motion can best realign patellar tracking of patellofemoral osteoarthritis,and improve knee function.