髋关节外展肌训练对全膝关节置换术后下肢肌力和步行功能的影响

Effects of the hip abductor muscle strengthening on the lower limb muscle strength and gait in patients with total knee arthroplasty

目的:探究全膝关节置换(TKA)术后早期康复训练中强化髋关节外展肌训练对患者下肢肌力及步行功能的影响。方法:选取2020年1月至2021年10月在山东大学齐鲁医院(青岛)因膝关节骨性关节炎初次行全膝关节置换的患者60例,采用随机数字法分为试验组(n=30)和对照组(n=30),对照组采用常规康复训练方法,试验组在常规康复基础上增加髋关节外展肌训练,两组进行4周每周5次的训练。干预前后分别对两组进行等速肌力测试、膝关节功能(KSS)评分、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分、“起立-行走”计时测试(TUGT)、三维步态分析。结果:经4周康复干预后:试验组髋关节外展相对峰力矩、膝关节屈伸相对峰力矩、KSS评分均显著高于干预前(均P<0.01);WOMAC疼痛、僵硬、功能、总分及TUGT完成时间显著低于干预前(均P<0.05);步速、步幅、患侧支撑百分比及髋、膝关节矢状面活动范围显著高于干预前(均P<0.05);双支撑百分比低于干预前(P<0.05)。干预后试验组髋关节外展相对峰力矩、KSS评分显著高于对照组(均P<0.01);WOMAC疼痛、功能、总分及TUGT完成时间低于对照组(均P<0.05);步幅、患侧支撑百分比患侧髋、膝关节矢状面活动范围均高于对照组(均P<0.05)。结论:全膝关节置换术后早期康复训练中强化髋关节外展肌训练能更好改善患者的下肢肌力及步行功能。

Objective:To explore the effects of the hip abductor muscle strengthening on the lower limb muscle strength and gait in patients with total knee arthroplasty.Method:From January,2020 to October,2021,60 patients with total knee arthroplasty were randomly divided into experimental group(n=30)and control group(n=30),The control group received conventional treatment,the experimental group received conventional treatment and the abductor muscle strengthening of the hip,5 times a week for 4 weeks.They were assessed with isokinetic muscle strength test,knee society score(KSS),western ontario and McMaster universities osteoarthritis index(WOMAC),time up and go test(TUGT)and three dimensional gait analysis before and after treatment.Result:After intervention,the hip abductor peak torque(PT)and knee flexor/extensor PT,the knee society score(KSS)of the experimental group was higher than before(all P<0.01);the pain,stiffness,physical function,total scores of WOMAC and the TUGT test of the experimental group was lower than before(all P<0.05);the walking speed,stride length,the proportion of affected side support,range of motion in sagittal plane of affected side hip,range of motion in sagittal plane of affected side knee of the experimental group was higher than before(all P<0.05),the proportion of double support was lower than before(P<0.05).After intervention,the hip abductor PT,the KSS in the experimental group was higher than that in the control group(all P<0.01);the pain,physical function,total scores of WOMAC and the TUGT test of the experimental group was lower than that in the control group(all P<0.05);The stride length,the proportion of affected side support,the range of motion in sagittal plane of affected side hip,the range of motion in sagittal plane of affected side knee of the experimental group was higher than that in the control group(all P<0.05).Conclusion:In the early rehabilitation training after total knee arthroplasty,the abductor muscle strengthening of the hip can improve the lower limb muscle strength and gait.