多角度等速肌力训练对膝关节置换术后膝关节活动度及本体感觉恢复效果  

Effect of multi-angle isokinetic muscle strength training on the recovery of knee motion and proprioception after knee arthroplasty

作　　者：张彭 杨鹏 赵菁 钟俊桥 万绍勇[4] ZHANG Peng;YANG Peng;ZHAO Jing;ZHONG Junqiao;WAN Shaoyong(School of Physical Education,China University of Mining and Technology,Xuzhou 221116,Jiangsu,China;Department of Physical Education,Harbin Institute of Technology,Harbin 150006,Heilongjiang,China;Department of Orthopedics,Affiliated Hospital of Jinggangshan University,Ji'an 343000,Jiangxi,China;School of Physical Education,Jinggangshan University,Ji'an 343009,Jiangxi,China)

机构地区：[1]中国矿业大学体育学院,江苏徐州221116 [2]哈尔滨工业大学体育部,黑龙江哈尔滨150006 [3]井冈山大学附属医院骨一科,江西吉安343000 [4]井冈山大学体育学院,江西吉安343009

出　　处：《山东大学学报(医学版)》2025年第3期36-43,54,共9页Journal of Shandong University:Health Sciences

基　　金：江西省教育厅科学技术研究一般项目(GJJ2201635)。

摘　　要：目的探讨不同角度等速肌力训练对膝关节置换术(total knee arthroplasty,TKA)后膝关节活动度及本体感觉的影响。方法选择2021年1月至2022年6月在井冈山大学附属医院行TKA手术患者96例,48~74岁,平均(62.92±4.36)岁,其中男49例,女47例。在等速肌力训练中,根据不同膝关节屈曲范围分为0°~30°组、31°~60°组和61°~90°组,每组32例。对比3组患者治疗前和治疗2个月后肌力指标、临床指标及本体感觉相关指标,并分析不同角度等速肌力训练后膝关节膝关节活动度(range of motion,ROM)与本体感觉之间的相关性。结果3组患者治疗2个月后股四头肌、小腿三头肌各项肌力指标均显著高于治疗前(P<0.05),治疗2个月后31°~60°组患者股四头肌各项肌力相关指标均显著高于0°~30°组和61°~90°组,而0°~30°组小腿三头肌各项肌力相关指标均显著高于31°~60°组和61°~90°组(P<0.05)。3组患者治疗后ROM、“起立-行走”计时(time“up and go”test,TUGT)时间、视觉模拟评分法(visual analogue scale,VAS)评分、Berg平衡量表(Berg balance scale,BBS)评分及美国特种外科医院膝关节功能(hospital for special surgery,HSS)评分均有显著改善(P<0.05),0°~30°组治疗后ROM、HSS评分显著高于31°~60°组和61°~90°组,31°~60°组TUGT时间则显著低于0°~30°组和61°~90°组(P<0.05);0°~30°组和31°~60°组治疗后BBS评分均高于61°~90°组(P<0.05);3组患者治疗后VAS评分差异无统计学意义(P>0.05)。治疗后被动运动阈值测量(threshold to detection of passive movement,TDPM)和主动角度重现(active angle reproduction,AAR)得到显著改善(P<0.05);31°~60°组治疗后TDPM(30°、45°、60°)和AAR(30°、45°、60°)均显著低于0°~30°组和61°~90°组(P<0.05)。Pearson分析结果显示,等速肌力训练角度为0°~30°时,治疗后膝关节ROM与AAR 30°(r=-0.50,P=0.03)存在相关性;等速肌力训练角度为31°~60°时,治疗后膝关节ROM与TDPM 30°(r=-0.49,P=0Objective To investigate the effect of different angle isokinetic muscle strength training on knee joint motion and proprioception after total knee arthroplasty(TKA).Methods A total of 96 patients who underwent TKA in Affiliated Hospital of Jinggangshan University from January 2021 to June 2022 were selected,aged 37-74 years,with a mean age of 52.72±5.37 years.The patients were divided into group 0°-30°,group 31°-60°and group 61°-90°according to the range of knee flexion during isokinetic training.Muscle strength index,clinical index and proprioceptive index were compared before and after treatment in the three groups.The correlation between knee ROM and proprioception was analysed after isokinetic strength training at different angles.Results After treatment,the muscle strength indexes of the quadriceps femoris and triceps crus were significantly higher in the three groups than those before treatment(P<0.05).After treatment,the muscle strength related indexes of quadriceps femoris in group 31°-60°were significantly higher than those in group 0°-30°and group 31°-60°,while the muscle strength related indexes of triceps crus in group 0°-30°were significantly higher than those in group 31°-60°and group 31°-60°(P<0.05).After treatment,range of motion(ROM),time“up and go”test(TUGT),visual analogue scale(VAS),Berg balance scale(BBS)score and hospital for special surgery(HSS)score were significantly improved in the three groups(P<0.05).The ROM and HSS scores of group 0°-30°were significantly higher than those in group 31°-60°and group 31°-60°,and the TUGT time of group 31°-60°was significantly lower than that of group 0°-30°and group 31°-60°(P<0.05).The BBS scores of group 0°-30°and group 31°-60°were higher than those of group 31°-60°after treatment(P<0.05).There was no significant difference in VAS score between the three groups after treatment(P>0.05).TDPM and AAR were significantly improved after treatment(P<0.05).After treatment,TDPM(30°,45°,60°)and AAR(30°,45°,60°)in g

关 键 词：等速肌力训练 膝关节置换术 膝关节活动度 本体感觉 

分 类 号：R687.409[医药卫生—骨科学]