髋膝踝关节周围肌群肌力训练对老年全膝关节置换术后患者下肢运动功能的影响

关键词：渐进抗阻肌力训练  膝关节置换术  步态  坐站转换  自我效能感

Keywords:progressive resistance training  total knee arthroplasty  gait performance  sit-to-stand  self-efficiency

摘要：

      摘要 目的:探讨两种不同的肌力训练方案：术侧下肢髋、膝、踝关节周围肌力训练和单纯膝关节周围肌力训练，对老年单侧全膝关节置换术后患者下肢运动功能的影响。 方法:选取29例全膝关节置换术后患者，分为髋膝踝训练组（A组）和膝关节训练组（B组），分别于研究开始（T0）、6周后(T1)、12周后(T2)对所有受试者进行步态分析和坐站转换时间（sit-to-stand，STS）、改良步态效能评分（mGES），计算患足支撑时间百分比、标准化步幅、步频、STS和mGES。对所得数据进行组间和组内比较。 结果:组内比较，在整个试验过程中，所有受试者单足支撑时间明显延长，步幅、步频均明显增加（P<0.05）；A组受试者STS时间明显缩短（P<0.05），mGES评分明显升高（P<0.05）。B组受试者STS时间仅在试验开始及结束时有差异（P<0.05），mGES变化不显著。组间比较，两组患者单足支撑时间、步幅、步频明显延长，但组间均无明显差异（P>0.05）。经过12周的渐进抗阻训练，A组患者STS时间明显短于B组（P<0.05）；A组患者mGES评分明显高于B组。 结论:术侧下肢渐进抗阻肌力训练能有效改善TKA患者步态。与单纯膝关节周围肌群肌力训练相比，增加髋关节和踝关节周围肌力训练可使患者在特殊环境下和自我效能感方面受益更多。

Abstract:

      Abstract Objective: To evaluate the effect of two different resistance training mode: strength training for muscles around hip, knee and ankle, versus strength training for muscles around the knee only，on functional performance in patients with unilateral knee arthroplasty (TKA). Method: Twenty-nine patients who underwent TKA were randomly assigned into two groups: hip, knee and ankle training group (group A, n=15) and knee training group (group B, n=14). The duration of stance（% of stride），stride length norm，cadence，STS and mGES had been assessed at baseline (T0), 6 weeks (T1) and 12 weeks (T2) after training respectively. Result: After 12 weeks training, all the patients had significantly increased in duration of stance, stride length norm and cadence (P<0.05). In group A, when compared T1 with T0, T2 with T1, STS had significant decrease and mGES increased significantly (P<0.05). In group B, significant decrease in STS only occurred when compared T2 with T0 while increase in mGES was not significant. In addition, there were more decrement in STS and increment in mGES in group A. Conclusion: Progressive resistance training was effective in improving gait performances of TKA patients in level walking. Compared with muscle strength training around the knee，strength training programs including hip and ankle should be more beneficial in more demanding activities.