经皮神经电刺激对膝周骨折术后患者膝关节疼痛、功能、肌力和步态的影响

关键词：经皮神经电刺激  膝  骨折

Keywords:transcutaneous electrical nerve stimulation  knee  fracture

摘要：

      摘要 目的：探讨经皮神经电刺激（TENS）对膝周骨折术后患者膝关节疼痛、功能、肌力和步态的影响。 方法：纳入40例膝周骨折术后患者，分为观察组（n=20）和试验组（n=20）。观察组接受中药熏蒸、关节松动、神经肌肉电刺激和肌力训练等常规康复治疗；试验组将常规康复治疗中的神经肌肉电刺激换为经皮神经电刺激，其他治疗与观察组一致。所有治疗5次/周，持续6周。于治疗前、治疗6周后对两组患者进行疼痛视觉模拟评分（VAS）、美国特种外科医院膝关节评分（HSS-KS）、等速肌力测试和三维步态测试。 结果：治疗前，两组患者各项评估指标差异无显著性意义（P>0.05）；治疗6周后，两组患者的HSS-KS、等速肌力测试和步态测试结果均显著优于治疗前（P<0.05），且试验组的VAS、HSS-KS、等速肌力测试中60°/s和180°/s下的相对峰力矩及部分步态参数显著优于观察组（P<0.05）。 结论：TENS治疗可显著减轻膝周骨折术后患者的疼痛，提高膝关节功能，提升股四头肌的绝对肌力，改善步态。

Abstract:

      Abstract Objective: To explore the effects of transcutaneous electrical nerve stimulation (TENS) on knee joint pain, function, muscle strength and gait in patients with knee fracture surgery. Method: Forty patients with knee fractures were divided into the control group and the experimental group, with 20 cases in each group. Strength training, joint mobilization techniques, neuromuscular electrical stimulation, and routine rehabilitation training were provided to the control group. The experimental group was given the same routine rehabilitation program, except the TENS intervention instead of neuromuscular electrical stimulation. For six weeks, each treatment was given once daily over five days. All the patients were evaluated by Visual analogue score (VAS), American hospital for special surgery knee score (HSS-KS), isometric muscle strength test and 3-D gait analysis before and after treatment. Result: There was no significant difference between the two groups in each evaluation scores before treatment (P>0.05). HSS-KS score, peak torque per bodyweight of knee extensors and flexors under 60°/s and 180°/s, and gait parameters in both groups were significantly improved after 6 weeks of treatment, compared to those before treatment (P<0.05). Meanwhile, the experimental group were significantly better than the control group in terms of the VAS score and HSS-KS score, peak torque/body weight (PT/BW) at 60°/s and 180°/s of knee extensors, and subparts of gait parameters (P<0.05). Conclusion: In patients with knee fractures surgery, TENS can significantly minimize the pain, improve knee function and gait pattern, and strengthen the absolute force of knee extensors.