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[1]蔣擁軍,李克軍,邵開超,等.等速向心和離心肌力訓(xùn)練對前交叉韌帶重建術(shù)后膝關(guān)節(jié)屈伸肌群肌力影響的對比研究[J].中醫(yī)正骨,2022,34(07):27-33.
　JIANG Yongjun,LI Kejun,SHAO Kaichao,et al.A comparative study of the effects of centripetal versus centrifugal isokinetic muscle strength training on knee flexor/extensor muscle strength after anterior cruciate ligament reconstruction[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(07):27-33.
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等速向心和離心肌力訓(xùn)練對前交叉韌帶重建術(shù)后膝關(guān)節(jié)屈伸肌群肌力影響的對比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年07期
頁碼:
27-33
欄目:
臨床研究
出版日期:
2022-07-20

文章信息/Info

Title:
A comparative study of the effects of centripetal versus centrifugal isokinetic muscle strength training on knee flexor/extensor muscle strength after anterior cruciate ligament reconstruction
作者:
蔣擁軍; 李克軍; 邵開超; 黃若彬; 何夢凡; 汪偉
(深圳平樂骨傷科醫(yī)院/深圳市坪山區(qū)中醫(yī)院,廣東 深圳 518010)
Author(s):
JIANG Yongjun; LI Kejun; SHAO Kaichao; HUANG Ruobin; HE Mengfan; WANG Wei
Shenzhen Pingle Orthopedic Hospital(Shenzhen Pingshan District Hospital of Traditional Chinese medicine),Shenzhen 518010,Guangdong,China
關(guān)鍵詞:
前交叉韌帶重建術(shù);  肌力訓(xùn)練;  等速肌力評定;  向心收縮;  離心收縮;  臨床試驗
Keywords:
anterior cruciate ligament reconstruction;  strength training;  isokinetic muscle strength test;  concentric contraction;  eccentric contraction;  clinical trial
摘要:
目的:比較等速向心和離心肌力訓(xùn)練對前交叉韌帶(anterior cruciate ligament,ACL)重建術(shù)后膝關(guān)節(jié)屈伸肌群肌力的影響。方法:選擇80例近期因ACL斷裂接受過ACL重建術(shù),且術(shù)后接受過3個月相同的常規(guī)康復(fù)訓(xùn)練的患者,隨機分為2組,每組40例。采用TUR ISOFORCE等速肌力評估訓(xùn)練系統(tǒng)進行等速肌力訓(xùn)練,向心訓(xùn)練組進行等速向心肌力訓(xùn)練,離心訓(xùn)練組進行等速離心肌力訓(xùn)練; 2組患者均隔日訓(xùn)練1次,每周訓(xùn)練3次,共訓(xùn)練8周。詳細記錄試驗過程中出現(xiàn)的不良事件,采用TUR ISOFORCE等速肌力評估訓(xùn)練系統(tǒng)測定患者的膝關(guān)節(jié)屈伸肌群峰力矩(peak torque,PT),并利用系統(tǒng)自動計算膝關(guān)節(jié)屈伸肌群峰力矩與體質(zhì)量比值(peak torque/body weight,PT/BW)和膝關(guān)節(jié)屈伸肌群峰力矩比值(flexor/extensor,F/E)。結(jié)果:①膝關(guān)節(jié)屈伸肌群PT。2組男性患者治療前和治療結(jié)束后的膝關(guān)節(jié)伸肌群PT比較,組間差異均無統(tǒng)計學(xué)意義[(85.45±10.45)N·m,(88.12±9.96)N·m,t=0.866,P=0.392;(118.37±12.45)N·m,(123.78±13.39)N·m,t=1.389,P=0.172]; 治療結(jié)束后2組男性患者的膝關(guān)節(jié)伸肌群PT均較治療前增大(t=13.496,P=0.000; t=12.207,P=0.000)。2組男性患者治療前和治療結(jié)束后的膝關(guān)節(jié)屈肌群PT比較,組間差異均無統(tǒng)計學(xué)意義[(48.93±8.47)N·m,(50.23±9.17)N·m,t=0.489,P=0.628;(78.56±10.25)N·m,(83.69±11.36)N·m,t=1.575,P=0.123]; 治療結(jié)束后2組男性患者的膝關(guān)節(jié)屈肌群PT均較治療前增大(t=11.616,P=0.000; t=14.325,P=0.000)。2組女性患者治療前和治療結(jié)束后的膝關(guān)節(jié)伸肌群PT比較,組間差異均無統(tǒng)計學(xué)意義[(48.16±7.43)N·m,(46.72±8.16)N·m,t=0.551,P=0.585;(65.38±9.96)N·m,(66.07±10.33)N·m,t=0.204,P=0.840]; 治療結(jié)束后2組女性患者的膝關(guān)節(jié)伸肌群PT均較治療前增大(t=17.556,P=0.000; t=10.907,P=0.000)。2組女性患者治療前和治療結(jié)束后的膝關(guān)節(jié)屈肌群PT比較,組間差異均無統(tǒng)計學(xué)意義[(26.93±5.47)N·m,(25.26±6.17)N·m,t=0.855,P=0.399;(41.84±6.25)N·m,(42.19±8.06)N·m,t=0.144,P=0.886]; 治療結(jié)束后2組女性患者的膝關(guān)節(jié)屈肌群PT均較治療前增大(t=18.816,P=0.000; t=13.585,P=0.000)。②膝關(guān)節(jié)屈伸肌群PT/BW。2組男性患者治療前和治療結(jié)束后的膝關(guān)節(jié)伸肌群PT/BW比較,組間差異均無統(tǒng)計學(xué)意義[(137.44±18.28)(N·m)·kg-1,(136.57±19.74)(N·m)·kg-1,t=0.152,P=0.880;(189.08±20.49)(N·m)·kg-1,(191.45±21.23)(N·m)·kg-1,t=0.377,P=0.708]; 治療結(jié)束后2組男性患者的膝關(guān)節(jié)伸肌群PT/BW均較治療前增大(t=17.146,P=0.000; t=14.571,P=0.000)。2組男性患者治療前和治療結(jié)束后的膝關(guān)節(jié)屈肌群PT/BW比較,組間差異均無統(tǒng)計學(xué)意義[(77.36±10.12)(N·m)·kg-1,(78.59±11.09)(N·m)·kg-1,t=0.385,P=0.702;(124.01±15.20)(N·m)·kg-1,(127.11±14.17)(N·m)·kg-1,t=0.698,P=0.489]; 治療結(jié)束后2組男性患者的膝關(guān)節(jié)屈肌群PT/BW均較治療前增大(t=21.154,P=0.000; t=23.171,P=0.000)。2組女性患者治療前和治療結(jié)束后的膝關(guān)節(jié)伸肌群PT/BW比較,組間差異均無統(tǒng)計學(xué)意義[(94.04±11.26)(N·m)·kg-1,(92.75±12.44)(N·m)·kg-1,t=0.325,P=0.747;(127.74±16.42)(N·m)·kg-1,(131.06±18.03)(N·m)·kg-1,t=0.575,P=0.569]; 治療結(jié)束后2組女性患者的膝關(guān)節(jié)伸肌群PT/BW均較治療前增大(t=18.460,P=0.000; t=11.971,P=0.000)。2組女性患者治療前和治療結(jié)束后的膝關(guān)節(jié)屈肌群PT/BW比較,組間差異均無統(tǒng)計學(xué)意義[(50.91±4.17)(N·m)·kg-1,(49.89±4.92)(N·m)·kg-1,t=0.667,P=0.509;(80.01±10.67)(N·m)·kg-1,(82.36±11.04)(N·m)·kg-1,t=0.648,P=0.522]; 治療結(jié)束后2組女性患者的膝關(guān)節(jié)屈肌群PT/BW均較治療前增大(t=19.954,P=0.000; t=21.125,P=0.000)。③膝關(guān)節(jié)F/E。2組男性患者治療前的F/E比較,差異無統(tǒng)計學(xué)意義[(57.16±4.13)%,(56.98±3.98)%,t=0.147,P=0.884]; 治療結(jié)束后,2組男性患者的F/E均較治療前增大(t=21.716,P=0.000; t=13.527,P=0.000),向心訓(xùn)練組男性患者的F/E低于離心訓(xùn)練組男性患者[(65.56±4.58)%,(68.21±4.01)%,t=2.033,P=0.048]。2組女性患者治療前和治療結(jié)束后的F/E比較,組間差異均無統(tǒng)計學(xué)意義[(55.96±3.93)%,(54.08±4.56)%,t=1.317,P=0.197;(63.06±4.19)%,(63.80±5.01)%,t=0.477,P=0.636]; 治療結(jié)束后2組女性患者的F/E均較治療前增大(t=22.116,P=0.000; t=16.271,P=0.000)。④不良事件。2組患者試驗過程中均未發(fā)生嚴重不良事件。結(jié)論:等速向心肌力訓(xùn)練和等速離心肌力訓(xùn)練均能有效增強ACL重建術(shù)后膝關(guān)節(jié)屈伸肌群肌力,而且安全性較高,2種訓(xùn)練模式提升肌力的效果無明顯差異。與等速向心肌力訓(xùn)練相比,等速離心肌力訓(xùn)練在改善男性患者膝關(guān)節(jié)屈伸肌群肌力比值方面具有一定優(yōu)勢,可能更有利于促進膝關(guān)節(jié)穩(wěn)定性的恢復(fù)。
Abstract:
Objective:To compare the effects of centripetal versus centrifugal isokinetic muscle strength training on knee flexor/extensor muscle strength after anterior cruciate ligament(ACL)reconstruction(ACLR).Methods:Eighty patients who underwent ACLR for ACL rupture and received the same conventional rehabilitation training for 3 months after the surgery were selected and randomly divided into centripetal training group and centrifugal training group,40 cases in each group.The knee isokinetic muscle strength training was conducted via TUR ISOFORCE isokinetic muscle strength assessment training system.The patients in centripetal training group were instructed to perform isokinetic centripetal strength training,while the ones in centrifugal training group were instructed to perform isokinetic centrifugal strength training.All patients in the 2 groups were trained 1 time every other day,3 times a week for consecutive 8 weeks.The adverse events occurred during the test were recorded in detail.The peak torque(PT)of knee flexor/extensor muscles was measured by using the TUR ISOFORCE isokinetic muscle strength assessment training system,meanwhile,the ratios of knee flexor/extensor muscle PT to body weight(PT/BW)and knee flexor muscle PT to knee extensor muscle PT(F/E)were calculated and recorded automatically by the TUR ISOFORCE isokinetic muscle strength assessment training system.Results:①There was no statistical difference in PTs of knee extensor muscles of the male patients between the 2 groups before the treatment and after the end of the treatment(85.45±10.45 vs 88.12±9.96 N/m,t=0.866,P=0.392; 118.37±12.45 vs 123.78±13.39 N/m,t=1.389,P=0.172).The PTs of knee extensor muscles of the male patients increased after the end of the treatment compared to pretreatment in the 2 groups(t=13.496,P=0.000; t=12.207,P=0.000).There was no statistical difference in PTs of knee flexor muscles of the male patients between the 2 groups before the treatment and after the end of the treatment(48.93±8.47 vs 50.23±9.17 N/m,t=0.489,P=0.628; 78.56±10.25 vs 83.69±11.36 N/m,t=1.575,P=0.123).The PTs of knee flexor muscles of the male patients increased after the end of the treatment compared to pretreatment in the 2 groups(t=11.616,P=0.000; t=14.325,P=0.000).There was no statistical difference in PTs of knee extensor muscles of the female patients between the 2 groups before the treatment and after the end of the treatment(48.16±7.43 vs 46.72±8.16 N/m,t=0.551,P=0.585; 65.38±9.96 vs 66.07±10.33 N/m,t=0.204,P=0.840).The PTs of knee extensor muscles of the female patients increased after the end of the treatment compared to pretreatment in the 2 groups(t=17.556,P=0.000; t=10.907,P=0.000).There was no statistical difference in PTs of knee flexor muscles of the female patients between the 2 groups before the treatment and after the end of the treatment(26.93±5.47 vs 25.26±6.17 N/m,t=0.855,P=0.399; 41.84±6.25 vs 42.19±8.06 N/m,t=0.144,P=0.886).The PTs of knee flexor muscles of the female patients increased after the end of the treatment compared to pretreatment in the 2 groups(t=18.816,P=0.000; t=13.585,P=0.000).②There was no statistical difference in PT/BW of knee extensor muscles of the male patients between the 2 groups before the treatment and after the end of the treatment(137.44±18.28 vs 136.57±19.74 N·m/kg,t=0.152,P=0.880; 189.08±20.49 vs 191.45±21.23 N·m/kg,t=0.377,P=0.708).The PT/BW of knee extensor muscles of the male patients increased after the end of the treatment compared to pretreatment in the 2 groups(t=17.146,P=0.000; t=14.571,P=0.000).There was no statistical difference in PT/BW of knee flexor muscles of the male patients between the 2 groups before the treatment and after the end of the treatment(77.36±10.12 vs 78.59±11.09 N·m/kg,t=0.385,P=0.702; 124.01±15.20 vs 127.11±14.17 N·m/kg,t=0.698,P=0.489).The PT/BW of knee flexor muscles of the male patients increased after the end of the treatment compared to pretreatment in the 2 groups(t=21.154,P=0.000; t=23.171,P=0.000).There was no statistical difference in PT/BW of knee extensor muscles of the female patients between the 2 groups before the treatment and after the end of the treatment(94.04±11.26 vs 92.75±12.44 N·m/kg,t=0.325,P=0.747; 127.74±16.42 vs 131.06±18.03 N·m/kg,t=0.575,P=0.569).The PT/BW of knee extensor muscles of the female patients increased after the end of the treatment compared to pretreatment in the 2 groups(t=18.460,P=0.000; t=11.971,P=0.000).There was no statistical difference in PT/BW of knee flexor muscles of the female patients between the 2 groups before the treatment and after the end of the treatment(50.91±4.17 vs 49.89±4.92 N·m/kg,t=0.667,P=0.509; 80.01±10.67 vs 82.36±11.04 N·m/kg,t=0.648,P=0.522).The PT/BW of knee flexor muscles of the female patients increased after the end of the treatment compared to pretreatment in the 2 groups(t=19.954,P=0.000; t=21.125,P=0.000).③There was no statistical difference in F/E of the male patients between the 2 groups before the treatment(57.16±4.13 vs 56.98±3.98%,t=0.147,P=0.884).The F/E of the male patients increased after the end of the treatment compared to pretreatment in the 2 groups(t=21.716,P=0.000; t=13.527,P=0.000),and it was smaller in centripetal training group compared with that of centrifugal training group(65.56±4.58 vs 68.21±4.01%,t=2.033,P=0.048).There was no statistical difference in F/E of the female patients between the 2 groups before the treatment and after the end of the treatment(55.96±3.93 vs 54.08±4.56%,t=1.317,P=0.197; 63.06±4.19 vs 63.80±5.01%,t=0.477,P=0.636).The F/E of the female patients increased after the end of the treatment compared to pretreatment in the 2 groups(t=22.116,P=0.000; t=16.271,P=0.000).④No serious adverse events occurred in the 2 groups during the test.Conclusion:Both isokinetic centripetal muscle strength training and isokinetic centrifugal muscle strength training can effectively enhance the knee flexor/extensor muscle strength after ACLR with high safety,and there is no significant difference between the two training modes in muscle strength improvement effects.The isokinetic centrifugal muscle strength training has certain advantage in improving F/E of knee flexor/extensor muscles of male patients compared to isokinetic centripetal muscle strength training and it may be more conducive to the recovery of knee stability.

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備注/Memo

備注/Memo:
基金項目:深圳市坪山區(qū)衛(wèi)生系統(tǒng)科研項目(201845) 通訊作者:蔣擁軍 E-mail:[email protected]
更新日期/Last Update: 1900-01-01