切换至 "中华医学电子期刊资源库"
高级检索
中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2018, Vol. 04 ›› Issue (03) : 168 -174. doi: 10.3877/cma.j.issn.2096-0263.2018.03.009

所属专题： 文献；

膝关节

渐进式抗阻训练治疗女性膝关节骨关节炎的效果研究
倪广晓1, 韩晓勇1, 周鸿斌1, 罗志飞1, 岳崴1, 牛彦平1,†()   
  1. 1. 050000　石家庄，河北医科大学第二医院康复科
  • 收稿日期:2017-02-27 出版日期:2018-06-05
  • 通信作者: 牛彦平
  • 基金资助:
    河北医科大学第二医院科研基金(20161032)

The effect of progressive resistance exercise program on female knee osteoarthritis

Guangxiao Ni1, Xiaoyong Han1, Hongbin Zhou1, Zhifei Luo1, Wei Yue1, Yanping Niu1,†()   

  1. 1. Department of Rehabilitation, The second hospital of HeBei Medical university, Shi Jiazhuang 050000, China
  • Received:2017-02-27 Published:2018-06-05
  • Corresponding author: Yanping Niu
  • About author:
    Corresponding author: Niu Yanping, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

倪广晓, 韩晓勇, 周鸿斌, 罗志飞, 岳崴, 牛彦平. 渐进式抗阻训练治疗女性膝关节骨关节炎的效果研究[J]. 中华老年骨科与康复电子杂志, 2018, 04(03): 168-174.

Guangxiao Ni, Xiaoyong Han, Hongbin Zhou, Zhifei Luo, Wei Yue, Yanping Niu. The effect of progressive resistance exercise program on female knee osteoarthritis[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2018, 04(03): 168-174.

目的

探讨渐进式抗阻训练（PRE）对女性膝关节骨关节炎（KOA）患者膝关节功能的影响。

方法

前瞻性收集2013年8月至2014年9月在河北医科大学第二医院康复科及骨科就诊的女性KOA患者92例，年龄40~70岁，平均（55±11）岁。随机分为试验组和对照组，各46例，试验组给予渐进式抗阻训练（PRE）和膝关节松动术，对照组给予膝关节松动术。由一位未参与本项目的康复师在初诊、治疗后6 w及12 w时对所有患者进行评定，评定内容包括骨性关节炎指数评分表（WOMAC）、健康调查简表（SF-36）、一次重复最大负荷（1RM）。治疗结束后应用李科特5级量表进行患者满意度调查。

结果

试验组44例患者获得随访，对照组45例患者获得随访，随访率96.7%，随访时间均为12 w。两组术后6 w和12 w VAS评分比较，试验组优于对照组[试验组：6 w：（6.0±1.8）分，12 w：（4.4±3.0）分；对照组：6 w：（7.0±1.5）分，12 w：（6.5±2.5）分]，差异有统计学意义（6 w：t=-2.573，P=0.022，12 w：t=-2.721，P=0.001）；两组术后6 w和12 w WOMAC评分结果比较，试验组优于对照组[试验组：6 w：（40±14）分，12 w：（31±14）分；对照组：6 w：（24±17）分，12 w：（38±13）分]，差异有统计学意义（6 w：t=0.001，P=0.017，12 w：t=-4.263，P=0.001）；两组12 w SF-36健康调查简表评定结果比较，试验组在生理功能和生理职能方面优于对照组，差异有统计学意义[生理功能：试验组：（50±22）分，对照组：（32±17）分，t=-3.601，P<0.001；生理职能：试验组：（48±40）分，对照组：（22±17）分，t=-2.093，P=0.001]。两组12 w 1 RM比较，试验组优于对照组[试验组：伸膝：（11.1±4.9）kg，屈膝：（8.6±2.7）kg；对照组：伸膝：（6.9±4.2）kg，屈膝：（6.3±2.4）kg]，差异有统计学意义（伸膝：t=-2.571，P=0.001；屈膝：t=-4.882，P<0.001）。治疗结束后试验组患者满意度明显高于对照组，差异有统计学意义（χ2=17.997，P<0.05）。

结论

渐进式抗阻训练相对于传统康复训练，更有助于改善女性KOA患者的关节功能和稳定性，同时减轻关节疼痛，提高生活质量。

关键词: 骨关节炎，膝, 疼痛, 生活质量, 渐进式抗阻训练
Objective

To discuss the effect of progressive resistance exercise (PRE) program on female knee osteoarthritis (KOA).

Methods

A prospective study including 92 female KOA patients was performed in the department of Rehabilitation and Orthopedics in second hospital of HeBei Medical university from August 2013 to September 2014, the average age was (55±11) years (rang from 40-70 years). All subjects were randomly divided into the experimental group (46 cases) and control group (46 cases). Subjects in experimental group participated PRE program and joint mobilization triple once a week. Subjects in the control group only participated joint mobilization. Assessments of pain, muscle strength, walking distance, function and quality of life were performed at baseline, 6 weeks and 12 weeks after surgery by a blinded assessor with The Western Ontario and McMaster Universities Osteoarthritis Index and the MOS item short from health survey (SF-36). After finishing the treatment, Satisfaction survey was conducted in all patients using Likert Scale.

Results

Both groups have one case dropped out, completed ratio of 12 months of follow-up was 96.7%. At 6 weeks and 12 weeks after surgery, VAS scores in experimental group were lower than control group [experimental group: 6 w: (6.0±1.8) scores, 12 w: (4.4±3.0) scores; control group: 6 w: (7.0±1.5) scores, 12 w: (6.5±2.5) scores]. Differences of VAS score between two groups had statistical significance (6 w: t=-2.573, P=0.022, 12 w: t=-2.721, P=0.001). WOMAC indexes in experimental group were higher than the control group [experimental group: 6 w: (40±14) scores, 12 w: (31±14) scores; control group: 6 w: (24±17) scores, 12 w: (38±13) scores], differences of WOMAC score between two groups had statistically significance (6 w: t=0.001, P=0.017, 12 w: t=-4.263, P=0.001). At 12 weeks postoperatively, the SF-36 scores of physical function and physical role limitation in the experimental group were higher than control group [experimental group: physical function: (50±22) scores, physical role limitation: (48±40) scores; control group: physical function: (32±17) scores, physical role limitation: (17±23) scores], differences of SF-36 score between two groups had statistically significance (physical function: t=-3.601, P<0.001, physical role limitation: t=-2.093, P=0.001). At 12 weeks postoperatively, the experimental group had better muscle strength than the control group [the experimental group: extensor: (11.1±4.9)kg, flexor: (8.6±2.7)kg; the control group: extensor: (6.9±4.2)kg, flexor: (6.3±2.4)kg], differences of 1 RM between two groups had statistically significance (extensor: t=-2.571, P=0.001, flexor: t=-4.882, P<0.001). The ratio of patient satisfaction of the experimental grup was significantly higher than the control group (χ2=17.997, P<0.05).

Conclusion

The PRE program was effective in reducing pain, improving function and stability of keen among female patients with KOA, our study demonstrate it is better than the traditional rehabilitation trainings.

Key words: Osteoarthritis, knee, Pain, Quality of life, Progressive resistance exercise
图1~2 老年女性骨关节炎患者，进行渐进式抗阻训练。图1　左侧伸膝（股四头肌）抗阻练习，阻力为1RM的50%；图2　左侧屈膝（腘绳肌）抗阻练习，阻力为1RM的70%
表1 两组膝关节骨关节炎患者治疗前一般情况比较（±s）
组别 例数 年龄（岁） WOMAC（分） BMI（kg/m2） VAS（分） SF-36总分（分）
试验组 46 62±6 40±12 29±4 7.2±1.2 65±22
对照组 46 60±8 39±13 29±5 7.1±1.4 62±24
t值 ? 0.035 0.062 0.078 0.059 0.126
P值 ? 0.920 0.763 0.968 0.561 0.672
表2 两组膝关节骨关节炎患者初诊各肌群1RM测定结果比较（分，±s）
组别 例数 伸膝 屈膝 髋外展 髋内收
试验组 44 7.8±4.8 6.7±2.8 23.8±6.4 17.2±3.5
对照组 45 7.9±3.7 6.5±3.2 22.9±7.8 16.8±5.8
t值 ? 0.042 0.051 0.611 0.071
P值 ? 0.053 0.096 0.035 0.023
表3 两组膝关节骨关节炎患者治疗后6 w、12w VAS评分比较（分，±s）
组别 例数 6w 12 w t值 P值
试验组 44 6.0±1.8 4.4±3.0 -3.064 0.001
对照组 45 7.0±1.5 6.5±2.5 0.032 0.780
t值 ? -2.573 -2.721 ? ?
P值 ? 0.022 0.001 ? ?
表4 两组膝关节骨关节炎患者治疗后6 w、12 w WOMAC评分比较（分，±s）
组别 例数 疼痛评分 t值 P值 僵硬评分 t值 P值
治疗6 w 治疗12 w 治疗6 w 治疗12 w
试验组 44 6.1±3.9 4.8±3.9 6.382 <0.001 2.1±1.8 1.8±1.7 13.412 0.601
对照组 45 9.3±3.2 9.2±3.1 ? ? 2.5±1.9 2.0±1.6 ? ?
t值 ? -2.763 -3.301 ? ? 0.038 0.026 ? ?
P值 ? 0.006 0.002 ? ? 0.124 0.073 ? ?
组别 例数 功能评分 t值 P值 总分 t值 P值
治疗6 w 治疗12 w 治疗6 w 治疗12 w
试验组 44 24.1±11.1 17.6±12.0 15.107 0.001 40.1±14.1 31.1±13.9 12.334 <0.001
对照组 45 27.6±9.9 26.8±10.1 ? ? 23.9±16.7 38.1±13.0 ? ?
t值 ? 0.012 -2.659 ? ? 0.001 -4.263 ? ?
P值 ? 0.011 0.006 ? ? 0.017 0.001 ? ?
表5 两组膝关节骨关节炎患者治疗后6 w、12 w SF-36各项评分比较（分，±s）
组别 例数 生理功能 t值 P值 生理职能 t值 P值
治疗6 w 治疗12 w 治疗6 w 治疗12 w
试验组 44 39±17 50±22 16.023 0.002 38±37 48±40 17.081 0.002
对照组 45 30±16 32±17 ? ? 22±17 23±17 ? ?
t值 ? 0.024 -3.601 ? ? 0.016 -2.093 ? ?
P值 ? 0.045 0.000 ? ? 0.060 0.001 ? ?
组别 例数 躯体疼痛 t值 P值 总体健康 t值 P值
治疗6 w 治疗12 w 治疗6 w 治疗12 w
试验组 44 42±22 59±24 5.491 0.035 63±21 66±22 2.203 0.061
对照组 45 41±14 42±20 ? ? 58±23 52±22 ? ?
t值 ? 0.530 -1.778 ? ? - - ? ?
P值 ? 0.105 0.006 ? ? - - ? ?
组别 例数 活力 t值 P值 社会功能 t值 P值
治疗6 w 治疗12 w 治疗6 w 治疗12 w
试验组 44 57±22 64±25 3.442 1.746 72±28 77±28 5.106 0.420
对照组 45 50±21 52±22 ? ? 60±25 58±28 ? ?
组别 例数 情感职能 t值 P值 精神健康 t值 P值
治疗6 w 治疗12 w 治疗6 w 治疗12 w
试验组 44 55±45 72±41 4.037 0.448 72±18 72±18 2.463 0.120
对照组 45 45±31 50±39 ? ? 56±23 59±21 ? ?
表6 两组膝关节骨关节炎患者治疗后6 w、12 w各肌群1RM测定结果比较（kg，±s）
组别 例数 伸膝 t值 P值 屈膝 t值 P值
治疗6 w 治疗12 w 治疗6 w 治疗12 w
试验组 44 9.4±5.2 11.1±4.9 12.605 <0.001 7.8±3.5 8.6±2.7 9.224 0.002
对照组 45 7.9±3.9 6.9±4.2 ? ? 6.2±4.4 6.3±2.4 ? ?
t值 ? -0.673 -2.571 ? ? -0.422 -4.882 ? ?
P值 ? 0.001 0.001 ? ? 0.003 0.000 ? ?
组别 例数 髋外展 t值 P值 髋内收 t值 P值
治疗6 w 治疗12 w 治疗6 w 治疗12 w
试验组 44 25.1±7.3 30.3±11.2 13.673 <0.001 23.0±6.7 25.9±8.7 10.092 <0.001
对照组 45 21.0±8.2 19.8±7.6 ? ? 16.7±6.6 16.7±7.8 ? ?
t值 ? -3.446 -4.772 ? ? -4.335 -5.661 ? ?
P值 ? 0.001 0.000 ? ? 0.000 0.000 ? ?
表7 两组膝关节骨关节炎患者李科特（Likert Scale）5点量表满意度调查
组别 例数 很满意 较满意 一般 不满意 很不满意
试验组 44 11（24.4%） 26（57.8%） 7（15.6%） 1（2.2%） 0（0%）
对照组 45 9（20.0%） 11（24.4%） 12（26.7%） 9（20.0%） 4（8.9%）
χ2值 ? ? ? 17.997 ? ?
P值 ? ? ? 0.010 ? ?
1
Hochberg MC, Altman RD, Brandt KD, et al. Guidelines for the medical management of osteoarthritis. Part II. Osteoarthritis of the knee. American College of Rheumatology [J]. Arthritis Rheum, 1995, 38(11): 1541-1546.
2
Slemenda C, Brandt KD, Heilman DK, et al. Quadriceps weakness and osteoarthritis of the knee [J]. Ann Intern Med, 1997, 127(2): 97-104.
3
Srikanth VK, Fryer JL, Zhai G, et al. A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis [J]. Osteoarthritis Cartilage, 2005, 13(9): 769-781.
4
沈梓维, 林子洪, 郑秋坚. 膝关节骨关节炎的非手术治疗现状[J]. 中华骨科杂志, 2015, 35(7): 774-780.
5
王剑雄, 周谋望. 膝关节骨关节炎患者髋周肌肉力量研究[J]. 中华物理医学与康复杂志, 2014, 36(9): 720-722.
6
解东风, 李奎, 李鑫, 等. 本体感觉训练在膝关节周围骨折术后所致关节僵硬患者康复治疗中的作用[J]. 中国康复医学杂志, 2013, 28(10): 945-947.
7
Lombardi I, Magri AG, Fleury AM, et al. Progressive resistance training in patients with shoulder impingement syndrome: a randomized controlled trial [J]. Arthritis Rheum, 2008, 59(5): 615-622.
8
Shimizu Y, Thuraner S, Ehrenberger K. Multifractal spectra as a measure of complexity in human posture [J]. Fractals, 2002, 10(01):103-116.
9
Baker KR, Nelson ME, Felson DT, et al. The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial [J]. J Rheumatol, 2001, 28(7): 1655-1665.
10
Costa RA, Oliveira LM, Watanabe SH, et al. Isokinetic assessment of the hip muscles in patients with osteoarthritis of the knee [J]. Clinics (Sao Paulo), 2010, 65(12): 1253-1259.
11
BennellKL, Hunt MA, Wrigley TV, et al. Hip strengthening reduces symptoms but not knee load in People with medial knee osteoarthritis and varusmalalignment:a randomised controlled trial [J]. Osteoarthritis Cartilage, 2010, 126(18): 621-628.
12
Van Dijk GM, Veenhof C, Spreeuwenberg P, et al. Prognosis of limitations in activities in osteoarthritis of the hip or knee: a 3-year cohort study [J]. Arch Phys Med Rehabil, 2010, 91(1): 58-66.
13
Jordan KP, Wilkie R, Muller S, et al. Measurement of change in function and disability in osteoarthritis: current approaches and future challenges [J]. Curr Opin Rheumatol, 2009, 21(5): 525-530.
14
Rannou F, Poiraudeau S. Non-pharmacological approaches for the treatment of osteoarthritis [J]. Best Pract Res Clin Rheumatol, 2010, 24(1): 93-106.
15
Silva LE, Valim V, Pessanha AP, et al. Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial [J]. Phys Ther, 2008, 88(1): 12-21.
16
Juhl C, Christensen R, Roos EM, et al. Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials [J]. Arthritis Rheumatol, 2014, 323(66): 622–636.
17
Lange AK, Vanwanseele B, Fiatarone Singh MA. Strength training for treatment of osteoarthritis of the knee: a systematic review [J]. Arthritis Rheum, 2008, 59(10): 1488-1494.
18
Tanaka R, Ozawa J, Kito N, et al. Efficacy of strengthening or aerobic exercise on pain relief in People with knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials [J]. Clin Rehabil, 2013, 27(12): 1059-1071.
19
Farr JN, Going SB, Mcknight PE, et al. Progressive resistance training improves overall physical activity levels in patients with early osteoarthritis of the knee: a randomized controlled trial [J]. Phys Ther, 2010, 90(3): 356-366.
20
Brooks PM. Impact of osteoarthritis on individuals and society: how much disability? Social Consequences and health economic implications [J]. Curr Opin Rheumatol, 2002, 14(5): 573-577.
21
Iversen MD. Managing hip and knee osteoarthritis with exercise: what is the best prescription? [J]. Ther Adv Musculoskelet Dis, 2010, 2(5): 279-290.
22
Jan MH, Lin JJ, Liau JJ, et al. Investigation of clinical effects of high- and low-resistance training for patients with knee osteoarthritis: a randomized controlled trial [J]. Phys Ther, 2008, 88(4): 427-436.
23
Foroughi N, Smith RM, Lange AK, et al. Progressive resistance training and dynamic alignment in osteoarthritis: A single-blind randomised controlled trial [J]. Clin Biomech (Bristol, Avon), 2011, 26(1): 71-77.
24
Verdijk LB, Van Loon L, Meijer K, et al. One-repetition maximum strength test represents a valid means to assess leg strength in vivo in humans [J]. J Sports Sci, 2009, 27(1): 59-68.
25
Sled EA, Khoja L, Deluzio KJ, et al. Effect of a home program of hip abductor exercises on knee joint loading, strength, function, and pain in People with knee osteoarthritis: a clinical trial [J]. Phys Ther, 2010, 90(6): 895-904.
26
Mikesky AE, Mazzuca SA, Brandt KD, et al. Effects of strength training on the incidence and progression of knee osteoarthritis [J]. Arthritis Rheum, 2006, 55(5): 690-699.
27
Ratamess N, Alvar BA, Evetoch TK, et al. Progressionmodels in resistance training for healthy adults [J]. Med Sci Sports Exerc, 2009, 218(41): 687-708.
[1] 刘嘉嘉, 王承华, 陈绪娇, 刘瑗玲, 王善钰, 屈海花, 张莉. 经阴道子宫-输卵管实时三维超声造影中患者疼痛发生情况及其影响因素分析[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 959-965.
[2] 董红华, 郭艮春, 江磊, 吴雪飞, 马飞翔, 李海凤. 骨科康复一体化模式在踝关节骨折快速康复中的应用[J]. 中华关节外科杂志(电子版), 2023, 17(06): 802-807.
[3] 闫文, 谢兴文, 顾玉彪, 雷宁波, 马成, 于文霞, 高亚雄, 张磊. 微小RNA与全膝关节置换术后深静脉血栓的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 842-846.
[4] 夏传龙, 迟健, 丛强, 连杰, 崔峻, 陈彦玲. 富血小板血浆联合关节镜治疗半月板损伤的临床疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 877-881.
[5] 李善武, 叶永杰, 王兵, 王子呓, 银毅, 孙官军, 张大刚. 胫骨高位截骨与单髁置换的早期疗效比较[J]. 中华关节外科杂志(电子版), 2023, 17(06): 882-888.
[6] 张中斌, 付琨朋, 朱凯, 张玉, 李华. 胫骨高位截骨术与富血小板血浆治疗膝骨关节炎的疗效[J]. 中华关节外科杂志(电子版), 2023, 17(05): 633-641.
[7] 吴畏, 吴永哲, 李宗倍, 崔宏力, 李华志, 许臣. 轻质大网孔补片腹腔镜下疝修补术治疗老年腹股沟疝的疗效及炎症因子的影响[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 70-73.
[8] 陆闻青, 陈昕怡, 任雪飞. 遗传代谢病儿童肝移植受者术后生活质量调查研究[J]. 中华移植杂志(电子版), 2023, 17(05): 287-292.
[9] 王可, 范彬, 李多富, 刘奎. 两种疝囊残端处理方法在经腹腹膜前腹股沟疝修补术中的疗效比较[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 692-696.
[10] 夏松, 姚嗣会, 汪勇刚. 经腹腹膜前与疝环充填式疝修补术治疗腹股沟疝的对照研究[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 702-705.
[11] 王敏, 蒋家斌, 李茂新. 预警宣教联合个性化疼痛管理对腹股沟疝手术患者的影响[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 764-767.
[12] 周晓艳, 王志钢, 周冬喜. 超声引导下腹横肌平面阻滞在腹腔镜腹股沟疝手术中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 579-583.
[13] 李梅, 孔珊珊. Robocare护理模式联合高频胸壁振荡在腹腔镜腹壁切口疝修补术的应用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 619-624.
[14] 孙晗, 武侠. 成人肠易激综合征患者肠道菌群特征与不同分型患者生活质量和精神症状的相关性[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 461-465.
[15] 王小娜, 谭微, 李悦, 姜文艳. 预测性护理对结直肠癌根治术患者围手术期生活质量、情绪及并发症的影响[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 525-529.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号