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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:
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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/OL]. 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/OL]. 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 ? ?
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