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膝前痛(anterior knee pain, AKP)包括髌股关节疼痛综合征在内的多种情况,典型症状是膝关节前的疼痛,下跪、下蹲和跑步等可使髌股关节压力增大的动作会诱发或加重症状[1]。AKP目前主要采用非手术治疗,但保守治疗如非甾体类消炎药、物理疗法、针灸、膝关节矫形器、足弓垫、肌内效贴等方法疗效不佳[2-8],而运动疗法对减轻AKP病人的疼痛有积极作用[9-12]。股四头肌作为髌股关节运动最主要的原动肌,其柔韧性的改善从运动解剖学和生物力学机制上分析,对于改善髌股关节的不良应力和稳定性有重要作用。研究[13]证实,AKP的发生与股四头肌柔韧性不足明显相关。但目前尚无股四头肌拉伸训练对AKP康复效果研究的相关报道。基于此,本研究拟探讨股四头肌拉伸训练对于AKP不同诱发因素的干预效果,以期为AKP病人选择具有针对性的康复训练方案提供参考。现作报道。
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2组均无提前退出试验者和不良事件发生。2组病人治疗前AKPS评分和各项VAS评分差异均无统计学意义(P>0.05)。治疗后,观察组病人AKPS评分较治疗前升高(P < 0.05),除屈膝久坐VAS评分(P>0.05)外,其他各项VAS评分均较治疗前降低(P < 0.05),而对照组治疗前后各项评分差异均无统计学意义(P>0.05);且治疗后观察组AKPS评分明显高于对照组(P < 0.01),除屈膝久坐VAS评分与对照组差异无统计学意义(P>0.05)外,其他各项VAS评分均明显低于对照组(P < 0.01)(见表 1)。
分组 AKPS 日常VAS 屈膝久坐VAS 上楼梯VAS 下楼梯VAS 下蹲VAS 慢跑VAS 治疗前 对照组 77.76±11.08 2.0(2.0,3.5) 1.0(0.0,1.0) 2.0(0.5,3.0) 3.0(2.0,4.0) 3.0(2.0,3.0) 4.0(3.0,5.0) 观察组 76.67±12.09 3.0(2.0,4.0) 0.0(0.0,2.0) 3.0(2.0,4.0) 3.0(1.0,4.0) 3.0(2.0,4.5) 4.0(3.5,6.0) uc 1.98△ 1.11 0.07 1.38 0.28 1.53 1.72 P >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 治疗后 对照组 78.29±10.91 2.0(1.5,3.0) 0.0(0.0,1.0) 2.0(1.0,3.0) 3.0(2.0,3.5) 3.0(2.0,3.0) 3.0(3.0,4.5) 观察组 84.86±6.51* 1.0(0.0, 1.0)* 0.0(0.0, 0.5) 1.0(0.0, 1.0)* 0.0(0.0, 1.0)* 1.0(0.0, 1.0)* 1.0(0.0, 2.0)* uc 2.37△ 4.11 1.17 3.46 4.58 4.52 4.21 P < 0.01 < 0.01 >0.05 < 0.01 < 0.01 < 0.01 < 0.01 △示t值;组内配对比较*P < 0.05 表 1 2组治疗前后AKPS评分和VAS评分比较(n=12;分)
股四头肌拉伸训练对膝前痛的康复效果
Rehabilitation effects of quadriceps stretch training on anterior knee pain
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摘要:
目的探讨股四头肌拉伸训练对膝前痛(anterior knee pain,AKP)病人症状和不同诱因的康复作用。 方法选取AKP病人42例,随机分为对照组和观察组,各21例。2组均给予常规康复治疗,观察组加用股四头肌拉伸训练。分别于治疗前后对2组病人进行Kujala评分(anterior knee pain scale,AKPS)和常见功能动作疼痛的VAS评分。 结果2组病人治疗前AKPS评分和日常生活、屈膝久坐、上楼梯、下楼梯、下蹲、慢跑动作的疼痛VAS评分差异均无统计学意义(P>0.05)。治疗6周后,对照组病人AKPS评分和各项VAS评分与治疗前差异均无统计学意义(P>0.05);观察组病人AKPS评分较治疗前升高(P < 0.05),且明显高于对照组治疗后(P < 0.01),除屈膝久坐VAS评分外,其他各项VAS评分均较治疗前降低(P < 0.05),且均明显低于对照组治疗后(P < 0.01)。 结论股四头肌拉伸训练对AKP病人临床疼痛症和功能受限有较好改善效果,对于常见诱因亦有积极的干预作用,可作为临床上AKP病人康复治疗的选择。 Abstract:ObjectiveTo investigate the rehabilitation effects of quadriceps stretch training on symptoms and different incentives of anterior knee pain(AKP). MethodsForty-two patients with AKP were randomly divided into the control group and observation group(21 cases in each group).Two groups were treated with routine rehabilitation method, and the observation group was additionally treated with quadriceps stretch training.The Kujala score(Anterior Knee Pain Scale, AKPS) and VAS scores of common functional movement-induced pain were evaluated before and after treatment. ResultsThe differences of AKPS scores, and pain VAS scores of daily life, knee-bending sedentary, up stairs, down stairs and squatting, jogging movements between two groups were not statistically significant before treatment(P>0.05).The differences of the AKPS scores and VAS scores in control group between before treatment and after 6 weeks of treatment were not statistically significant(P>0.05).After treatment, the AKPS score in the observation group increased compared with before treatment(P < 0.05), and which was significantly higher than that in control group(P < 0.01).Except for the knee-bending sedentary, the other items' scores in observation group after treatment decreased compared with before treatment(P < 0.05), and which was significantly lower than that in control group(P < 0.01). ConclusionsThe quadriceps stretch training has a good effect on the improvement of clinical pain and function limitation in AKP patients, and also has a positive intervention effect on common incentives, so it can be used as the choice of clinical rehabilitation treatment for AKP patients. -
表 1 2组治疗前后AKPS评分和VAS评分比较(n=12;分)
分组 AKPS 日常VAS 屈膝久坐VAS 上楼梯VAS 下楼梯VAS 下蹲VAS 慢跑VAS 治疗前 对照组 77.76±11.08 2.0(2.0,3.5) 1.0(0.0,1.0) 2.0(0.5,3.0) 3.0(2.0,4.0) 3.0(2.0,3.0) 4.0(3.0,5.0) 观察组 76.67±12.09 3.0(2.0,4.0) 0.0(0.0,2.0) 3.0(2.0,4.0) 3.0(1.0,4.0) 3.0(2.0,4.5) 4.0(3.5,6.0) uc 1.98△ 1.11 0.07 1.38 0.28 1.53 1.72 P >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 治疗后 对照组 78.29±10.91 2.0(1.5,3.0) 0.0(0.0,1.0) 2.0(1.0,3.0) 3.0(2.0,3.5) 3.0(2.0,3.0) 3.0(3.0,4.5) 观察组 84.86±6.51* 1.0(0.0, 1.0)* 0.0(0.0, 0.5) 1.0(0.0, 1.0)* 0.0(0.0, 1.0)* 1.0(0.0, 1.0)* 1.0(0.0, 2.0)* uc 2.37△ 4.11 1.17 3.46 4.58 4.52 4.21 P < 0.01 < 0.01 >0.05 < 0.01 < 0.01 < 0.01 < 0.01 △示t值;组内配对比较*P < 0.05 -
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