[1]蒋拥军,李克军,邵开超,等.等速向心和离心肌力训练对前交叉韧带重建术后膝关节屈伸肌群肌力影响的对比研究[J].中医正骨,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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等速向心和离心肌力训练对前交叉韧带重建术后膝关节屈伸肌群肌力影响的对比研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年07期
页码:
27-33
栏目:
临床研究
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:
蒋拥军; 李克军; 邵开超; 黄若彬; 何梦凡; 汪伟
(深圳平乐骨伤科医院/深圳市坪山区中医院,广东 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
关键词:
前交叉韧带重建术;  肌力训练;  等速肌力评定;  向心收缩;  离心收缩;  临床试验
Keywords:
anterior cruciate ligament reconstruction;  strength training;  isokinetic muscle strength test;  concentric contraction;  eccentric contraction;  clinical trial
摘要:
目的:比较等速向心和离心肌力训练对前交叉韧带(anterior cruciate ligament,ACL)重建术后膝关节屈伸肌群肌力的影响。方法:选择80例近期因ACL断裂接受过ACL重建术,且术后接受过3个月相同的常规康复训练的患者,随机分为2组,每组40例。采用TUR ISOFORCE等速肌力评估训练系统进行等速肌力训练,向心训练组进行等速向心肌力训练,离心训练组进行等速离心肌力训练; 2组患者均隔日训练1次,每周训练3次,共训练8周。详细记录试验过程中出现的不良事件,采用TUR ISOFORCE等速肌力评估训练系统测定患者的膝关节屈伸肌群峰力矩(peak torque,PT),并利用系统自动计算膝关节屈伸肌群峰力矩与体质量比值(peak torque/body weight,PT/BW)和膝关节屈伸肌群峰力矩比值(flexor/extensor,F/E)。结果:①膝关节屈伸肌群PT。2组男性患者治疗前和治疗结束后的膝关节伸肌群PT比较,组间差异均无统计学意义[(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]; 治疗结束后2组男性患者的膝关节伸肌群PT均较治疗前增大(t=13.496,P=0.000; t=12.207,P=0.000)。2组男性患者治疗前和治疗结束后的膝关节屈肌群PT比较,组间差异均无统计学意义[(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]; 治疗结束后2组男性患者的膝关节屈肌群PT均较治疗前增大(t=11.616,P=0.000; t=14.325,P=0.000)。2组女性患者治疗前和治疗结束后的膝关节伸肌群PT比较,组间差异均无统计学意义[(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]; 治疗结束后2组女性患者的膝关节伸肌群PT均较治疗前增大(t=17.556,P=0.000; t=10.907,P=0.000)。2组女性患者治疗前和治疗结束后的膝关节屈肌群PT比较,组间差异均无统计学意义[(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]; 治疗结束后2组女性患者的膝关节屈肌群PT均较治疗前增大(t=18.816,P=0.000; t=13.585,P=0.000)。②膝关节屈伸肌群PT/BW。2组男性患者治疗前和治疗结束后的膝关节伸肌群PT/BW比较,组间差异均无统计学意义[(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]; 治疗结束后2组男性患者的膝关节伸肌群PT/BW均较治疗前增大(t=17.146,P=0.000; t=14.571,P=0.000)。2组男性患者治疗前和治疗结束后的膝关节屈肌群PT/BW比较,组间差异均无统计学意义[(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]; 治疗结束后2组男性患者的膝关节屈肌群PT/BW均较治疗前增大(t=21.154,P=0.000; t=23.171,P=0.000)。2组女性患者治疗前和治疗结束后的膝关节伸肌群PT/BW比较,组间差异均无统计学意义[(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]; 治疗结束后2组女性患者的膝关节伸肌群PT/BW均较治疗前增大(t=18.460,P=0.000; t=11.971,P=0.000)。2组女性患者治疗前和治疗结束后的膝关节屈肌群PT/BW比较,组间差异均无统计学意义[(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]; 治疗结束后2组女性患者的膝关节屈肌群PT/BW均较治疗前增大(t=19.954,P=0.000; t=21.125,P=0.000)。③膝关节F/E。2组男性患者治疗前的F/E比较,差异无统计学意义[(57.16±4.13)%,(56.98±3.98)%,t=0.147,P=0.884]; 治疗结束后,2组男性患者的F/E均较治疗前增大(t=21.716,P=0.000; t=13.527,P=0.000),向心训练组男性患者的F/E低于离心训练组男性患者[(65.56±4.58)%,(68.21±4.01)%,t=2.033,P=0.048]。2组女性患者治疗前和治疗结束后的F/E比较,组间差异均无统计学意义[(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]; 治疗结束后2组女性患者的F/E均较治疗前增大(t=22.116,P=0.000; t=16.271,P=0.000)。④不良事件。2组患者试验过程中均未发生严重不良事件。结论:等速向心肌力训练和等速离心肌力训练均能有效增强ACL重建术后膝关节屈伸肌群肌力,而且安全性较高,2种训练模式提升肌力的效果无明显差异。与等速向心肌力训练相比,等速离心肌力训练在改善男性患者膝关节屈伸肌群肌力比值方面具有一定优势,可能更有利于促进膝关节稳定性的恢复。
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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备注/Memo

备注/Memo:
基金项目:深圳市坪山区卫生系统科研项目(201845) 通讯作者:蒋拥军 E-mail:2450687893@qq.com
更新日期/Last Update: 1900-01-01