肌電生物反饋療法對(duì)髕股關(guān)節(jié)疼痛綜合征患者臨床療效的研究
發(fā)布時(shí)間：2019-06-20 08:32
【摘要】：目的:髕股關(guān)節(jié)疼痛綜合征(patella femoral pain syndrome,PFPS)是一種臨床常見(jiàn)及多發(fā)的疾病,由多種原因引起,研究表明,此病發(fā)病率較高,約為10%~40%,尤以10至35歲的年輕人最多見(jiàn)【1】。如果不能有效的治療PFPS,將導(dǎo)致患者的生活質(zhì)量與工作受到一定的影響。因此PFPS的預(yù)防、延緩進(jìn)展及治療就成為了一個(gè)重大課題。PFPS的患者大多主訴髕骨后或髕周疼痛,可有摩擦音、打軟腿、關(guān)節(jié)腫脹等,在膝關(guān)節(jié)屈伸活動(dòng)時(shí)疼痛加重。目前有關(guān)PFPS的病因尚不清楚,但是一般認(rèn)為股四頭肌的股內(nèi)側(cè)斜肌(vastus medialis oblique,VMO)肌肉無(wú)力是PFPS的主要影響因素。與髕骨滑行軌跡有關(guān)的股內(nèi)側(cè)斜肌(VMO)和股外側(cè)肌(vastus lateralis,V L)之間的肌力不平衡,將引起髕骨與股骨髁間滑車(chē)應(yīng)力增加而引起膝關(guān)節(jié)屈伸疼痛。因此,進(jìn)行選擇性股內(nèi)側(cè)斜肌肌力訓(xùn)練對(duì)于PFPS患者的康復(fù)治療尤為重要。本研究的主要目的就是通過(guò)使用肌電生物反饋療法選擇性地進(jìn)行股內(nèi)側(cè)斜肌訓(xùn)練,來(lái)調(diào)節(jié)VMO、VL的相對(duì)活動(dòng),以達(dá)到改善髕骨在膝關(guān)節(jié)屈伸時(shí)在股骨髁間滑車(chē)的運(yùn)行,減輕患者疼痛,延緩疾病進(jìn)展的效果。方法:本實(shí)驗(yàn)研究所有入選患者均符合髕股關(guān)節(jié)疼痛綜合征的診斷標(biāo)準(zhǔn),年齡在18~45歲之間;髕股關(guān)節(jié)摩擦試驗(yàn)陽(yáng)性,病程在6個(gè)月以上;上下樓、屈膝久坐及蹲起時(shí)疼痛加劇;排除膝關(guān)節(jié)滑膜皺襞綜合征、髕周韌帶炎、半月板撕裂等,所有PFPS患者膝關(guān)節(jié)均無(wú)外傷史及韌帶修復(fù)、重建等膝關(guān)節(jié)手術(shù)史;之前未接受任何物理治療。根據(jù)以上入選標(biāo)準(zhǔn)共選取2013年10月—2014年6月在河北醫(yī)科大學(xué)第三醫(yī)院門(mén)診就診的PFPS患者40例,采用系統(tǒng)隨機(jī)法將所有入選患者分為治療組(Group A)與對(duì)照組(Group B),其中A組21例(男8例,女13例);年齡(36.9±6.6)歲;病程在6至24個(gè)月之間。B組19例(男9例,女1 0例),年齡(35.6±5.8)歲;病程在6至32個(gè)月之間。A組與B組間患者的一般情況(如年齡、性別、病程、身高、體重等)差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。所有入組病例均已簽知情同意書(shū)。對(duì)照組Group B給予股四頭肌肌力耐力訓(xùn)練、肌肉牽伸以及針灸按摩等康復(fù)治療。治療組A組則在B組治療基礎(chǔ)上應(yīng)用加拿大生產(chǎn)的SA9800型生物刺激反饋儀,進(jìn)行肌電生物反饋療法來(lái)選擇性針對(duì)股內(nèi)側(cè)斜肌肌力訓(xùn)練,20分/次,1次/天,5次/周,持續(xù)治療8周。分別在治療前及治療8周后對(duì)所有入組者進(jìn)行Lysholm膝關(guān)節(jié)功能評(píng)分、視覺(jué)疼痛量表(Visual Analogy Scale,V A S)評(píng)分、表面肌電圖VMO/VL肌電比率評(píng)定。結(jié)果:(1)A、B兩組患者的膝關(guān)節(jié)Lysholm評(píng)分在治療前比較,差異無(wú)明顯統(tǒng)計(jì)學(xué)意義(P0.05);治療8周后兩組患者的Lysholm功能評(píng)分與治療前各組比較均有明顯提高(P0.05),治療組A組膝關(guān)節(jié)功能評(píng)分改善更為顯著,且兩組間比較,差異存在統(tǒng)計(jì)學(xué)意義(P0.05)。(2)A、B兩組患者的VAS評(píng)分在治療前比較,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);治療8周后兩組患者上下樓梯的VAS評(píng)分與治療前各組比較均有明顯改善(P0.05),疼痛減輕,有統(tǒng)計(jì)學(xué)差異,治療組Group A改善情況更為顯著,且兩組間比較,差異存在統(tǒng)計(jì)學(xué)意義(P0.05)。(3)A、B兩組患者的VMO/VL神經(jīng)肌電活動(dòng)比率在治療前比較,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);經(jīng)過(guò)共8周的系統(tǒng)康復(fù)治療后,兩組患者VMO/VL比率均與治療前有所改善(P0.05),且兩組間比較,差異存在統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:(1)股內(nèi)側(cè)斜肌作為股四頭肌的一部分,它的主要作用是控制髕骨的運(yùn)行軌跡。但是,常規(guī)的股四頭肌力量訓(xùn)練并不能有針對(duì)性的訓(xùn)練股內(nèi)側(cè)斜肌。(2)應(yīng)用肌電生物反饋療法可以針對(duì)股內(nèi)側(cè)斜肌肌力訓(xùn)練,有效緩解髕股關(guān)節(jié)疼痛綜合征患者的癥狀,改善膝關(guān)節(jié)功能,減輕膝關(guān)節(jié)的疼痛并提高患者工作及生活質(zhì)量。
[Abstract]:Objective: The pain syndrome (PFPS) of the femoral joint is a common and multiple disease, which is caused by a variety of reasons. The study has shown that the incidence of this disease is high, about 10% ~ 40%, especially among young people from 10 to 35 years. If PFPS is not effective, the quality of life and work of the patient will be affected. Therefore, the prevention, delay and treatment of PFPS has become a major task. Most of the patients with PFPS complained of pain in the post-patellar or peripatellar pain, friction, soft-leg, joint swelling, and the like, and the pain was increased during the flexion and extension of the knee. At present, the etiology of PFPS is not clear, but it is generally considered that the muscle weakness of the medial oblique muscle (VMO) of the quadriceps femoris is the main influencing factor of the PFPS. The imbalance of the muscle strength between the medial oblique muscle (VMO) and the lateral lateral muscle (V L) in the femoral medial oblique muscle (VMO) associated with the patella sliding track will cause the knee flexion and extension pain due to the increase in the stress between the patella and the femoral condyle. Therefore, it is very important to carry out the muscle strength training of the medial oblique muscle of the selective unit to the rehabilitation of the patients with PFPS. The main purpose of this study is to adjust the relative movement of the VMO, VL by using the myoelectric biofeedback therapy to selectively perform the medial oblique muscle training to achieve the effect of improving the operation of the patella in the femoral intercondylar block when the knee joint is in flexion and extension, relieving the pain of the patient, and delaying the progress of the disease. Methods: All the patients enrolled in the study met the diagnostic criteria of the femoral joint pain syndrome, and the age was between 18 and 45 years; the friction test of the femoral joint was positive, the course of the disease was over 6 months; the upper and lower stairs, the knee flexion and the time of the squatting and the pain were increased; and the synovium of the knee joint was excluded. The knee joint of all the PFPS patients had no history of trauma, the repair of the ligament, and the reconstruction of the knee joint without any physical treatment. According to the above criteria,40 cases of PFPS were selected from October 2013 to June 2014 in the third hospital of Hebei Medical University, and all the enrolled patients were divided into treatment group (Group A) and control group (Group B) by system random method, of which 21 cases (8 males and 13 females) were randomly divided into treatment group (group A) and control group (Group B). Age (36.9 to 6.6) years; duration between 6 and 24 months. In group B,19 cases (9 males and 100 females) were aged (35.6 to 5.8), and the course was between 6 and 32 months. There was no significant difference between group A and group B (such as age, sex, course, height, body weight, etc.) (P0.05). The informed consent was signed for all enrolled cases. Group B of the control group was given quadriceps muscle strength endurance training, muscle drafting and acupuncture and moxibustion massage. In the treatment group A, the SA9800 type bio-stimulation feedback instrument manufactured by Canada was applied on the basis of group B treatment, and the myoelectric biofeedback therapy was performed to selectively target the muscle strength training of the medial oblique muscle,20 minutes/ time,1 time/ day,5 times/ week, and the treatment for 8 weeks. The Lysholm knee function score, the visual pain scale (V A S) score, and the surface electromyogram VMO/ VL myoelectric rate were evaluated before and after 8 weeks of treatment, respectively. Results: (1) The Lysholm scores of the knee joint of group A and group B were no significant difference before treatment (P <0.05). The scores of Lysholm function in both groups were significantly improved after 8 weeks of treatment (P0.05). The improvement of functional score of knee joint in group A was more significant, and the difference between the two groups was statistically significant (P0.05). (2) The VAS scores of the two groups in group A and B were no significant difference before treatment (P0.05). The VAS scores of the upper and lower stairs of the two groups were significantly improved after 8 weeks of treatment (P0.05). The improvement of Group A in the treatment group was more significant, and the difference between the two groups was statistically significant (P0.05). (3) The ratio of VO/ VL in the patients with group A and group B was no statistical difference before treatment (P0.05). After a total of 8 weeks of system rehabilitation, the ratio of VMO/ VL in both groups was improved (P0.05), and between the two groups, There was a significant difference in the difference (P0.05). Conclusion: (1) The medial oblique muscle is a part of the quadriceps femoris, and its main function is to control the running track of the patella. However, the conventional quadriceps muscle strength training does not have a targeted training unit medial oblique muscle. (2) The application of the myoelectric biofeedback therapy can effectively relieve the symptoms of the knee joint pain syndrome, improve the function of the knee joint, relieve the pain of the knee joint and improve the work and the quality of life of the patient.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R684
本文編號(hào)：2503077
[Abstract]:Objective: The pain syndrome (PFPS) of the femoral joint is a common and multiple disease, which is caused by a variety of reasons. The study has shown that the incidence of this disease is high, about 10% ~ 40%, especially among young people from 10 to 35 years. If PFPS is not effective, the quality of life and work of the patient will be affected. Therefore, the prevention, delay and treatment of PFPS has become a major task. Most of the patients with PFPS complained of pain in the post-patellar or peripatellar pain, friction, soft-leg, joint swelling, and the like, and the pain was increased during the flexion and extension of the knee. At present, the etiology of PFPS is not clear, but it is generally considered that the muscle weakness of the medial oblique muscle (VMO) of the quadriceps femoris is the main influencing factor of the PFPS. The imbalance of the muscle strength between the medial oblique muscle (VMO) and the lateral lateral muscle (V L) in the femoral medial oblique muscle (VMO) associated with the patella sliding track will cause the knee flexion and extension pain due to the increase in the stress between the patella and the femoral condyle. Therefore, it is very important to carry out the muscle strength training of the medial oblique muscle of the selective unit to the rehabilitation of the patients with PFPS. The main purpose of this study is to adjust the relative movement of the VMO, VL by using the myoelectric biofeedback therapy to selectively perform the medial oblique muscle training to achieve the effect of improving the operation of the patella in the femoral intercondylar block when the knee joint is in flexion and extension, relieving the pain of the patient, and delaying the progress of the disease. Methods: All the patients enrolled in the study met the diagnostic criteria of the femoral joint pain syndrome, and the age was between 18 and 45 years; the friction test of the femoral joint was positive, the course of the disease was over 6 months; the upper and lower stairs, the knee flexion and the time of the squatting and the pain were increased; and the synovium of the knee joint was excluded. The knee joint of all the PFPS patients had no history of trauma, the repair of the ligament, and the reconstruction of the knee joint without any physical treatment. According to the above criteria,40 cases of PFPS were selected from October 2013 to June 2014 in the third hospital of Hebei Medical University, and all the enrolled patients were divided into treatment group (Group A) and control group (Group B) by system random method, of which 21 cases (8 males and 13 females) were randomly divided into treatment group (group A) and control group (Group B). Age (36.9 to 6.6) years; duration between 6 and 24 months. In group B,19 cases (9 males and 100 females) were aged (35.6 to 5.8), and the course was between 6 and 32 months. There was no significant difference between group A and group B (such as age, sex, course, height, body weight, etc.) (P0.05). The informed consent was signed for all enrolled cases. Group B of the control group was given quadriceps muscle strength endurance training, muscle drafting and acupuncture and moxibustion massage. In the treatment group A, the SA9800 type bio-stimulation feedback instrument manufactured by Canada was applied on the basis of group B treatment, and the myoelectric biofeedback therapy was performed to selectively target the muscle strength training of the medial oblique muscle,20 minutes/ time,1 time/ day,5 times/ week, and the treatment for 8 weeks. The Lysholm knee function score, the visual pain scale (V A S) score, and the surface electromyogram VMO/ VL myoelectric rate were evaluated before and after 8 weeks of treatment, respectively. Results: (1) The Lysholm scores of the knee joint of group A and group B were no significant difference before treatment (P <0.05). The scores of Lysholm function in both groups were significantly improved after 8 weeks of treatment (P0.05). The improvement of functional score of knee joint in group A was more significant, and the difference between the two groups was statistically significant (P0.05). (2) The VAS scores of the two groups in group A and B were no significant difference before treatment (P0.05). The VAS scores of the upper and lower stairs of the two groups were significantly improved after 8 weeks of treatment (P0.05). The improvement of Group A in the treatment group was more significant, and the difference between the two groups was statistically significant (P0.05). (3) The ratio of VO/ VL in the patients with group A and group B was no statistical difference before treatment (P0.05). After a total of 8 weeks of system rehabilitation, the ratio of VMO/ VL in both groups was improved (P0.05), and between the two groups, There was a significant difference in the difference (P0.05). Conclusion: (1) The medial oblique muscle is a part of the quadriceps femoris, and its main function is to control the running track of the patella. However, the conventional quadriceps muscle strength training does not have a targeted training unit medial oblique muscle. (2) The application of the myoelectric biofeedback therapy can effectively relieve the symptoms of the knee joint pain syndrome, improve the function of the knee joint, relieve the pain of the knee joint and improve the work and the quality of life of the patient.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R684
【引證文獻(xiàn)】
相關(guān)期刊論文 前1條
1 王謀;徐婧;;慢性髕骨紊亂綜合癥:選擇性股內(nèi)側(cè)斜肌訓(xùn)練與股四頭肌力量訓(xùn)練的隨機(jī)對(duì)照實(shí)驗(yàn)[J];世界最新醫(yī)學(xué)信息文摘;2016年89期
，本文編號(hào)：2503077
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