髋周肌群力量训练对功能性踝关节不稳的疗效及表面肌电评价

doi:10.3969/j.issn.1006-9771.2021.08.008

摘要/Abstract

摘要：

目的探讨髋周肌群力量训练对功能性踝关节不稳(FAI)的疗效,并采用表面肌电(sEMG)进行评价。方法从2019年1月至2020年6月,青岛市市立医院FAI患者60例,随机分为对照组(n = 30)和观察组(n = 30)。对照组患者接受常规治疗,包括踝关节松动训练、力量训练和平衡训练;观察组加用髋周肌群力量训练。治疗前、治疗6周后采用坎伯兰踝关节不稳问卷(CAIT)、星形偏移平衡测试(SEBT)进行评定,采用sEMG测量积分肌电值(iEMG)。臀中肌、臀大肌的iEMG分别与CAIT和SEBT进行Pearson相关性分析。结果试验过程无脱落。治疗前,两组的CAIT评分、SEBT 8个方向距离和iEMG均无显著性差异(P > 0.05)。治疗6周后,两组CAIT评分、SEBT 8个方向距离均较治疗前显著增加(t > 3.657, P < 0.001);观察组的臀中肌和臀大肌iEMG显著增加(t > 22.038, P < 0.001),对照组无显著变化(t < 1.916, P > 0.05);观察组CAIT评分、SEBT 8个方向距离及臀中肌、臀大肌iEMG均优于对照组(t > 2.125, P < 0.05)。观察组臀中肌、臀大肌iEMG均与CAIT、SEBT呈中高度相关(r = 0.712~0.866, P < 0.05)。结论髋周肌群力量训练可以进一步改善FAI患者踝关节功能。臀中肌、臀大肌的iEMG可以评价力量训练的疗效。

关键词: 功能性踝关节不稳, 髋周肌群, 表面肌电, 积分肌电值, 踝关节, 臀中肌, 臀大肌

Abstract:

Objective To investigate the effect of strength training of hip muscles on functional ankle instability (FAI), and be evaluated with surface electromyography (sEMG). Methods From January, 2019 to June, 2020, 60 FAI patients were recruited in Qingdao Municipal Hospital. They were divided into control group (n = 30) and observation group (n = 30) randomly. The control group received conventional therapy, including ankle joint mobilization training, strength training and balance training for six weeks, while the observation group received strength training of hip muscles in addition. Cumberland Ankle Instability Tool (CAIT), Star Excursion Balance Test (SEBT) and sEMG were used to assess the function before and after intervention, and integrated electromyography (iEMG) was measured with sEMG. The correlation of CAIT and SEBT to iEMG was analyzed with Pearson coefficient. Results No one dropped out. Before intervention, there was no significant difference between CAIT, SEBT and iEMG between two groups (P > 0.05). CAIT and SEBT improved significantly in both groups (t > 3.657, P < 0.001) after six-week intervention; the iEMG increased significantly in the observation group (t > 22.038, P < 0.001), while no significance was found in the control group (t < 1.916, P > 0.05); all the indexes were better in the observation group than in the control group (t > 2.125, P < 0.05). iEMG of gluteus medius and gluteus maximum correlated to CAIT and SEBT in the observation group (r = 0.712 to 0.866, P < 0.05). Conclusion The strength training of the hip muscles could improve the ankle function of FAI patients. iEMG of gluteus medius and gluteus maximum could be a valid measure to assess the effect of strength training on FAI.

Key words: functional ankle instability, hip muscles, surface electromyography, integrated electromyography, ankle joint, gluteus medius, gluteus maximus

张梅莹,赵蕾,李慧,王颖颖,戴世友. 髋周肌群力量训练对功能性踝关节不稳的疗效及表面肌电评价[J]. 《中国康复理论与实践》, 2021, 27(8): 936-942.

ZHANG Mei-ying,ZHAO Lei,LI Hui,WANG Ying-ying,DAI Shi-you. Effect of Strength Training of Hip Muscles on Functional Ankle Instability: Evaluated with Surface Electromyography[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(8): 936-942.

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组别	n	性别(n)		年龄(岁)	病程(d)	侧别(n)
组别	n	男	女	年龄(岁)	病程(d)	左	右
对照组	30	13	17	18.4±4.0	38.7±16.1	17	13
观察组	30	11	19	20.3±3.8	36.6±16.2	14	16
χ²/t值		0.278		1.887	0.504	0.601
P值		0.598		0.064	0.616	0.438

组别	n	治疗前	治疗后	t值	P值
对照组	30	23.3±2.4	25.4±1.1	4.357	< 0.001
观察组	30	22.9±2.6	26.9±1.8	6.928	< 0.001
t值		0.619	3.895
P值		0.538	< 0.001

组别	n	方向	治疗前	治疗后	t值	P值
对照组	30	前	68.6±5.5	73.7±5.3	3.657	< 0.001
		外前	63.9±4.9	69.6±3.3	5.285	< 0.001
		外方	56.1±5.9	65.7±5.4	6.574	< 0.001
		外后	69.1±6.2	78.7±5.5	6.344	< 0.001
		后	77.2±6.8	85.7±3.5	6.088	< 0.001
		后内	73.7±7.0	80.7±3.3	4.954	< 0.001
		内	68.1±7.2	77.9±3.8	6.593	< 0.001
		内前	72.4±6.2	84.7±5.7	8.000	< 0.001
观察组	30	前	69.7±4.6^a	76.3±4.1ⁱ	5.867	< 0.001
		外前	64.4±5.6^b	74.1±4.0^j	7.720	< 0.001
		外方	57.3±7.3^c	69.0±5.2^k	7.150	< 0.001
		外后	70.3±5.6^d	88.0±6.7^l	11.102	< 0.001
		后	78.3±5.7^e	90.6±6.1^m	8.070	< 0.001
		后内	72.2±6.3^f	85.0±4.6ⁿ	8.988	< 0.001
		内	69.3±7.3^g	83.1±4.9^o	8.597	< 0.001
		内前	71.5±5.5^h	88.0±6.3^p	10.806	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组	30	194.1±25.7	204.4±26.3	1.532	0.130
观察组	30	201.3±23.5	385.2±28.4	27.325	< 0.001
t值		1.132	25.584
P值		0.262	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组	30	230.8±20.3	243.1±28.7	1.916	0.060
观察组	30	238.6±25.5	389.2±27.4	22.038	< 0.001
t值		1.311	20.167
P值		0.195	< 0.001