不同神经肌肉训练方法对早期膝骨关节炎患者疼痛和运动功能效果的比较

doi:10.3969/j.issn.1006-9771.2023.09.013

摘要/Abstract

摘要：

目的比较3种不同神经肌肉训练方式对早期膝骨关节炎(KOA)膝关节疼痛和运动能力的效果。

方法 2022年11月至2023年5月，于北京博爱医院和社区选取早期KOA患者60例，随机分为A组、B组和C组各20例，分别采用本体感觉神经肌肉促进技术(PNF)、神经肌肉运动训练(NEMEX)和联合治疗训练(PNF+NEMEX)，共6周。治疗前后采用疼痛视觉模拟量表(VAS)、膝关节角度重现测试、股内侧肌与股外侧肌运动前反应时差值(VM-VL)、膝主动关节活动度(AROM)、10米步行测试(10MWT)，以及膝关节损伤和骨关节炎评分量表(KOOS)进行评定。

结果治疗后，3组各项评价指标均改善(|t| > 2.532, P < 0.05)。组间比较，VAS评分A组 < C组 < B组；角度重现差值C组 < A组 = B组；VM-VL差值A组 = C组 < B组。

结论 PNF、NEMEX和PNF+NEMEX均可改善早期KOA患者的疼痛，提高膝关节运动功能；PNF缓解疼痛最有效，联合治疗改善膝关节功能作用更显著。

关键词: 膝骨关节炎, 疼痛, 本体感觉, 本体感觉神经肌肉促进法, 神经肌肉运动训练, 反应时

Abstract:

Objective To compare the effect of proprioceptive neuromuscular training methods on pain and motor ability of knee in patients with early knee osteoarthritis (KOA).

Methods From November, 2022 to May, 2023, 60 early KOA patients from Beijing Bo'ai Hospital and community were randomly divided into groups A, B and C, with 20 patients in each group. Group A received proprioceptive neuromuscular facilitation (PNF), group B received neuromuscular exercise (NEMEX), and group C received PNF and NEMEX, for six weeks. They were assessed with Visual Analogue Scale for pain (VAS), angle reappearance test, difference of pre-motor reaction time (VM-VL), active range of motion (AROM) of knee flexion, 10-meter walk test (10MWT), and Knee Injury and Osteoarthritis Outcome Score (KOOS) before and after treatment.

Results All the indexes improved in all the groups after treatment (|t| > 2.532, P < 0.05). Among the groups, the VAS score was the least in group A, and then groups C and B; the angle reappearance error was the least in group C, and similar in groups A and B; the VM-VL was the least in groups A and C, followed by group B.

Conclusion PNF, NEMEX and PNF+NEMEX can relieve the pain and improve the motor function of knee in patients with early KOA, however, PNF is the most effective on relieving pain, and PNF+NEMEX is the most effective on improving knee function.

Key words: knee osteoarthritis, pain, proprioception, proprioceptive neuromuscular facilitation, neuromuscular exercise, reaction time

中图分类号:

R684.3

张冠聪, 黄秋晨, 顾蕊, 刘四海, 胡春英, 刘克敏. 不同神经肌肉训练方法对早期膝骨关节炎患者疼痛和运动功能效果的比较[J]. 《中国康复理论与实践》, 2023, 29(9): 1090-1097.

ZHANG Guancong, HUANG Qiuchen, GU Rui, LIU Sihai, HU Chunying, LIU Kemin. Comparative effect of different neuromuscular exercises on pain and motor function of knee in patients with early knee osteoarthritis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1090-1097.

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组别	n	性别(男/女)/n	年龄/岁	身高/cm	体质量/kg	体质量指数/(kg·m^-2)
A组	20	8/12	57.55±5.14	166±8.10	76.35±14.67	27.26±4.49
B组	20	8/12	57.85±4.10	167±7.62	75.45±16.05	26.80±4.49
C组	20	8/12	56.55±4.01	166±6.17	74.60±15.01	26.84±4.79
χ²/F值		0	0.467	0.06	0.066	0.064
P值		1	0.629	0.942	0.936	0.938

组别	n	治疗前	治疗后	t值	P值
A组	20	5.01±1.19	1.82±0.67	23.602	< 0.001
B组 C组	20	5.17±1.16 5.02±1.42	4.19±1.26^a 2.76±0.91^a,b	13.052 14.960	< 0.001
B组 C组	20	5.17±1.16 5.02±1.42	4.19±1.26^a 2.76±0.91^a,b	13.052 14.960	< 0.001
F值		0.097	29.938
P值		0.907	< 0.001

组别	n	治疗前	治疗后	t值	P值
A组	20	12.21±2.00	5.25±1.03	29.754	< 0.001
B组 C组	20	12.83±2.03 11.88±2.06	5.38±1.41 2.58±1.42^a,b	47.376 55.736	< 0.001
B组 C组	20	12.83±2.03 11.88±2.06	5.38±1.41 2.58±1.42^a,b	47.376 55.736	< 0.001
F值		1.129	29.536
P值		0.331	< 0.001

动作	组别	n	治疗前	治疗后	t值	P值
坐-站	A组	20	542.82±379.68	159.84±125.45	6.658	< 0.001
	B组	20	425.96±287.66	286.38±146.84^a	4.123	0.001
	C组	20	528.59±471.61	117.28±86.90^b	4.750	< 0.001
下台阶	A组	20	186.16±114.85	62.79±49.03	8.147	< 0.001
	B组	20	176.71±136.10	104.88±68.42^a	4.554	< 0.001
	C组	20	179.08±101.10	14.89±68.66^a,b	17.281	< 0.001
F值^①			0.543	10.351
P值^①			0.584	< 0.001
F值^②			0.035	10.309
P值^②			0.966	< 0.001

组别	n	治疗前	治疗后	t值	P值
A组	20	107.10±5.13	114.23±6.11	-10.910	< 0.001
B组	20	108.62±5.24	111.88±5.98	-3.143	0.005
C组	20	107.22±4.86	111.55±6.78	-3.665	0.002
F值		0.556	1.074
P值		0.576	0.348