肌电生物反馈疗法对髌股关节疼痛综合征患者临床疗效的研究
发布时间：2019-06-20 08:32
【摘要】：目的:髌股关节疼痛综合征(patella femoral pain syndrome,PFPS)是一种临床常见及多发的疾病,由多种原因引起,研究表明,此病发病率较高,约为10%~40%,尤以10至35岁的年轻人最多见【1】。如果不能有效的治疗PFPS,将导致患者的生活质量与工作受到一定的影响。因此PFPS的预防、延缓进展及治疗就成为了一个重大课题。PFPS的患者大多主诉髌骨后或髌周疼痛,可有摩擦音、打软腿、关节肿胀等,在膝关节屈伸活动时疼痛加重。目前有关PFPS的病因尚不清楚,但是一般认为股四头肌的股内侧斜肌(vastus medialis oblique,VMO)肌肉无力是PFPS的主要影响因素。与髌骨滑行轨迹有关的股内侧斜肌(VMO)和股外侧肌(vastus lateralis,V L)之间的肌力不平衡,将引起髌骨与股骨髁间滑车应力增加而引起膝关节屈伸疼痛。因此,进行选择性股内侧斜肌肌力训练对于PFPS患者的康复治疗尤为重要。本研究的主要目的就是通过使用肌电生物反馈疗法选择性地进行股内侧斜肌训练,来调节VMO、VL的相对活动,以达到改善髌骨在膝关节屈伸时在股骨髁间滑车的运行,减轻患者疼痛,延缓疾病进展的效果。方法:本实验研究所有入选患者均符合髌股关节疼痛综合征的诊断标准,年龄在18~45岁之间;髌股关节摩擦试验阳性,病程在6个月以上;上下楼、屈膝久坐及蹲起时疼痛加剧;排除膝关节滑膜皱襞综合征、髌周韧带炎、半月板撕裂等,所有PFPS患者膝关节均无外伤史及韧带修复、重建等膝关节手术史;之前未接受任何物理治疗。根据以上入选标准共选取2013年10月—2014年6月在河北医科大学第三医院门诊就诊的PFPS患者40例,采用系统随机法将所有入选患者分为治疗组(Group A)与对照组(Group B),其中A组21例(男8例,女13例);年龄(36.9±6.6)岁;病程在6至24个月之间。B组19例(男9例,女1 0例),年龄(35.6±5.8)岁;病程在6至32个月之间。A组与B组间患者的一般情况(如年龄、性别、病程、身高、体重等)差异无统计学意义(P0.05)。所有入组病例均已签知情同意书。对照组Group B给予股四头肌肌力耐力训练、肌肉牵伸以及针灸按摩等康复治疗。治疗组A组则在B组治疗基础上应用加拿大生产的SA9800型生物刺激反馈仪,进行肌电生物反馈疗法来选择性针对股内侧斜肌肌力训练,20分/次,1次/天,5次/周,持续治疗8周。分别在治疗前及治疗8周后对所有入组者进行Lysholm膝关节功能评分、视觉疼痛量表(Visual Analogy Scale,V A S)评分、表面肌电图VMO/VL肌电比率评定。结果:(1)A、B两组患者的膝关节Lysholm评分在治疗前比较,差异无明显统计学意义(P0.05);治疗8周后两组患者的Lysholm功能评分与治疗前各组比较均有明显提高(P0.05),治疗组A组膝关节功能评分改善更为显著,且两组间比较,差异存在统计学意义(P0.05)。(2)A、B两组患者的VAS评分在治疗前比较,无统计学差异(P0.05);治疗8周后两组患者上下楼梯的VAS评分与治疗前各组比较均有明显改善(P0.05),疼痛减轻,有统计学差异,治疗组Group A改善情况更为显著,且两组间比较,差异存在统计学意义(P0.05)。(3)A、B两组患者的VMO/VL神经肌电活动比率在治疗前比较,无统计学差异(P0.05);经过共8周的系统康复治疗后,两组患者VMO/VL比率均与治疗前有所改善(P0.05),且两组间比较,差异存在统计学意义(P0.05)。结论:(1)股内侧斜肌作为股四头肌的一部分,它的主要作用是控制髌骨的运行轨迹。但是,常规的股四头肌力量训练并不能有针对性的训练股内侧斜肌。(2)应用肌电生物反馈疗法可以针对股内侧斜肌肌力训练,有效缓解髌股关节疼痛综合征患者的症状,改善膝关节功能,减轻膝关节的疼痛并提高患者工作及生活质量。
[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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R684
本文编号：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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R684
【引证文献】
相关期刊论文 前1条
1 王谋;徐婧;;慢性髌骨紊乱综合症:选择性股内侧斜肌训练与股四头肌力量训练的随机对照实验[J];世界最新医学信息文摘;2016年89期
，本文编号：2503077
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