前膝疼痛症候群的運動治療效果：系統性回顧與統合分析

Effect of Exercise for Anterior Knee Pain Syndrome: Systemic Review and Meta-analysis

黃炳堯(Bing-Yao Huang) ； 王昱棠(Yu-Tang Wang) ； 張棋興(Qi-Xing Chang) ； 王元慶(Yuan-Ching Wang) ； 陳文英(Wen-Yin Chen) ； 李雪禎(Hsuei-Chen Lee) ； 施怡芬(Yi-Fen Shih)

《物理治療》 37卷1期 (2012/03) Pp. 48-59

摘要

背景：前膝疼痛症候群（anterior knee pain）為運動員常見之慢性骨骼肌肉疼痛，臨床上常以運動介入方式加以治療，近年來文獻更提出髖關節肌群之加強訓練。然而，上一篇關於前膝疼痛症候群之運動介入臨床效果統合分析（meta-analysis）發表於2003年，且其證據力不高。因此本研究目的為藉由統合分析，整理近十年及過去相關文獻，檢視運動介入及不同的運動介入方式，對於前膝疼痛症候群的療效。方法：以電腦資料庫及交叉比對方式進行文獻蒐集。收集的研究須符合下列條件：（1）各篇文獻的受試者須為前膝疼痛、髖股疼痛症候群或是髕骨軟化症；（2）介入方式為運動介入，介入的項目須包含膝關節肌群訓練或膝關節合併髖關節肌群訓練的其中一種；（3）排除控制組為健康受試者進行配對之設計；（4）排除控制組有進行其他介入方式；（5）治療成效的評估項目需包含疼痛、功能表現、運動學或動力學參數；（6）治療成效結果資料需包含各組之前後測之平均值及標準差的呈現。療效測量包含膝痛指數、功能改善情況及肌力進步程度三個項目。結果：本研究共收錄十三篇相關研究文獻。統合分析結果顯示運動介入可有效改善前膝疼痛患者在活動中的疼痛（成效值為-0.973）及功能表現（成效值為1.537）;不論是否包含髖關節肌群運動，運動訓練都能有效改善疼痛及功能表現，但包含髖關節肌群的訓練運動在疼痛改善上明顯優於單獨膝關節肌群訓練。結論：運動介入可以有效改善前膝疼痛患者的疼痛分數、功能表現及肌力表現。臨床上以膝關節合併髖關節肌群的運動訓練方式，對疼痛降低有更佳的治療效果。

關鍵字

前膝疼痛 ； 運動介入 ； 系統性回顧 ； 統合分析

並列摘要

Background: Exercise training is a common management method for anterior knee pain. In recent years, an increasing number of studies suggested that exercise training should include strengthening of hip muscle groups. However, no consensus was reached regarding the effect of exercise training focusing on the hip muscle strengthening in patients with anterior knee pain Therefore, the purpose of this study was to systemically review and meta-analyze the exercise effect on pain reduction, and muscle and functional performance in patients with anterior knee pain. Methods: Studies were identified by a systematic computer database and cross-reference search. The inclusion criteria included: (1) subjects with anterior knee pain, patellofemoral pain or chondromalacia; (2) exercise interventions which included knee exercise or knee and hip exercise; (3) outcome measures containing the following items: pain score, functional performance, muscle strength, kinematic or kinetic variables, and giving pre-and-post scores with means and standard deviations. We excluded studies which used the healthy controls or used non-exercise intervention for the control group. Results: There were 13 studies recruited for our analysis. The results of meta-analysis showed that exercise, with or without hip muscle strengthening. decreased pain during activities (effect size = -0.973) and improved functional performance (effect size = 1.537) in patients with anterior knee pain. Knee combined hip muscle strengthening was significantly better in pain reduction as compared to knee exercise only. Conc1usion: Exercise could effective1y improve the symptoms, function and muscle performance in patients with anterior knee. Clinicians cou1d use hip combined knee exercise to achieve better pain reduction effect. However, more evidence is needed to explain the kinematic and kinetic mechanisms behind the treatment effect, and to determine whether patients with particular biomechanica1 deficits would benefit more from exercise with hip strengthening component. (FJPT 2012;37(1):48-59)

並列關鍵字

Anterior knee pain ； Exercise ； Systematic review ； Meta-analysis