神經肌肉電刺激對於前十字韌帶重建術後的病人在肌肉表現方面之療效探討－系統性回顧與統合分析

Effectiveness of Neuromuscular Electrical Stimulation on Muscle Performance after Anterior Cruciate Ligament Reconstruction-Systematic Review and Meta-analysis of Randomized Controlled Trials

許映欣(Yin-Hsin Hsu) ； 陳慶駿(Ching-Chung Chen) ； 何賢貞(Shien-Chen He) ； 陳文英(Wen-Yin Chen) ； 李雪楨(Hsuei-Chen Lee) ； 施怡芬(Yi-Fen Shih)

《物理治療》 32卷1期 (2007/02) Pp. 8-16

摘要

背景與目的：前十字韌帶重建術後之病人常因肌肉功能不足，影響日常功能表現。針對此類病人，利用神經肌肉電刺激進行輔助訓練的療效尚無系統性的分析。本研究針對近年發表的文獻，利用統合分析方法，探討神經肌肉電刺激對前十字韌帶重建術後肌肉表現的療效。方法：本研究以電腦資料庫交互比對，蒐集的文獻須符合：有隨機控制的對照組、發表於二十年內(1987~2006)、前十字韌帶重建術後之治療包含神經肌肉電刺激、肌肉功能之定量測試結果、且須提供測試值及標準差以計算效益值(effect size)。結果：本研究納入六篇研究，共151位受試者。神經肌肉電刺激組之股四頭肌與膕旁肌等長肌力明顯優於控制組，但等速肌力表現無顯著差異。有單篇研究顯示神經肌肉電刺激的介入對肌橫斷面積、肌肉組成、酵素活性、步態表現及日常生活功能方面具有正向效果。結論：神經肌肉電刺激的適時介入對前十字韌帶重建術後之患者的肌肉表現，在術後12週之內，相較於控制組有顯著療效。

關鍵字

電刺激 ； 前十字韌帶重建術 ； 肌肉表現 ； 系統回顧 ； 統合分析

並列摘要

Background and Purposes: Insufficiency of knee muscle function is one of the most common sequela after anterior cruciate ligament reconstruction and may affect functional performance in daily activities. Although neuromuscular electrical stimulation (NMES) is used extensively as an auxiliary treatment for patients post anterior cruciate ligament reconstruction, its therapeutic effects have not been clearly identified. The purpose of this study is to systemically review and analyze published studies on the effectiveness of NMES for patients after anterior cruciate ligament reconstruction. Methods: Studies were identified by a systematic computer database and cross-reference search. The inclusion criteria were: randomized controlled trials (RCTs), publish date within twenty years (1987-2006), human subjects after unilateral anterior cruciate ligament reconstruction, postoperative treatment with NMES. The outcome measures must contain at least one measurement of muscle function. Pre-training and post-training data should include means and standard deviations for calculating and comparing the effect sizes between groups. Results: Six RCTs were included with a total of 151 subjects. The outcome measures of muscle function included muscle strength, muscle composition, and functional performance in daily activities. Patients trained with NMES significantly improved their isometric quadriceps and hamstring muscle strength (effect sizes 0.97 and 4.12 respectively) in the first 12 weeks. The cross-sectional area, muscle composition and enzyme activation of the quadriceps, ADLS (Activities of Daily Living Scale) score, and gait performance also showed significant improvements in patients received NMES. Conclusions: Application of NMES significantly improved muscle function in the first 12 weeks after anterior cruciate ligament reconstruction as compared to regular exercise programs. It is a useful management option for patients with this type of operation, especially during the early stage of rehabilitation.

並列關鍵字

Electrical stimulation ； Anterior cruciate ligament reconstruction ； Muscle performance ； Systemic review ； Meta-analysis