髖內收合併膝伸直運動對髕股關節疼痛症候群病人其 股四頭肌肌肉型態、疼痛及功能性活動能力之影響

Effect of Hip Adduction Combination with Knee Extension Exercise on Morphology of Quadriceps Muscles, Pain and Functional Outcomes in Patients with Patellofemoral Pain Syndrome

宋貞儀(Chen-Yi Song)

指導教授 ： 詹美華

國立臺灣大學/醫學院/物理治療學研究所/碩士(2006年)

https://doi.org/10.6342/NTU.2006.01204

摘要

背景及目的：髕股關節疼痛症候群為一臨床常見之膝關節疾病，主要原因之一乃股內斜肌失能使髕骨有不正常的外側偏移，造成髕股關節的壓迫。股內斜肌為膝關節動作時髕骨的內側動態穩定者，臨床上常用保守療法即針對股內斜肌作特定性的訓練。由於股內斜肌肌纖維起始於髖內收肌群，學者認為髖內收肌的收縮能誘發股內斜肌的活動，然而文獻除了相關的肌電圖實驗外，至今仍未有臨床試驗之研究。因此，本隨機控制試驗選用超音波儀器量測股內斜肌之肌肉型態，評估在訓練介入前後的變化，探討髖內收合併膝伸直運動訓練對髕股關節疼痛症候群患者的臨床治療效益，並且和傳統末端膝伸直運動，及控制組間作療效比較。方法：本研究徵召62位年齡小於55歲之髕股關節疼痛症候群患者，隨機分配至髖內收合併膝伸直推蹬運動訓練組、傳統末端膝伸直推蹬運動訓練組、及控制組，進行每週3次、為期8週的推蹬運動訓練，然後評估股內斜肌的肌肉型態（包括股內斜肌肌纖維角度、髕骨上緣水平位之股內斜肌截面積、及髕骨上緣水平位以下之股內斜肌體積）、膝關節視評疼痛分數（包括一般疼痛分數、最嚴重疼痛分數、及活動疼痛分數）、以及Lysholm Scale功能量表分數在介入前後之改變。結果：髖內收合併膝伸直推蹬運動及傳統末端膝伸直推蹬運動訓練組患者，經過8週運動訓練後，其髕骨上緣水平位之股內斜肌截面積、髕骨上緣水平位以下之股內斜肌體積皆有顯著進步（p< .005），然進步未較控制組顯著（p= .011~ .042）。而膝關節一般疼痛分數、最嚴重疼痛分數、活動疼痛分數、及Lysholm Scale功能量表分數除了在訓練前後有顯著進步（p< .005）外，進步亦較控制組顯著（p< .005），唯髖內收合併膝伸直推蹬運動組患者之活動疼痛分數之進步，比起控制組仍未達足夠的顯著（p= .016）。此外，兩運動組之間並無組間統計顯著差異。而股內斜肌肌纖維角度則是在訓練前後並無統計顯著差異。控制組患者之股內斜肌肌肉型態、膝關節視評疼痛分數、及Lysholm Scale功能量表分數在8週前後皆無統計顯著差異。結論：閉鎖鏈髖內收合併膝伸直推蹬運動訓練，可使髕股關節疼痛症候群患者的股內斜肌肥厚，疼痛下降，並且增加下肢功能性活動能力。然而其療效與閉鎖鏈末端膝伸直推蹬運動訓練相似。建議臨床上可以任擇一運動訓練計畫，若考量方便及實用性，則可優先選擇閉鎖鏈末端膝伸直推蹬運動。

關鍵字

髕股關節疼痛症候群 ； 股內斜肌 ； 超音波 ； 下肢推蹬運動 ； 髖內收

並列摘要

Background and purpose：Patellofemoral pain syndrome（PFPS） is a common knee disorder characterized by anterior or retropatellar pain associated with activities that load the patellofemoral joint. Previous studies reveal that the vastus medialis obliquus（VMO） is an important dynamic medial stabilizer of the patella. Insufficiency of the VMO leads to lateral shift of the patella and the increases of patellofemoral contact pressure. Thus VMO-specific training is a well-accepted clinical treatment conservatively. Hip adduction is thought to enhance VMO contraction because of its anatomic origin from hip adductors. In order to determine its training effect, we used ultrasonography as a measurement tool to examine the VMO morphology changes after hip adduction combination with knee extension exercise training compared with traditional terminal knee extension exercise training and control in patients with PFPS.
Methods：62 PFPS patients with age under 55 were recruited for the study and then randomly assigned to either one training or control group. Muscle morphology of VMO（including fiber angle, cross-sectional area on patella-base level, and volume under patella-base level）, 10 cm-visual analog scale of usual pain（VAS-U）,worst pain (VAS-W), activity pain (VAS-activity), and Lysholm Scale scores were measured before and after 8-wk leg press exercise training or control periods.
Results：Significant improvements of VMO cross-sectional area, volume, VAS-U, VAS-W, VAS-activity, and Lysholm Scale scores were found after 8-wk training in both exercise groups（p< .005）, but not in the control group. The improvements were also significantly different between the exercise and control groups（p< .005）, except for the VMO cross-sectional area and volume（p= .011~ .042）, and for the VAS-activity between the hip adduction combination with knee extension exercise and control groups（p= .016）. However, no differences were found between two exercise groups. In all three groups, no significant differences were found in VMO fiber angle throughout the experiment.
Conclusion：The results suggest that immediate effects of VMO hypertrophy, pain reduction, and functional ability improvement occurred following hip adduction combination with knee extension exercise. Treatment effects did not show significant differences between two exercise groups; therefore, therapists could choose either of these two exercise programs. Moreover, clinical practices may consider the application of leg-press exercise with terminal knee extension alone since additional equipments are not required.

並列關鍵字

Patellofemoral pain syndrome ； vastus medialis obliquus ； ultrasonography ； leg press exercise ； hip adduction

參考文獻

74.Teng HL. Clinical and electromyographic characteristics of Patellofemoral pain dyndrome. Master thesis 2004.

1.Crossley KM, Bennell KL, Cowan SM, et al. Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid? Arch Phys Med Rehabil 2004; 85: 815-22.

2.Doucette SA, Goble EM. The effect of exercise on patellar tracking in lateral patellar compression syndrome. Am J Sports Med 1992; 20(4): 434-40.

3.Insall J. Patellar pain. J Bone Joint Surg Am. 1982; 64(1): 147-52.

4.Zappala FG, Taffel CB, Scuderi GR. Rehabilitation of patellofemoral joint disorders. Orthop Clin North Am 1992; 23(4): 555-66.