等速肌力訓練對前十字韌帶損傷之復健成效研究

前十字韌帶(Anterior Cruciate Ligament, ACL)是膝關節穩定的重要結構，若因職場上的工作跌落、滑倒或球場跑跳競技等會導致ACL損傷，將造成膝關節不穩或退化，影響患者的行動、工作效率與生活品質。通常患者可藉由重建手術加以治療，但重建後的復健則有賴適當的肌力訓練來縮短康復期，讓患者能及早恢復正常生活和重返職場。等速肌力(Isokinetic)訓練儀是肌力訓練的有效工具，本研究的主要目的在於探討前十字韌帶手術重建個案採用等速肌力訓練後的復健成效。首先針對ACL手術重建的73個個案，用Kin-Com等速肌力訓練儀進行等速肌力評估，包括︰伸肌(60o/s等速向心)、伸肌(60o/s等速離心)、屈肌(60o/s等速向心)、屈肌(60o/s等速離心)、伸肌(180o/s等速向心)、伸肌(180o/s等速離心)、屈肌(180o/s等速向心)、屈肌(180o/s等速離心)等八個力矩峰值變量之肌力指標，作為統計分析的數據資料。應用MINITAB統計軟體的配對t、ANOVA和主成份分析等功能，統計分析ACL後患者經歷一個月/兩個月等速肌力訓練後之肌力復健康復成效，並探討患者的性別、BMI(＞25、≦25)、年齡(＞30、≦30)與患側(慣用腳、非慣用腳)等四項變因對於肌力等速肌力訓練前/後肌力指標的差異性。統計分析結果顯示：73位患者中女性22人(平均28.41±9.99歲，最大52歲，最小14歲)，男性51人(平均28.47± 8.23歲，最大56歲，最小17歲)；患者的年齡平均28.45±8.73歲(最大56歲，最小14歲)；BMI平均值27.97±4.81(BMI＞25者49人，BMI≦25者24人)；患側為慣用腳者58人，非慣用腳者15人。73位患者等速肌力訓練前/後的八個肌力指標中，等速向心的平均值.均小於等速離心的檢測值；以配對t檢定73位患者持續一個月與39位患者持續兩個月的等速肌力訓練前/後之四組八個肌力指標變量，均達到統計上極顯著差異(p<0.001)且訓練後八個肌力指標的平均值均大於訓練前，此結果可以推斷ACL重建患者輔以等速肌力訓練，確實有助於提高患者的肌力指標值，縮短其復健治療時間；患者的性別、BMI(＞25、≦25)、年齡(＞30、≦30)與患側(慣用腳、非慣用腳)等變因，對於訓練前/後的八個肌力進步率均未達統計上的顯著差異，即患者的肌力進步率對於性別、BMI、年齡與患側(慣用腳、非慣用腳)等變因無顯著差異；透過多變量主成份分析法將等速肌力訓練前/後的兩組八個肌力指標濃縮成兩個肌力綜合指標，據此檢定等速肌力訓練前後之差異性，所得結果與用兩組八個肌力指標檢定相同變因的結果一致，即均達到統計上的顯著差異，因此應用多變量主成份分析法比較分析等速肌力訓練前後的差異性不僅可行且可以減省統計分析的工作量。本文的研究成果可以提供ACL手術重建臨床復健治療及等速肌力訓練之參考。

關鍵字

十字韌帶；復健；等速肌力；慣用腳

並列摘要

The anterior cruciate ligament (ACL) is a vital structure in stabilizing the knee. If injured from professional field, accidental fall, or athletic activity, patients can develop complication with ACL causing knee joint instability or degradation, which affecting the patient's actions work efficiency and quality of life. Typically patients can be treated by reconstructive surgery and the rehabilitation of reconstruction will depend on strength training on the muscle. If proper strength training is applied, the recovery period will shorten and the patient can resume normal lifestyle as well as return back to the workplace as soon as possible.. The isokinetic instrument is an effective training tool for muscle strength training, the main objective of this study is to investigate the ACL reconstruction surgery using the effectiveness of rehabilitation after isokinetic strength training. Seventy-three cases of ACL reconstruction with surgery are selected to be analysis samples. The kin-com isokinetic muscle strength training is applied three times a week for eight weeks and each training is 30 minutes. Every four weeks, the isokinetic assessment will be done. The assessment evaluates 60º and 180º angular velocity of the extensor, flexor peak torque to the contraction and eccentric torque ratio resulting in 8 sets of data for analysis. Using the MINITAB statistical analysis to match up with t, ANOVA and main active agent, the data can be used to evaluate the effectiveness of rehabilitation one and two months during their recovery period. Variation contributing to the difference in degree of muscle recovery includes gender, weight, dominant feet and the isokinetic training strength. Among the 73 case study individuals, there are 51 males and 22 females. The average age of female participants are 28.41±9.99 with the oldest being 52 years old and youngest being 14 years old. The average age the male participants is 28.47±8.23 years old with oldest being 56 and youngest being 17 years old. The overall age average of both genders is 28.45±8.73 with the oldest being 56 and youngest being 14 years old. The overall average of BMI for both genders is 27.97±4.81 with 49 patients having BMI greater than 25 while 24 patients having equal or less than 25 BMI value. There are 58 patients who have dominant leg usage, while 15 patients do not. The analysis result indicates that 73 patients have shown decreasing difference between their average muscle strength and the standard muscle strength. With the matching “paired t” analysis, the 73 participants who have been receiving muscle strength training for one month and the 39 participants for over two months period both demonstrate increasing muscle strength comparing above the standard average. The significant difference, (p<0.001), from the set of training index is much higher than what the patients have demonstrated before the training. This result strongly suggests that the effectiveness of isokinetic strength training is significant in minimizing the recovery the period for the patients after the ACL surgery. The variations of gender, age, BMI and dominant leg do not have any statistical significance to affect the result of the data. The results of this study may provide a practical application of the ACL reconstruction surgery rehabilitation therapy clinical, and a reference of clinical demonstration of muscle strength training