前十字韌帶重建患者之膝關節肌力變化–使用髕骨韌帶與腿後肌腱移植物的比較

背景：正常的前十字韌帶是完整膝關節功能的重要指標。前十字韌帶損傷除了會造成膝關節功能下降，進一步還可能造成平衡失調、功能性活動受限，甚至喪失參與激烈運動的可能。前十字韌帶的重建是一種在關節鏡下使用自體移植物之重建手術，選擇包括使用腿後肌腱或髕骨韌帶作為前十字韌帶的替代物。自體移植物的選擇，對於術後肌力的恢復可能有不同表現，進而影響動作的恢復。方法：針對使用腿後肌肌腱（11位）、髕骨韌帶（12位）自體移植之前十字韌帶損傷之患者與年齡相符的正常人（15位），在術前、術後三個月及六個月時使用等速肌力器測量雙側股四頭肌與腿後肌在膝關節90°至10°下之最大等長肌力的表現，以探討此類患者在使用不同移植物後肌力恢復的進程。結果：前十字韌帶損傷患者在術前患側，即有明顯低於健側與正常受試者之等長肌力。術後患側肌力的變化則與移植物的選擇有關。不論使用何種自體移植物，患側的股四頭肌在術後三個月時在各測試角度下皆有不可避免的肌肉無力，嚴重程度更甚於術前。而腿後肌腱組則有明顯的腿後肌無力，可能是因為供應移植區受損所造成。術後六個月時，兩組患側之股四頭肌肌力皆有逐漸改善，但在部分的角度仍小於正常人。分析顯示但髕骨韌帶組之股四頭肌在術後六個月時肌力缺失仍較為嚴重；而腿後肌腱組之腿後肌則恢復與正常人相當。結論：前十字韌帶在膝關節活動中扮演著非常重要的角色。前十字韌帶損傷與重建對於膝關節肌肉造成的影響不容忽視。前十字韌帶重建之後復健的主要目的之一是重新恢復膝關節正常的肌力。當物理治療師在設計前十字韌帶重建患者的治療計劃時，應針對不同移植物選擇者提供更確實的治療計劃。

關鍵字

前十字韌帶；前十字韌帶重建手術；腿後肌腱自體移植；髕骨韌帶自體移植；肌力

並列摘要

Background: Normal anterior cruciate ligament（ACL）is an essential indicator of integral knee function. In addition to the loss of the knee function, ACL injury can also impair balance, limit functional activities, and even restrict the participation in vigorous sports activities. The reconstruction of the ACL utilizes arthroscope to transfer selection of autografts, often hamstring tendon（HT）or patella tendon（PT）, to substitute the injured ligament. The choice of the autografts may affect the recovery of knee muscle strength. Methods: ACL injured patients planned for reconstruction（12 with HT and 11 with PT aurograft）and a group of healthy, aged matched controls were recruited for this study. They were tested bilaterally for isometric knee muscle strength at knee flexion of 90°-10° with an isokinetic dynamometer, before, three and six months after reconstruction to investigate the recovery of knee muscle strength with different autografts. Results: The quadriceps of the affected side of the ACL injured clients was found to be weaker than their sound sides and the controls. Muscle strength recovery of the affected knee was found associated with the autograft selection. For both HT and PT groups, the quadriceps of the affected knees was much weaker at all testing knee positions at the third month post reconstruction. In addition, the HT group also showed significant weakness of the hamstrings at the affected side, which might be due to the damage to the donor site. At the sixth month post reconstruction, the affected quadriceps of both HT and PT groups have much recovered, though the quadriceps was till weaker than the controls at some of the testing angles. Further analysis showed that, at the sixth month post reconstruction, the PT group still exhibited more deficits in quadriceps strength, though the HT group had largely recovered to normal. Conclusion: ACL plays a very important role in knee control. The impact to knee muscle strength should not be ignored in those who have had an ACL injury and those with a reconstruction. Since a major goal of rehabilitation after ACL reconstruction is to regain normal muscle strength of knee joint, physical therapists should plan the ACL rehabilitation programs with emphasis to clients with different autografts.

並列關鍵字

anterior cruciate ligament ； ACL reconstruction ； hamstring autograft ； bone-patella tendon-bone autograft ； muscle strength

參考文獻

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前十字韌帶重建患者之膝關節肌力變化–使用髕骨韌帶與腿後肌腱移植物的比較

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