Title

冷療對韌帶重建手術後關節源性肌肉抑制現象的效果

Translated Titles

Therapeutic effects of cryotherapy on arthrogenic muscle inhibition in patients with cruciate ligament reconstruction

DOI

10.6342/NTU.2013.00358

Authors

李松青

Key Words

冷療 ; 物理治療 ; 力量發展速率 ; 肌電訊號上升速率 ; 關節源性肌肉抑制 ; cryotherapy ; physical therapy ; rate of force development ; rate of EMG raise ; arthrogenic muscle inhibition

PublicationName

臺灣大學物理治療學研究所學位論文

Volume or Term/Year and Month of Publication

2013年

Academic Degree Category

碩士

Advisor

王興國

Content Language

繁體中文

Chinese Abstract

前言:關節受傷或是手術常會造成股四頭肌長期無力的現象,嚴重影響膝關節功能,股四頭肌無力可能是因為關節源性肌肉抑制現象所造成,已有研究顯示冷療可以短時間降低關節源性肌肉抑制的現象,另一方面,日常活動通常在50-250毫秒內完成,最大肌力測試所需時間則超過300毫秒,並不是一個好的方式來評估病人復原的狀況是否足以應付日常生活及運動所需,目前尚沒有研究利用肌電訊號上升速率(rate of EMG raise, RER) 、早期力量發展速率(initial phase rate of force developement)和股四頭肌活化程度來評估韌帶重建術後膝關節功能及股四頭肌快速收縮能力。本實驗的目的是評估在訓練計劃前加入冷療,是否可以提高訓練效果。 方法:本研究收集8位十字韌帶重建的病人及9位年齡、身高、體重相仿的對照組,在韌帶重建手術前、術後3個月及術後6個月利用測力儀(Biodex system 4)量測膝關節等長收縮及等速收縮時,肌肉功能和肌電圖訊號並測試膝關節功能。測試後計算股四頭肌最大等長收縮肌力、收縮初期力量發展速度、股四頭肌肌耐力、收縮期間肌電訊號最大均方根值、收縮初期肌電訊號上升速率、腿後肌拮抗共同收縮程度、疼痛量表、單腳跳距離和膝關節功能量表,利用SPSS13.0統計軟體Mann-Whitney U test分析實驗組和對照組間差異,Wilcoxon signed rank test分析健患側兩腳間差異,Friedman test分析術前、術後3個月及術後6個月間的差異,若有顯著差異,再以Wilcoxon signed rank test做事後分析,以Spearman's Rank Order correlation做功能表現及膝功能問卷和神經肌肉參數間的相關性檢查。 結果:實驗組在股四頭肌最大等長自主收縮肌力、股四頭肌肌耐力、肌電訊號最大均方根值方面和對照組無明顯差異,實驗組在力量發展速率、單腳跳距離、半腱肌拮抗共同收縮程度在術後3個月時和對照組有明顯差異,半腱肌的肌電訊號上升速率在術前及術後3個月時都比對照組慢,股二頭肌在術前、術後3個月及術後6個月時的肌電訊號上升速率都比正常對照組慢且和膝關節功能量表有高相關性,腿後肌拮抗共同活化程度和膝功能及最大肌力間無顯著相關性。 結論:術後6個月時股四頭肌最大肌力及肌電訊號最大均方根值己和對照組無明顯差異,證實冷療可能可以降低關節源性肌肉抑制現象,提高訓練的效果,但是在初期力量發展速率及肌電訊號上升速率和對照組間仍有顯著差異,建議將來治療應加入低阻力爆發性訓練,另外,初期肌電訊號上升速率和膝關節功能量表的高相關性,值得我們用更多的時間去關注。

English Abstract

Quadriceps strength deficit is a mojor problem in knee injuries or post-surgery. Arthrogenic muscle inhibition (AMI) is thought the reason of quadriceps weakness. Previous studies suggest cryotherapy can inhibit AMI to increase motor neuron excitability. Quadriceps peak torque in maximal voluntary isometric contraction usually takes a longer time to reach maximum force than daily activity like go up/down stairs.peak torque maybe not a good criteria to evaluate someone’s knee function. To date, there is no study using initial phase rate of EMG raise (RER), rate of force development (RFD) and quadriceps normalized EMG to evaluate fast and forceful quadriceps contraction in subjects with knee surgery.Our purpose is to evaluate the therapeutic effects of cryotherapy on AMI in subjects with cruciate ligament injury. Method: Our study includes 8 subjects with cruciate ligament reconstruction and 9 health controls. Isometric and isokinetic test at pre-surgery, post-surgery 3 months and post-surgery 6 months. EMG was recorded at the same time. MVIC, initial phase rate of force development, endurance, peak RMS EMG, RER, hamstrings antagonist coactivation, quadriceps normalized EMG, pain scale, single hop for distance and knee functional scale were measured. Statistic: Mann-Whitney U test, Wilcoxon signed rank test and Friedman test were performed to analysis the difference between subjects and controls, the difference between involved and un-involved and the difference among pre-surgery, post-surgery 3 months and post-surgery 6 months. Spearman's Rank Order correlation was performed to evaluate the correlation between knee function and neuromuscular parameters. Outcome: Subjects were lower than controls in RFD, RER, single hop.Hsmastings antagnosit coactivation in subjects was higher than in controls.High correlation was noted between biceps RER and knee function. Conclusion:Cryotherapy and rehabilitation programs can improve muscle performance. RFD and RER in subjects were lower than controls.Cryotherapy and low resistance explosive training programs should be inclused in future training programs. Beside, we should pay more attention on hamstrings RER due to the high correlation between hamstrings RER and knee functions. Keyword : cryotherapy、physical therapy、rate of force development、rate of EMG raise、arthrogenic muscle inhibition

Topic Category 醫藥衛生 > 醫藥總論
醫學院 > 物理治療學研究所
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