神经肌肉训练对膝关节骨关节炎患者关节稳定性的影响

来源 :中华医学杂志 | 被引量 : 0次 | 上传用户:youdong2010
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目的:研究神经肌肉训练对膝关节骨关节炎(OA)患者关节稳定性的影响。方法:北京大学人民医院关节病诊疗中心从2017年9月至2018年10月以连续入组的方式对110例膝关节OA患者给予为期6周成小组的神经肌肉训练,并对患者进行纵向随访。于基线、6周、3个月对患者进行访视,随访时通过膝关节瞄准测试记录膝关节光点移动轨迹,结合多尺度熵法测量受试者的膝关节稳定性指数(IKJS);同时采集患者疼痛视觉模拟评分(VAS)、西大略湖麦克马斯特骨关节炎评分(WOMAC)、欧洲五维健康量表(EQ-5D-VAS)、30 s椅子坐起试验、40 m快走试验等。使用单因素重复测量方差分析比较各随访点的结果变化。应用Pearson偏相关性检测,比较每次随访时IKJS与膝关节影像学分级、疼痛、WOMAC评分、躯体功能等的相关性。结果:96例患者[(65±8)岁;男21例,女75例]完成了3个月的随访,6周随访时,IKJS较基线增加0.369(95%n CI:0.241~0.496,n P0.05)。6周和3个月随访时,患者VAS疼痛评分、WOMAC评分、EQ-5D-VAS生活质量评分、30 s椅子坐起试验、40 m快走试验较基线均有明显改善(均n P<0.05)。n 结论:神经肌肉训练可改善膝关节OA患者的关节稳定性,但效果随时间有下降趋势;同时神经肌肉训练可缓解膝关节疼痛、改善关节功能。“,”Objective:To evaluate the effects of neuromuscular exercise therapy on joint stability of knee osteoarthritis (OA) patients.Methods:One hundred and ten patients with knee OA were enrolled in this ongoing prospective cohort study at Arthritis Clinic and Research Center, Peking University People′s Hospital from September 2017 to October 2018. The treatment consisted of six-week neuromuscular exercise therapy. The participants were followed up at 6 weeks and 3 months after the therapy. The stability of the joint was evaluated by the index of knee joint stability (IKJS), which was extracted by a novel knee-aiming task combined with the multiscale entropy (MSE) analysis of the complexity of the light spot trajectories. The secondary outcomes were pain on the visual analogue scale (VAS, 0-100), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), quality of life on the Euro-quality of life-5 Dimensional (EQ-5D) VAS form, 30-second chair stand test and 40-meter walk test. One-way repeated measures ANOVA analysis was applied to compare the outcomes at baseline and 6 weeks and 3 months. Pearson partial analysis was used to investigate the correlation between the IKJS and the Kellgren-Lawrence (K/L) rate, pain and knee function.Results:Ninety-six participants ((65±8) years, 21 males, 75 females) completed 3-month follow-up. There was a significant improvement in IKJS at the 6-week visit compared with that at baseline (0.369, 95% confidence interval (n CI) 0.241-0.496, n P0.05n ). There was improvement in pain VAS, WOMAC, EQ-5D-VAS, 30-second chair stand test and 40-meter walk test at 6 weeks and 3 months (all n P<0.05).n Conclusion:The neuromuscular exercise therapy is effective in improving the joint stability of the knee OA patients. However, the effect gradually diminished over time. In addition, neuromuscular exercise can help relieve pain, improve the function and quality of life in patients with knee OA.
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