比較不同運動方式對退化性膝關節功能改善之效益

Comparison of Clinical Effect in Different Exercise Modes on Osteoarthritic Knees

退化性膝關節炎患者有日益增多的趨勢，物理治療項目中的運動治療也益顯其重要性。近年來有多位學者發表：運動治療應加強感覺神經的誘發訓練。本實驗即針對依誘發感覺神經多寡不同的三種運動，進行評估其臨床功能改善的情形。62位退化性膝關節炎患者依門診的先後次序分為三組。A組接受以肌力訓練為主的膝末端伸直運動；B組接受以誘發感覺神經為主的踩平衡板運動；C組以兼具肌力及誘發感覺訓練的踩階梯運動。經過6週每週至少4次的訓練，三組患者的班弟(Bandi)膝功能障礙指數、等速肌力、平衡反應速度皆明顯改善；但踩平衡板運動組之各種評估項目在效果上並無統計上有意義的優於其他兩種運動方式(p>0.05)。在重心位移測試的平衡反應速度上，B組患者在各方向的反應速度皆有意義加快(p<0.05)，其他兩組則無此現象(P>0.05)，A、C兩組各方向位移的總時間在訓練後亦顯示出明顯減少。又膝末端伸直運動有效增加伸肌肌力，踩平衡板運動則有效增加屈肌肌力。本實驗結果肯定運動治療對早期退化性關節炎患者之療效，並且有助於針對不同程度之退化性關節炎患者設計個別需要之運動治療計劃。

Therapeutic exercise is the most important component of physical therapy for patients with osteoarthritic knee. Recently, many authors reported that therapeutic exercises should emphasize facilitating proprioception of affected joints. We studied the effectiveness of three different modes of exercise that depend on proprioceptor contribution for training patients with osteoarthritic knee. Sixty-two patients with osteoarthritic knees were divided into 3 groups by registration sequence. In group A, the patients performed terminal knee extension exercise. In group B, patients performed proprioceptive balance board exercise with the affected leg. Group C, patients did stair stepping exercise with comfortable resistance. All of the subjects were treated at least 4 times a week for 6 weeks. The following variables were assessed before and after the training program for all subjects; (l) isokinetic peak torque of knee extensor and flexor; (2) functional incapacity score of the osteoarthritic knee; (3) reaction time of shifting center of gravity to 4 targets; and (4) patient's self evaluation of effect. There was improvement of both flexor and extensor peak torque after the three modes of exercisc. Among the three groups, there were no significantly difference in clinical effects, including the improvement of peak torque, functional incapacity score, or reaction time of shifting center of gravity. The reaction time was most improved in group B patients. Terminal knee extension exercise effectively increased extensor torque. Proprioceptive balance board exercise effectively increased flexor torque. The results of this study support the importance of exercise for early-stage osteoarthritis patients. Our results are also valuable in designing individual exercise programs for the specific needs of such patients.