全人工膝關節置換術前功能性肌力訓練成效

The Effectiveness of Preoperative Functional Muscle Strength Training for Total Knee Arthroplasty

研究退化性膝關節炎第四級患者，在進行全人工膝關節置換手術前接受功能性肌力訓練，是否會對手術後的關節炎症狀和功能表現產生影響。本研究招募了6名受試者，將他們均勻分配到未訓練組和訓練組。訓練組在手術前兩周至少進行一次肌力訓練。訓練前後使用踏步機進行熱身和收操，然後在主要訓練階段使用穿戴式負重背心進行三種功能性運動訓練，包括平地行走、上下樓梯和椅子坐立訓練。兩組均接受常規衛教、術後床邊運動和助行器行走訓練。數據分別在安排手術的門診進行前測（T0）和手術後第6週的後測（T1），包括（1）WOMAC膝關節功能評分、（2）椅子坐站測試、（3）功能性伸手測試、（4）四方格跨步測試、（5）起身繞圓測試、（6）40米快步行測試、（7）爬樓梯測試和（8）Y字平衡測試。使用Wilcoxon signed rank test符號檢驗統計各組前測和後測的差異。結果顯示未訓練組和訓練組的受試者在WOMAC膝關節功能評分上皆有進步，表明全人工膝關節置換手術的成功，而訓練組的受試者在上下樓梯則有顯著進步。對於退化性膝關節炎第四級患者，在進行全人工膝關節置換手術前進行功能性肌力訓練後，訓練組在樓梯攀爬能力上顯著提升，顯示術前訓練對於特定功能性動作的影響。

This study examined the impact of functional strength training on patients with stage IV degenerative knee osteoarthritis before undergoing total knee arthroplasty (TKA) surgery. Six participants were recruited and evenly allocated to the untrained group and the trained group. The trained group underwent exercise intervention at least once in the two weeks leading up to the surgery. The warm-up and cool-down phases of the exercise intervention involved using a stepper, followed by three functional exercises during the main training phase, which included flat walking, stair climbing, and chair sit-to-stand training. Both groups received routine education, bedside exercises post-surgery, and training for walking with assistive devices. Data were collected through assessments conducted before the scheduled surgery (T0) and at the 6th week post-surgery (T1). The assessments included (1) WOMAC knee joint function scores, (2) chair sit-to-stand test, (3) functional reach test, (4) four-square step test, (5) timed up-and-go test, (6) 40-meter fast-paced walking test, (7) stair climbing test, and (8) Y-balance test. The Wilcoxon signed-rank test was used to statistically analyze the differences between pre-test and post-test results within each group. The results showed that both the untrained and trained groups exhibited improvements in WOMAC knee joint function scores, indicating the success of total knee replacement surgery. However, the trained group showed significant improvements in stair climbing ability. For stage IV degenerative knee osteoarthritis patients, undergoing preoperative functional strength training intervention can enhance their ability to climb stairs, while other assessments may involve relatively easier movements that show significant differences.