慢性中風病人膝關節過度伸直與膝關節疼痛、退化和身體動作功能的關係

Association of Knee Hyperextension with Knee Pain, Degeneration, and Body Motor Function in Chronic Stroke Patients

目的：以X光評估慢性期中風病人患側膝蓋過度伸直的情形，了解膝關節過度伸直與膝蓋退化、疼痛、身體動作功能的相關性。方法：採橫斷面研究，納入中風3個月以上之中風病人，拍攝病人正面與側面負重膝部X光片以判斷膝蓋過度伸直、退化及骨刺的情形，利用VAS紀錄膝疼痛程度、使用手持式測肌力機測量兩下肢膝伸直肌肌力、利用改良Ashworth量表評估患側膝伸直肌張力。身體動作功能的評估包括30秒坐站測試、站姿前伸測試、伯格式平衡量表、六分鐘行走測試、行走速度。結果：研究結果顯示，中風時間超過3個月以上的病人，若患側有膝關節過度伸直的情形，其患側膝伸直肌肌力顯著較小(p=0.009)、站姿前伸距離亦顯著較小(p=0.046)。結論：有膝關節過度伸直的慢性中風病人患側膝伸直肌肌力與站姿前伸距離顯著較小，但在其他變項則與有無患側膝過度伸直無顯著相關。臨床上是否需要過度強調治療慢性中風病人患側膝蓋過度伸直的問題值得省思。

Objectives. To evaluate hyperextension of affected knees in chronic stroke patients by X-ray, and to understand the correlation between knee hyperextension and knee degeneration, pain, and body motor function.
Methods. A cross-sectional study was taken. Stroke patients who had stroke for more than 3 months were taken. X-rays of patients’front and side weight-bearing knees were taken to measure the angle between coronal and sagittal planes of knee joints, and to determine knee hyperextension, degeneration and spurs; use VAS to record knee pain; use a handheld dynamometer to measure knee extensor strength; use the modified Ashworth scale to assess muscle tone of affected knee extensors. Measurement of body motor function includes 30-second sit-to-stand test, forward reach test, Berg format balance scale, six-minute walking test, and walking speed.
Results. This study showed that in patients with stroke for more than 3 months, if affected side had hyperextension of knee, the extensor muscle strength of affected knee was significantly weaker (p=0.009), and the distance of standing forward was also significantly shorter. (p=0.046).
Conclusion. In chronic stroke patients with knee hyperextension, the strength of affected knee extensor is significantly weaker, and the distance of forward reaching is significantly shorter. However, other variables are not significantly related to presence or absence of knee hyperextension. Whether it is necessary to over-emphasize the problem of hypertension of the affected knee in chronic stroke patients in clinical practice is worth pondering.