肌力訓練、貼紮治療、牽拉運動於髕股關節痛患者臨床治療成效之比較

Abstract

介紹：髕股關節痛，是臨床上相當常見的一項疼痛的膝關節疾患。造成髕股關節痛的原因主要有過度使用、軟組織不平衡、下肢骨骼排列不正確。目前認為物理治療的介入對於軟組織不平衡的髕股關節痛患者是最有幫助的。臨床上，物理治療對於此類患者常用的工具包含肌力訓練、貼紮治療與牽拉運動。上述的物理治療工具有其不同的治療機轉。然而文獻中鮮少針對這三種物理治療工具作單一項的成效評估。本研究的目的在於利用隨機控制試驗的方式研究肌力訓練、貼紮治療、牽拉運動對於髕股關節痛患者的治療成效。方法：本研究徵求80名髕股關節痛的患者並加以隨機分組至肌力訓練組、貼紮治療組、牽拉運動組。在治療前，各組都接受視評疼痛量表、主動—主動關節角度配對測試、中文版西安大略及麥可麥斯特大學關節炎量表的身體功能副表、不同路面行走所需時間與最大肌力的評估。並在接受八週的治療後再接受相同的評估。藉此比較不同的治療方式對於患者之臨床治療成效。結果：研究結果發現經過八週的治療之後，三組的患者在視評疼痛量表、主動—主動關節角度配對測試、中文版西安大略及麥可麥斯特大學關節炎量表的身體功能副表、不同路面行走所需時間都有顯著的進步，並且組間沒有顯著差異。三組患者的最大肌力在經過八週的物理治療之後，也都有顯著差異。而肌力訓練組的進步比起貼紮治療組或牽拉運動組有更顯著的進步。結論： 本研究顯示對於髕股關節痛的患者，三種物理治療工具各有其獨特的治療成效。雖然無統計上顯著差異但疼痛的改善、身體功能副表的得分進步、最大肌力值、水平地面快走和跨越障礙物以肌力訓練組進步最多。貼紮治療組則是在主動—主動關節角度配對誤差和海綿墊上行走所需時間的改善進步最多。各組患者的進步，可能來自不同的機轉。肌力訓練組的患者功能性的進步可能由於肌力增加和循環的改善。貼紮治療組可能由於本體感覺的進步而得到功能的改善。此外，牽拉運動組則可能由於膝關節周圍緊張的軟組織被放鬆而得到改善。由目前短期的成果，各種治療的初步成果相似。需要長期的追蹤以評估治療成效所能維持的時間。而本結果也顯示髕股關節痛的患者可能同時具有柔軟度不佳、肌力不足、本體感覺缺失的問題。因此三種治療都能夠改善患者的問題。未來研究可著重於合併不同的治療是否能對治療成效產生加成作用。

Introduction: Patellofemoral pain syndrome ( PFPS ) is a common knee disorder. Factors that cause patellofemoral pain include: over use, soft tissue imbalance, and malalignment of lower extremity. Patients with patellofemoral pain, caused by soft tissue imbalance were thought to be favorite to receive physical therapies. Clinically, physical therapies for patients with PFPS are including: strength training, taping, and stretching exercise. The aforementioned treatment tools showed different effect mechanism. However, there were few clinical studies to compare the clinical effects among the aforementioned three treatment tools. The purpose of this study was to investigate the different effects among the strength training, taping, and stretching exercise in patients with patellofemoral pain syndrome by randomized control trial study. Method: 80 young adults with patellofemoral pain syndrome were randomly allocated into one of three treatment groups: (1) strength training, (2) taping, and (3) stretching exercise. Each group received treatment for 8 weeks. Outcome measures were including visual analog scales for worst pain, active-active joint reposition error test, physical function subscale of the Chinese version of the Western Ontario and McMaster Universities Osteoarthritis Index, times of walking on different surfaces recorded, and one repetition maximum at baseline and after the interventions for 8 weeks. Result: After intervention for 8 weeks, patients in all groups showed significant improvement in visual analog scales for worst pain, active-active joint reposition error test, physical function subscale of the Chinese version of the Western Ontario and McMaster Universities Osteoarthritis Index, and times of walking on different surfaces recorded but no difference between groups. The one repetition maximum of patients are showed improvements, too. The improvements in strength training group are more than in taping group or stretching group. However, the three groups showed distinctively different effects on clinical effects in patients with PFPS. Conclusions: This study shows that each physical therapeutic tool used in patients with patellofemoral pain syndrome has its unique effect. Though there were no significant difference between groups, strength training group got most improvements in pain reduction, physical function subscale, one repetition maximum, fast walking on ground level, and obstacle crossing. Taping groups got most improvements in all groups in active-active joint reposition error test and walking on sponge. Patients in strength training group, their functional improvements were probably caused by increasing muscle strength and circulation. As regards, patients in taping group, got functional improvements may resulted in increasing proprioceptive accuracy. Additionally, the stretching exercise group, got improvements may caused by loosening the tightness structures around the knee joints. The short term results are similar between groups, continuous follow up should be taken to test how long the outcomes can maintain. This result also showed patients with patellofemoral pain syndrome may have problems like poor flexibility, insufficient muscle strength, and proprioception deficit at the same time. Therefore, these three methods can improve the performance of patients with patellofemoral pain syndrome. The future study could focus on if there were additional treatment effects of combination of two or more treatment methods.