開放式與閉鎖式動力鏈運動對於全膝人工關節置換術患者之成效

本研究目的旨在探討提供下肢閉鎖式動力鏈運動(CKCE)之復健方案，對全膝人工關節置換術病患的肌力與膝關節功能之成效，屬臨床試驗，採類實驗型、縱貫性之研究設計。以北部某一醫學中心，立意取樣方式，經病患同意後，收集50名病患為研究對象，隨機分派為實驗組25名及對照組25名。實驗組行下肢閉鎖式動力鏈復健運動指導，對照組依常規行下肢開放式動力鏈運動(OKCE)。研究工具包括等速肌力測試儀(Isokinetic dynamometer)、病患基本資料表、「Knee Injury and Osteoarthritis Outcome Score」(KOOS)量表，測量點為術前、術後六週及術後三個月。所得資料以SPSS11.0版套裝軟體進行編碼及分析，主要之統計方法包含：描述性統計、卡方檢定、T檢定及General Linear Mix-effect Model。研究結果以等速肌力測驗時，兩組病患在60度∕秒、180度∕秒膝屈肌力及180度∕秒膝伸肌力之差異，皆達到統計上顯著意義(p<0.05)，顯示CKCE之介入措施成效優於OKCE；膝屈肌力/膝伸肌力之比值，兩組皆維持在0.49-0.87的範圍，未達統計上之顯著差異(p>0.05)。以KOOS量表測得之膝關節功能，不同介入措施在日常生活活動、運動和休閒功能及膝部相關的生活品質皆能達統計上之顯著差異(p<0.05)，而疼痛及症狀面向未達統計上之顯著差異(p>0.05)。因此，本研究顯示CKCE之介入措施成效優於OKCE，值得臨床加以推廣。
The purpose of this study was to evaluate the efficacy of lower limb closed kinetic chain exercise (CKCE) and open kinetic chain exercise (OKCE) in the muscle strength and knee function after total knee arthroplasty (TKA). This was a quasi-experimental, longitudinal clinical study done at a medical center in the northern part of Taiwan. Fifty patients with their consents were randomly and equally divided into either study group or control group. The study group was instructed for CKCE, while the control group was routinely given OKCE. The study instruments included the isokinetic dynamometer and Knee Injury and Osteoarthritis Outcome Score (KOOS). The assessment time points were set at pre-operation, 6 weeks and three months after operation. Data was processed by SPSS 11.0 and the major statistical procedures applied were: descriptive statistics, chi-square test, Student t test and general linear mix-effect model (GLMM). All tests were considered statistically significant at the p<0.05 level. The isokinetic test results presented significant differences (p<0.05) between the two groups in the muscle strength of knee flexor muscles at the test speed of 600 per second, 1800 per second, and also in knee extensor muscles at the speed of 1800 per second. It indicated the superior outcome with the intervention of CKCE. The ratio of the two muscles was at the range of 0.49~0.87 for both groups, thus there was no statistically significance (p>0.05). By using the KOOS to assess knee function, we found different interventions did reveal statistical differences in the daily activities, sports and recreational functions, and life quality (p<0.05); however, there was no significant difference found in pain and symptoms (p>0.05). The study results suggest that CKCE can help patient have better knee function after TKA than OKCE.