膝关节骨关节炎患者屈伸膝肌群的等速肌力评价

目的：评价单侧膝关节骨关节炎患屈伸肌群的肌肉功能。方法：用Ctbex-6000型等速肌力涮试系统对30例单侧膝关节骨关节炎患的肌肉功能进行测试。结果：患膝股四头肌和眉绳肌的峰力矩、作功量、平均功率和爆发力均较健侧显降低．但两侧腘绳肌股四头肌峰力矩比值(H/Q)未见差异。结论：废用性肌肉萎缩、关节不稳和关节源性肌肉抑制是导致肌肉功能降低的主要原因。     

膝关节骨性关节炎经关节镜手术后的等速肌力评价

目的评价单侧膝关节骨性关节炎患者经关节镜手术前后膝屈伸肌群的肌肉功能。方法用LKSS量表及CYBEX-6000型等速肌力测试系统对24例单侧膝关节骨性关节炎患者膝关节镜手术的疗效及肌肉功能进行测试。结果膝关节镜术后1年关节疼痛及关节活动度有明显改善,患膝股四头肌峰力矩、总作功量和爆发力有明显提高,而月国绳肌与股四头肌峰力矩的比值较术前有所降低。结论膝关节镜手术术后应加强屈膝肌力的训练以改善膝关节的稳定性。     

膝关节内损伤患者的等速肌力测定

用Ｃｙｂｅｘ－６０００型等速肌力测试系统对４２例膝关节内损伤患者股四头月国绳肌肌肉功能进行评价。结果表明：患膝屈伸肌群的峰力矩、总作功量和力矩加速能量均较健侧显著降低，患侧月国绳肌股四头肌峰力矩比值（Ｈ／Ｑ）在６００／ｓ较健侧增高。废用性肌肉萎缩和关节源性肌肉抑制是导致肌肉功能降低的主要原因。在膝关节内损伤后的康复治疗中，应加强屈伸膝肌群的肌力训练，并注意屈伸膝肌力的平衡，以增强关节稳定性     

膝关节骨性关节炎经关节镜手术后的等速肌力评价

目的：评价单侧膝关节骨性关节炎患经关节镜手术前后膝屈伸肌群的肌肉功能。方法：用LKSS量表及CYBEX－6000型等速肌力测试系统对24例单侧漆关节骨性关节炎患膝关节镜手术的疗效及肌肉功能进行测试。结果：膝关节镜术后1年关节疼痛及关节活动度有明显改善，患膝股四头肌峰力矩、总作功量和爆发力有明显提高，而Guo绳肌与股四头肌峰力矩的比值较术前有所降低。结论：膝关节镜手术术后应加强屈膝肌力的训练以改善膝关节的稳定性。     

膝关节内损伤患者的等速肌力测定

用Cybex-6000型等速肌力测试系统对42例膝关节内损伤患股四头厢绳肌肌肉功能进行评价。结果表明：患膝屈肿肌群的峰力矩、总作功量和力矩加速能量均较健侧显降低．患侧胭绳肌股四头肌峰力矩比值(H/Q)在60°/s较健侧增高.废用性肌肉萎缩和关节源性肌肉抑制是导致肌内功能降低的主要原因。在膝关节内损伤后的康复治疗中．应加强屈伸膝肌群的肌力训练．并注意屈伸膝肌力的平衡．以增强关节稳定性。     

膝关节骨性关节炎等速离心收缩肌力的研究

目的评价单侧膝关节骨性关节炎(OA)患者患侧和健侧膝关节股四头肌和腘绳肌的向心收缩和离心收缩肌力的变化,重点研究膝OA股四头肌和腘绳肌离心收缩功能的变化。方法应用BiodexSystem-3型等速测试系统对42例单侧膝关节骨性关节炎患者进行患侧和健侧的股四头肌及腘绳肌的向心和离心收缩功能测试。结果患侧和健侧股四头肌及健侧腘绳肌向心收缩时,当速度增加,峰力矩值显著减小;离心收缩时,随着角速度增加峰力矩未见下降;相同速度下,患侧和健侧股四头肌和腘绳肌离心收缩肌力明显大于向心收缩;膝OA患者存在股四头肌向心收缩和离心收缩肌力的下降(P<0.05),肌力缺失百分比>10%,以及腘绳肌低速向心肌力下降(P<0.05),肌力缺失百分比为14.33%。膝OA股四头肌的离心/向心肌力比值(E/C比值)低于腘绳肌,随运动速度增加,股四头肌的E/C比值明显增大。患侧股四头肌60°/s角速度下的E/C比值较健侧有显著增高(P<0.05)。结论膝OA患者股四头肌存在向心和离心收缩功能异常,提示膝OA患者的肌肉功能测试应增加离心测试,并注意加强膝OA患者股四头肌的离心收缩训练。     

髌韧带替代前交叉韧带重建术后股四头肌及guo绳肌等速测试结果

目的评价前交叉韧带(ACL)损伤经骨-髌韧带-骨(BPB)重建术后患侧及健侧膝关节股四头肌及腘绳肌的向心性收缩及离心性收缩功能的变化,重点观测作为协同保护前交叉韧带的腘绳肌拮抗性离心性收缩在不同运动速度及不同的关节位置下的功能变化.方法用Cybex-770型等速测试系统对30例陈旧性前交叉韧带损伤经关节镜行BPB替代ACL重建术后的患者进行患肢及健肢的股四头肌及腘绳肌的向心性和离心性收缩的肌肉功能进行测试.结果 显示在30°/s、60°/s、90°/s、120°/s的4组测试运动速度下患膝的股四头肌及在30°/s、60°/s、90°/s三组测试运动速度下患膝腘绳肌的向心性及离心性收缩的峰力矩都较健侧有明显下降,具显著性差异(P<0.05),而在120°/s运动速度下两下肢腘绳肌的向心性及离心性收缩峰力矩已无显著性差异.患肢腘绳肌离心性收缩与股四头肌向心性收缩的峰力矩之比(H/Q的E/C)及两者的向心性收缩峰力矩之比(H/Q的C/C)在4组运动速度下均大于健侧,具极显著性差异(P<0.01).随着运动速度的加大及膝关节的伸直两个比值逐步加大,H/Q的E/C比值在膝关节近伸直位时达到最高峰.结论前交叉韧带损伤BPB替代ACL重建术后患肢的股四头肌及腘绳肌都发生了废用性萎缩,但后者比前者恢复要快,术后2年在较快速运动下两侧腘绳肌的收缩功能已无明显差异,患侧肢体适应性地加强了作为保护前交叉韧带的动力装置腘绳肌的收缩功能,尤其是离心性收缩,随着运动速度的加快及膝关节的逐渐伸直至ACL最易损伤处这种保护反应达到最高峰.     

膝关节骨关节炎患者膝屈伸肌的表面肌电信号研究

目的 评价单侧膝关节骨关节炎（OA）患者在不同运动状态下的健、患侧膝屈伸肌的肌肉功能和协调活动差异，为临床制定康复方案提供依据。方法 用Noraxon Myosystem1200型表面肌电图仪对26例单侧膝关节骨关节炎患者的等长肌肉收缩功能和下蹲运动进行表面肌电信号的测试。结果 患侧股外侧肌和股二头肌在最大等长收缩和下蹲运动时的肌电振幅均值小于健侧（P〈0．05）。在最大等长收缩过程中，患侧的拮抗肌协同收缩率较健侧增高（P〈0．05）；在下蹲运动过程中，患侧的胭绳肌共同活动比率高于检测（P〈0．05）。结论 表面肌电图测试可用于量化评价膝OA患者在不同运动过程中肌肉功能。膝OA患肢在不同运动状态下均可能存在肌肉功能降低和肌力平衡异常。康复治疗不仅应重视股四头肌肌力增强而且应重视改善膝关节的肌力平衡。     

早期膝关节骨关节炎的关节源性肌肉软弱

目的：了解早期膝关节骨关节炎的关节源性肌肉软弱的特性。方法：１４例发病１个月内的单侧膝关节骨关节炎患者的等速肌力参数的自身对照研究。结果：患侧屈伸膝等速肌力参数处于低位,其中大部分明显弱于健侧。结论：早期膝关节骨关节炎即表现出屈伸膝肌群的肌肉软弱,由于萎缩因素少,这种肌肉软弱应该主要是关节源性肌肉抑制的后果。     

视觉反馈下肌肉能量技术对膝骨关节炎和髌骨骨折患者功能的影响

目的:探讨视觉反馈下肌肉能量技术对膝骨关节炎和髌骨骨折患者功能的影响。方法:将19例骨性关节炎患者随机分为反馈组和对照组,将10例髌骨骨折保守治疗患者随机分为反馈组和对照组,各组患者每天治疗1次,每周5次,持续4周,于治疗前、治疗2周及4周时对各组患者进行疗效评定,采用视觉模拟评分法(VAS)对患者膝关节疼痛进行评定,使用量角器测量法评定患者膝关节主动活动度(AROM)和被动活动度(PROM),使用等速肌力测试与训练系统对患者股四头肌肌力进行评定。结果:(1)治疗2周后,反馈组和治疗组VAS评分均降低,PROM和AROM均增加,股四头肌峰力矩均增加,但两组无显著性差异;(2)治疗4周后,反馈组和治疗组VAS评分均降低,PROM和AROM均增加,但两组无显著性差异;两组股四头肌峰力矩均增加,其中反馈组股四头肌峰力矩较对照组增加明显,两组具有显著性差异(P0.05)。结论:视觉反馈下肌肉能量技术可以减轻患者膝关节疼痛,增加膝关节关节活动度,且相较传统肌肉能量技术增强股四头肌肌力更为显著。     

等速向心肌力训练对膝关节骨性关节炎患者关节功能水平的影响

目的:研究腿部肌群等速向心肌力训练对提高膝关节骨性关节炎患者关节功能水平的作用。方法:将膝关节骨性关节炎患者100例(168膝)随机分为两组,对照组50例(85膝),进行推髌骨、股四头肌训练及楔形垫行走训练等常规康复治疗;等速组50例(83膝),在常规康复治疗的基础上进行患腿肌群等速运动训练。所有患者均在治疗前和治疗后8周时接受等速肌力测试及采用Lysholm膝关节功能评分作为康复疗效判定标准。结果:经过8周的系统康复治疗,等速组与对照组患者的屈、伸肌峰力矩(PT)、总功量(TW)、平均功率(AP)和伸屈肌单次最大作功量(MRTW)均较前有改善,等速组改善较对照组更明显(P<0.01)。两组的患者的Lysholm评分均较前有改善,等速组Lysholm评分较对照组进步明显(P<0.01)。结论:等速向心肌力训练明显提高膝关节骨性关节炎膝部肌群力量,改善关节功能。     

Relationship between gait speed and strength parameters in multiple sclerosis]

INTRODUCTION: Recent studies have focused on correlation between strength and gait parameters in hemiplegia, suggesting the interest for strength training in patients with central nervous system lesions. The aim of this study was to evaluate this correlation in multiple sclerosis (MS) patients with special regard to the different clinical forms including proprioceptive loss or cerebellar ataxia. PATIENTS AND METHOD: Gait speed and muscular function were performed in 27 patients with moderate affected gait (EDDS < 6). Gait speed was evaluated with Locometre and peak-torques of quadriceps and hamstrings were evaluated with isokinetic dynamometer. Patients were separated in three groups related to their deficiency: spastic group (8 patients), spastic with proprioceptive loss (12 patients) and spastic with cerebellar ataxia (7 patients). Gait parameters were evaluated in 10 healthy subjects as control group. RESULTS: Gait speeds (spontaneous and maximal) and peak torques of quadriceps and hamstring were similar in the three groups. In the whole patients group, gait speed was reduced and related to hamstring peak torque (r = 0.56 at spontaneous speed and 0.51 at high speed) but not with quadriceps peak torque. Patients with proprioceptive loss exhibited not only a higher correlation between gait speed and hamstring torque (r = 0.76 and 0.65 respectively) than other patients but also with quadriceps torque (r = 0.66 and 0.59 respectively) when patients in other groups did not. CONCLUSION: As it was previously pointed out in hemiplegic patients, MS patients exhibit some correlation between gait speed and muscle strength, mainly with hamstrings. These correlations can change in special sensory conditions suggesting that patients with sensory loss use different muscular strategies to maintain gait speed. Strength training may therefore be discussed in MS including specific modalities as a function of clinical parameters.     

Foot-pounds of torque of the normal knee and the rehabilitated postmeniscectomy knee.

Foot-pounds of torque of the knee flexors and knee extensors of eight rehabilitated patients who had had meniscectomies were obtained isometrically and at 60 and 210 degrees per second by use of an isokinetic apparatus. Our purpose was to test the null hypothesis that no significant difference in torque would be manifested between the rehabilitated postmeniscectomy knee and the normal knee. Mean torque developed by the rehabilitated postoperative knee was 10 to 12 percent less than the mean torque developed by the normal knee. We found a significant difference between means of torque of the normal knee and the rehabilitated knee for isometric flexion, rapid dynamic flexion, and rapid dynamic extension. Means of torque of knee extension for the three types of contraction for both knees of the subjects demonstrated similar patterns in which torque developed isometrically was greater than torque developed by slow dynamic tension, which in turn was greater than torque developed by rapid dynamic contraction. Means of torque of knee flexion for the three types of contraction for both knees of the subjects created patterns in which torque developed isometrically was essentially equal to torque developed by slow dynamic tension, and both these measurements exceeded torque developed by rapid dynamic contractions. Overall, the results suggest that physical therapists need to use rehabilitative techniques that promote muscular power and muscular endurance in addition to muscular strength and that more attention needs to be directed to the rehabilitation of knee flexors.     

Knee flexor/extensor strength ratio in follow-up of acute knee distortion injuries

This study evaluated the peak torque and total work hamstring/quadriceps (HQ) ratios of 77 knees with a previous grade I distortion injury to find the possible relationship between different HQ ratios and long-term outcome. For measurement of quadriceps and hamstrings strengths, the CYBEX II isokinetic dynamometer was used. Peak torque values were recorded at low (60 degrees/sec) and high (180 degrees/sec) speeds of isokinetic movement, and the maximal isometric extension and flexion outputs were measured with the knee at a 60 degree angle. Three standardized knee scoring scales were used to determine the subjective, functional, clinical, and radiologic outcome of the injured knees. In every test, great intersubject variation of the HQ ratio was observed, even in healthy knees (range 19% to 148%). Follow-up scores of the groups with low (less than 50%), optimal (50% to 80%), or high (greater than 80%) HQ ratios of the injured knees did not differ significantly from each other. However, in every test the scores were significantly (p less than 0.001 to less than 0.0001) better in patients whose injured knee HQ ratio was nearly identical (less than or equal to 15%) rather than clearly different from (greater than 15%) the uninjured knee. These findings confirm our previous observation that the HQ ratio is an idiosyncratic parameter. Any general recommendation about optimal value is difficult to give. In evaluating long-term outcome, the most ideal HQ ratio of an injured knee seems to be the HQ ratio of the opposite, healthy extremity.     

Relationship between knee alignment and the electromyographic activity of quadriceps muscles in patients with knee osteoarthritis

[Purpose] We evaluated the relationship between knee alignment and the electromyographic (EMG) activity of the vastus medialis (VM) to the vastus lateralis (VL) muscles in patients with knee osteoarthritis (OA) in a cross-sectional study. [Subjects and Methods] Forty subjects with knee OA were assessed by anatomic radiographic knee alignment and the VM/VL ratio was calculated. Surface EMG from both the VM and VL muscles were evaluated during maximal isometric contraction at 60° knee flexion. Simultaneously, peak quadriceps torque was assessed using an isokinetic dynamometer. Subjects were categorized into low, moderate, and high varus groups according to knee malalignment. The peak quadriceps torque and VM/VL ratio across groups, and their relationships with varus malalignment were analyzed. [Results] All subjects had medial compartment OA and the VM/VL ratio of all subjects was 1.31 ± 0.28 (mean ± SD). There were no significant differences in the peak quadriceps torque or VM/VL ratios across the groups nor were there any significant relationships with varus malalignment. [Conclusion] The VM/VL ratio and peak quadriceps torque were not associated with the severity of knee varus malalignment.Key words: Malalignment, Knee, Quadriceps     

TIMELINE OF GAINS IN QUADRICEPS STRENGTH SYMMETRY AND PATIENT-REPORTED FUNCTION EARLY AFTER ACL RECONSTRUCTION

Background:Quadriceps weakness is a predictor of long-term knee function and strength recovery can vary from months to years after anterior cruciate ligament reconstruction (ACLR). However, few studies evaluate quadriceps strength and self-reported function within the first several weeks after ACLR.Hypothesis/Purpose:To examine changes over time in quadriceps strength symmetry, quadriceps peak torque, and self-reported knee function prior to and at six, 12, and 24 weeks post-ACLR. The hypotheses were 1) quadriceps strength symmetry, bilateral quadriceps peak torque, and patient-reported function would improve over time from pre-ACLR to 24 weeks post-ACLR and 2) significant improvements in patient-reported function, but not strength symmetry, would occur between time points.Study Design:Prospective, cohort studyMethods:Thirty participants completed four testing sessions: pre-surgery and six, 12, and 24 weeks post-ACLR. Isometric quadriceps strength testing was performed at six weeks and isokinetic quadriceps strength was measured at all other testing points. Quadriceps index was calculated to evaluate between limb quadriceps strength symmetry. The Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC) were administered at each time point. A repeated-measures analysis of variance evaluated changes over time, with post-hoc comparisons to determine at which time-point significant changes occurred.Results:Quadriceps strength symmetry, involved limb quadriceps peak torque and all patient-reported outcome scores increased over time (p<0.02). Post-hoc tests showed that neither self-reported outcomes, nor quadriceps index improved between pre-surgery and six-weeks post-ACLR. From six to 12 weeks post-ACLR, scores on IKDC and KOOS Pain, Symptoms, Quality of Life, and Sport subscales improved (p≤0.003). From 12 to 24 weeks post-ACLR, quadriceps strength symmetry, involved limb quadriceps peak torque, KOOS-Symptoms, Quality of Life, and Sport subscales and the IKDC improved (p≤0.01). Uninvolved limb quadriceps peak torque did not change across any time point (p≥0.18).Conclusion:Patient-reported knee function increased between six and 24 weeks post-ACLR, while increases in involved limb quadriceps strength and quadriceps strength symmetry were not noted until 12-24 weeks post-ACLR.Level of Evidence:2b, individual cohort study     

Ratio of hamstring to quadriceps femoris muscles' strength in the anterior cruciate ligament insufficient knee. Relationship to long-term recovery

The purposes of this study were 1) to investigate the peak torque and total-work ratios of hamstring to quadriceps femoris muscles' (HQ) in 41 subjects (27 male, 14 female; means age = 35 years) with an anterior cruciate ligament insufficient knee (ACLIK) and 2) to determine the relationship between HQ ratios and long-term subject outcome. Quadriceps femoris and hamstring musculature strengths of both legs were measured at follow-up with an isokinetic dynamometer, and peak torque values were recorded at lower (60 degrees/sec) and higher (180 degrees/sec) speeds. Maximal isometric extension and flexion outputs were measured at a 60-degree knee-flexion angle. Three standardized knee-scoring scales were used to determine the overall outcome of the ACLIK. High intersubject variability of the HQ ratios (range = 23%-205%) was observed in all strength tests, including tests of healthy knees. The injured knee of all subjects had a higher HQ ratio (46%-95%) in every test than the healthy knee (42%-85%). The HQ ratio difference between knees was significant at the isokinetic higher speed (p less than .05) and for the total-work (p less than .05) tests because of the weak quadriceps femoris muscle of the injured knee. Outcome scores did not differ significantly between the groups with low, optimal, or high HQ ratios of the ACLIK but were significantly better in subjects whose HQ ratio of the injured knee was similar to that of their uninjured knee.(ABSTRACT TRUNCATED AT 250 WORDS)     

膝骨关节炎患者膝屈伸肌群等速肌力及其与功能的相关性

目的观察膝关节骨关节炎(KOA)患者膝屈伸肌群等速肌力变化及其与膝关节功能的关系。方法23 例双侧KOA患者及14 名正常人进行膝屈伸肌等速肌力检查、五次坐-起试验(FTSST)、静态平衡测试、步态分析。KOA组还完成疼痛视觉模拟评分(VAS)及WOMAC骨关节炎指数评定。结果KOA组伸肌及屈肌峰力矩、峰力矩均值、平均功率、单次最佳做功及总功主患侧均小于对侧(P<0.05);峰力矩屈肌/伸肌(H/Q)百分比主患侧大于对侧(P<0.05)。组间比较,伸肌所有观察指标、屈肌平均功率KOA组均小于正常对照组(P<0.05);峰力矩H/Q 百分比KOA组大于正常对照组(P<0.05)。KOA组伸肌等速肌力峰力矩与FTSST、步行速度、步行距离、跌倒指数、VAS 评分、WOMAC-疼痛评分之间存在相关性(P<0.05),屈肌等速肌力峰力矩与FTSST、步态参数、跌倒指数、VAS评分、WOMAC评分之间无明显相关性(P>0.05)。结论KOA患者伸肌及屈肌等速肌力主患侧较对侧减弱,伸肌等速肌力较正常人减弱,膝伸屈肌肌力变化不同步。KOA患者伸肌等速肌力峰力矩与膝关节疼痛、功能之间存在相关性。     

Effect of quadriceps femoris muscle stretch on knee extension torque

Peak and angle specific knee extension torques produced after a quadriceps femoris muscle stretch and after a 15-second rest were compared to determine the effect of stretch on knee extension torque. Twenty healthy subjects performed eight maximum voluntary knee extensions at 90 degrees/sec under each condition. Although peak torque and torques at 15, 30, 45, and 60 degrees from full extension were measured, knee extension torque was only significantly greater (p less than .02) at 60 degrees of knee flexion after quadriceps femoris muscle stretch. The absolute difference, which was only a mean 4.9 N X m (3.6 ft-lb), was not substantial. When quadriceps femoris muscle stretch is a consequence of passive knee flexion at 90 degrees/sec, knee extension torque is apparently facilitated only during the initial part of the knee extension movement. Therefore, in healthy patients, a muscle stretch, such as used in this study, is probably of little therapeutic value.     

Knee flexor and extensor strength ratios with deficiency of the lateral collateral ligament

This investigation studied the peak torque and total work hamstring/quadriceps (HQ) ratios of 24 lateral collateral ligament (LCL) insufficient knees, and clarified the possible associations between different HQ ratios and the long-term outcomes of patients. Peak torque values were recorded at low (60 degrees/sec) and high (180 degrees/sec) speed of isokinetic movement, and the maximal isometric extension and flexion outputs were measured at the knee angle of 60 degrees from straight. Three standardized knee scoring scales were used to determine the subjective, functional, clinical, and radiologic outcomes of these LCL insufficient knees. In every test a great interpersonal variation of the HQ ratios was noticed, even in the healthy knees (range 24% to 154%). On the injured side the HQ ratios were in every test higher than on the healthy side, because of the weaker quadriceps muscle of the injured leg. In most cases, followup scores did not differ significantly between the groups with low (less than 50%), optimal (50% to 80%), or high (greater than 80%) HQ ratios of the LCL insufficient knees. However, in every test the scores were significantly (p less than 0.005 to 0.0001) better in the patients who had the HQ ratio of the injured knee near the uninjured side (less than 15%) compared with those with a clear difference (greater than 15%). These findings suggest that the HQ ratio is a very individual parameter, and therefore any general recommendation about the optimal value is very difficult to give. With regard to long-term outcome, the most ideal HQ ratio of an LCL insufficient knee seems to be the HQ ratio of the opposite, healthy extremity.