微創全人工膝關節置換術後之結果及效益：動力學及功能性恢復之探討

Abstract

目的: 瞭解接受微創全人工膝關節置換手術後，受試者下肢動力學參數及功能性回復之自然過程，並探討不同肌力檢測時，膝伸肌與膝屈肌之最大力矩值的變化。方法: 本實驗採前瞻性（prospective）方式，共收集22名受試者(平均年齡68.6±6.6歲；平均身高：154.5±7.9公分；平均體重66.6±8.5公斤)，均接受單側微創全人工膝關節置換術，並於術前、術後第一、二、六及十二個月，總共做五次的評估。使用Biodex測試儀評估病患健側和患側的膝伸、屈肌之等長、等速肌力、關節活動度、關節敏感度及瞬發率。結果: 術前患側及健側只在等速肌力及關節活動度有顯著差異。在術後第一及第二個月患側之膝伸肌在等長60度、等速60及180角速度之最大力矩值均顯著小於健側。術後二個月患側之肌力均和術前無顯著差異。術後六個月患側及健側在等速180角速度的膝伸肌最大力矩值有顯著差異。至於患側0-150毫秒之膝伸肌瞬發率則在術後每一時間點均顯著小於健側。結論：患側之下肢肌力於術後一個月相較於術前會有一明顯下降之現象；術後二個月患側下肢肌力約可恢復至術前水準；至術後六個月時，患側尚有快縮肌之肌力比健側低，術後一年間患側下肢之瞬發率均持續低於健側。此一結果可提供運動科學人員日後設計專門之運動訓練器材或研擬相關之運動處方之參考。

Purpose: To investigate the kinetic parameters of lower limb and nature course of functional recovery of the patient who underwent the minimal invasive total knee replacement surgery and determine the change of maximal torque in knee flexors and knee extensors at different muscle strength testing condition. Methods: In this prospective study, twenty-two participants underwent the unilateral minimal invasive total knee replacement surgery, and the knee extensors, knee flexors muscle strength were evaluated at five different times: before surgery, post surgery 1th, 2th, 6th and 12th month. Isometric, isokinetic muscle strength, range of motion(ROM), joint sense and rate of force development(RFD) were analyzed. Results: There is significant difference in isokinetic muscle strength of knee extensor and ROM between both sides before surgery. On post surgery 1st and 2nd month, the maximal torquethe of knee extensor in the operative side were significant smaller than the non-operative side at isometric testing in 60°, and isokinetic test at 60°, and 180° angular velocity. There is no significant difference between post surgery 2nd month and pre surgery in operative side.Only isokinetic 180° the maximal torque of knee extensors in non-operation side was greater than the operation side. 0-150ms RFD of operative leg is significant smaller than non-operative leg duing post surgery 1th, 2th, 6th and 12th month.Conclusion: This study concluded that there was a significant decreased maximal torque of operative leg at one month after surgery compare with the value before surgery; The muscle strength of operative leg can recover to the level before surgery at post surgery 2nd month;There is still lower muscle strength of fast msucle in operative leg than non-operative leg at post surgery 6th month.The values of RFD in operative leg is always lower than non-operative leg during post surgery 1 year.This conclusion could be the reference for the exercise scientists or other exercise experts to design the exercise equipment and exercise prescription.