Petterson Stephanie, Snyder-Mackler Lynn
Department of Physical Therapy, University of Delaware, Newark, DE 19716, USA.
J Orthop Sports Phys Ther. 2006 Sep;36(9):678-85. doi: 10.2519/jospt.2006.2305.
Case report.
Long-term deficits in quadriceps femoris muscle strength and impaired muscle activation are common among individuals with total knee arthroplasty (TKA). Failure to address strength-related impairments results in poor surgical and functional outcomes, which may accelerate the progression of osteoarthritis in other lower extremity joints. The purpose of the current case report was to implement a neuromuscular electrical stimulation (NMES) treatment protocol in conjunction with an intense weight-training program, with the aim of reversing persistent quadriceps muscle impairments after TKA.
The patient was a 62-year-old male cyclist 12 months following simultaneous, bilateral TKA with impairments in left quadriceps strength and volitional muscle activation. His left quadriceps strength was 26% weaker than his right and central activation ratio (CAR) of his left quadriceps was 13% lower than his right quadriceps CAR. NMES to the left quadriceps was implemented for 6 weeks, in addition to an intense volitional weight-training program with emphasis on unilateral lower extremity exercises.
The patient demonstrated a 25% improvement in left quadriceps femoris maximal volitional force output following 16 treatments of combined NMES and volitional strength training over a 6-week period. The patient's volitional muscle activation improved from a CAR of 0.83 before treatment to 0.97 after treatment. At discharge from physical therapy and at his 18-month postoperative follow-up, the patient's left quadriceps strength was only 4% lower than his right quadriceps strength. At the 24-month follow-up, the patient's left quadriceps strength was 6% stronger than his right quadriceps strength.
The patient was able to achieve symmetrical quadriceps strength and complete muscle activation following 6 weeks of NMES and volitional strength training. An intense strengthening program may have the potential to reverse persistent strength-related impairments following TKA.
病例报告。
全膝关节置换术（TKA）患者中，股四头肌肌力长期不足和肌肉激活受损很常见。未能解决与力量相关的损伤会导致手术和功能效果不佳，这可能会加速其他下肢关节骨关节炎的进展。本病例报告的目的是实施一项神经肌肉电刺激（NMES）治疗方案，并结合强化的重量训练计划，以逆转TKA后持续存在的股四头肌损伤。
该患者为一名62岁男性自行车运动员，在双侧同时进行TKA术后12个月，左股四头肌力量和自主肌肉激活存在损伤。他的左股四头肌力量比右侧弱26%，左股四头肌的中枢激活率（CAR）比右股四头肌CAR低13%。除了一项强调单侧下肢锻炼的强化自主重量训练计划外，还对左股四头肌实施了6周的NMES。
在6周内进行16次NMES与自主力量训练相结合的治疗后，患者左股四头肌最大自主力量输出提高了25%。患者的自主肌肉激活从治疗前的CAR 0.83提高到治疗后的0.97。在物理治疗出院时和术后18个月随访时，患者的左股四头肌力量仅比右股四头肌力量低4%。在24个月随访时，患者的左股四头肌力量比右股四头肌力量强6%。
经过6周的NMES和自主力量训练，患者能够实现双侧股四头肌力量对称和完全肌肉激活。强化的强化计划可能有潜力逆转TKA后持续存在的与力量相关的损伤。
