Centre for Health, Exercise & Sports Medicine, School of Physiotherapy, University of Melbourne, Australia.
Osteoarthritis Cartilage. 2010 May;18(5):621-8. doi: 10.1016/j.joca.2010.01.010. Epub 2010 Feb 6.
To determine whether hip abductor and adductor muscle strengthening reduces medial compartment knee load and improves symptoms in people with medial tibiofemoral OA and varus malalignment.
In a randomised controlled trial, 89 participants were randomly allocated to a hip strengthening group or to a control group with no intervention. The strengthening group performed a physiotherapist-supervised home exercise program targeting the hip abductor and adductor muscles for 12 weeks. The primary outcome was the peak external knee adduction moment measured using three-dimensional gait analysis by a blinded assessor. Secondary outcomes included a pain numeric rating scale, Western Ontario and McMaster Universities Osteoarthritis Index, step test, stair climb test, maximum isometric strength of hip and quadriceps muscles and participant-perceived rating of overall change. Intention-to-treat analyses were performed using linear regression modelling adjusting for baseline outcomes and other characteristics.
The trial was completed by 76/89 participants (85%). There was no significant between-group difference in change in the knee adduction moment [mean difference (95% confidence interval (CI)) 0.134 (-0.069 to 0.337) Nm/BW x HT%]. All pain, physical function and muscle strength measures showed significantly greater improvement in the strengthening group (all P<0.05). The relative risk (95% CI) of participant-perceived overall improvement in the strengthening group compared to the control group was 20.02 (6.21-64.47).
Although strengthening the hip muscles improved symptoms and function in this patient group, it did not affect medial knee load as measured by the knee adduction moment. Thus it is unlikely that hip muscle strengthening influences structural disease progression.
ACTR12607000001493.
确定髋关节外展肌和内收肌强化是否能降低内侧间室膝关节负荷并改善内翻型胫骨股骨 OA 和内翻畸形患者的症状。
在一项随机对照试验中，89 名参与者被随机分配到髋关节强化组或无干预的对照组。强化组接受物理治疗师监督的家庭锻炼计划，针对髋关节外展肌和内收肌进行 12 周的强化。主要结局指标是由盲法评估者通过三维步态分析测量的膝关节外展峰值力矩。次要结局指标包括疼痛数字评分量表、西安大略和麦克马斯特大学骨关节炎指数、台阶试验、爬楼梯试验、髋关节和股四头肌最大等长肌力以及参与者对整体变化的感知评分。采用线性回归模型进行意向治疗分析，调整基线结局和其他特征。
89 名参与者中有 76 名（85%）完成了试验。膝关节外展力矩的组间变化无显著差异[平均差异（95%置信区间（CI））0.134（-0.069 至 0.337）Nm/BW x HT%]。所有疼痛、身体功能和肌肉力量测量指标在强化组均有显著改善（均 P<0.05）。与对照组相比，强化组参与者感知整体改善的相对风险（95%CI）为 20.02（6.21-64.47）。
尽管强化髋关节肌肉改善了该患者群体的症状和功能，但它并未如膝关节外展力矩所测量的那样影响内侧膝关节负荷。因此，髋关节肌肉强化不太可能影响结构性疾病进展。
ACTR12607000001493。
