Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Mail Stop C244, 13121 E 17th Ave, Room 3116, Aurora, CO 80045, USA.
Phys Ther. 2012 Feb;92(2):210-26. doi: 10.2522/ptj.20110124. Epub 2011 Nov 17.
The recovery of quadriceps muscle force and function after total knee arthroplasty (TKA) is suboptimal, which predisposes patients to disability with increasing age.
The purpose of this investigation was to evaluate the efficacy of quadriceps muscle neuromuscular electrical stimulation (NMES), initiated 48 hours after TKA, as an adjunct to standard rehabilitation.
This was a prospective, longitudinal randomized controlled trial.
Sixty-six patients, aged 50 to 85 years and planning a primary unilateral TKA, were randomly assigned to receive either standard rehabilitation (control) or standard rehabilitation plus NMES applied to the quadriceps muscle (initiated 48 hours after surgery). The NMES was applied twice per day at the maximum tolerable intensity for 15 contractions. Data for muscle strength, functional performance, and self-report measures were obtained before surgery and 3.5, 6.5, 13, 26, and 52 weeks after TKA.
At 3.5 weeks after TKA, significant improvements with NMES were found for quadriceps and hamstring muscle strength, functional performance, and knee extension active range of motion. At 52 weeks, the differences between groups were attenuated, but improvements with NMES were still significant for quadriceps and hamstring muscle strength, functional performance, and some self-report measures.
Treatment volume was not matched for both study arms; NMES was added to the standard of care treatment. Furthermore, testers were not blinded during testing, but used standardized scripts to avoid bias. Finally, some patients reached the maximum stimulator output during at least one treatment session and may have tolerated more stimulation.
The early addition of NMES effectively attenuated loss of quadriceps muscle strength and improved functional performance following TKA. The effects were most pronounced and clinically meaningful within the first month after surgery, but persisted through 1 year after surgery.
全膝关节置换术后（TKA）股四头肌力量和功能的恢复并不理想，这使得患者随着年龄的增长更容易出现残疾。
本研究旨在评估 TKA 后 48 小时开始的股四头肌神经肌肉电刺激（NMES）作为标准康复辅助治疗的疗效。
这是一项前瞻性、纵向随机对照试验。
66 名年龄在 50 至 85 岁之间、计划行单侧初次 TKA 的患者被随机分配接受标准康复（对照组）或标准康复加 NMES（术后 48 小时开始应用于股四头肌）。NMES 以最大耐受强度每天应用两次，每次进行 15 次收缩。在手术前以及 TKA 后 3.5、6.5、13、26 和 52 周时，测量肌肉力量、功能表现和自我报告测量结果的数据。
TKA 后 3.5 周时，NMES 治疗组股四头肌和腘绳肌力量、功能表现和膝关节伸展主动活动度均有显著改善。52 周时，组间差异减弱，但 NMES 治疗组股四头肌和腘绳肌力量、功能表现和一些自我报告测量结果仍有显著改善。
两组的治疗量不匹配；NMES 是在标准治疗的基础上增加的。此外，测试人员在测试过程中没有设盲，但使用了标准化脚本以避免偏见。最后，一些患者在至少一次治疗过程中达到了最大刺激器输出，可能耐受了更多的刺激。
早期添加 NMES 可有效减轻 TKA 后股四头肌力量的丧失，并改善功能表现。这些效果在手术后第一个月最为明显和具有临床意义，但在手术后 1 年内仍持续存在。
