股四头肌肌电刺激强度与全膝关节置换术后肌力恢复的关系。
Relationship between intensity of quadriceps muscle neuromuscular electrical stimulation and strength recovery after total knee arthroplasty.
机构信息
Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Mail Stop C244 13121 East 17th Ave, Room 3116, Aurora, CO 80045, USA.
出版信息
Phys Ther. 2012 Sep;92(9):1187-96. doi: 10.2522/ptj.20110479. Epub 2012 May 31.
BACKGROUND
Neuromuscular electrical stimulation (NMES) can facilitate the recovery of quadriceps muscle strength after total knee arthroplasty (TKA), yet the optimal intensity (dosage) of NMES and its effect on strength after TKA have yet to be determined.
OBJECTIVE
The primary objective of this study was to determine whether the intensity of NMES application was related to the recovery of quadriceps muscle strength early after TKA. A secondary objective was to quantify quadriceps muscle fatigue and activation immediately after NMES to guide decisions about the timing of NMES during rehabilitation sessions.
DESIGN
This study was an observational experimental investigation.
METHODS
Data were collected from 30 people who were 50 to 85 years of age and who received NMES after TKA. These people participated in a randomized controlled trial in which they received either standard rehabilitation or standard rehabilitation plus NMES to the quadriceps muscle to mitigate strength loss. For the NMES intervention group, NMES was applied 2 times per day at the maximal tolerable intensity for 15 contractions beginning 48 hours after surgery over the first 6 weeks after TKA. Neuromuscular electrical stimulation training intensity and quadriceps muscle strength and activation were assessed before surgery and 3.5 and 6.5 weeks after TKA.
RESULTS
At 3.5 weeks, there was a significant association between NMES training intensity and a change in quadriceps muscle strength (R(2)=.68) and activation (R(2)=.22). At 6.5 weeks, NMES training intensity was related to a change in strength (R(2)=.25) but not to a change in activation (R(2)=.00). Furthermore, quadriceps muscle fatigue occurred during NMES sessions at 3.5 and 6.5 weeks, whereas quadriceps muscle activation did not change.
LIMITATIONS
Some participants reached the maximal stimulator output during at least 1 treatment session and might have tolerated more stimulation.
CONCLUSIONS
Higher NMES training intensities were associated with greater quadriceps muscle strength and activation after TKA.
背景
神经肌肉电刺激（NMES）可以促进全膝关节置换术（TKA）后股四头肌力量的恢复，但 NMES 的最佳强度（剂量）及其对 TKA 后力量的影响尚未确定。
目的
本研究的主要目的是确定 NMES 应用的强度是否与 TKA 后早期股四头肌力量的恢复有关。次要目的是量化 NMES 后即刻股四头肌疲劳和激活，以指导 NMES 在康复治疗期间的时间安排。
设计
本研究为观察性实验研究。
方法
从 50 至 85 岁接受 TKA 后 NMES 的 30 人收集数据。这些人参加了一项随机对照试验，他们接受了标准康复或标准康复加 NMES 治疗股四头肌，以减轻力量损失。对于 NMES 干预组，在 TKA 后 48 小时内，每天以最大耐受强度进行 2 次 15 次收缩的 NMES，持续 6 周。在手术前以及 TKA 后 3.5 和 6.5 周评估 NMES 训练强度和股四头肌力量和激活。
结果
在 3.5 周时，NMES 训练强度与股四头肌力量变化（R(2)=.68）和激活变化（R(2)=.22）之间存在显著关联。在 6.5 周时，NMES 训练强度与强度变化有关（R(2)=.25），但与激活变化无关（R(2)=.00）。此外，在 3.5 和 6.5 周时，NMES 治疗期间发生股四头肌疲劳，而股四头肌激活没有变化。
局限性
一些参与者在至少 1 次治疗期间达到了最大刺激器输出，可能耐受更多的刺激。
结论
更高的 NMES 训练强度与 TKA 后股四头肌力量和激活增加有关。
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