髕股關節疼痛症候群女性患者與健康成年女性在髖部肌肉力量、下肢運動學以及日常生活功能之相關性探討

Abstract

背景：髕股關節疼痛症候群為一臨床常見之膝關節疾病，過去針對此病症的保守治療幾可有效的降低疼痛並改善日常生活功能表現。然而不幸的是，至今仍無一有效的治療方式能讓他們完全根治，導致患者不定期便會出現反覆性疼痛。至此，學者開始懷疑是否問題癥結並非髕股關節本身。近年有文獻指出，相較於正常人，此類患者的髖外展肌群及髖外轉肌群存有肌力缺失問題，但髖部的肌力缺失是否會影響患者下肢運動學改變進而產生疼痛，目前仍是缺乏正面文獻；另外在髖部肌力與下肢運動學之變化，是否會影響髕股關節疼痛症候群患者日常功能表現仍缺乏研究佐證。因此，本研究欲比較並探討髕股關節疼痛症候群患者與健康成年人其髖部肌肉力量、下肢運動學以及日常生活功能之間其相關性。究目的：比較患有髕股關節疼痛症候群之女性患者及一般健康成年女性之髖部肌力值(髖外展肌、髖外轉肌、髖伸直肌)與下肢運動學(髖關節冠狀切面、髖關節水平切面)之差異；並進一步了解髖部肌力與下肢運動學兩者之相關性；最後探討髖部肌力與下肢運動學之變化是否可以用來預測患者其日常功能表現。究方法：徵召20位髕股關節疼痛症候群女性患者，及20位相符條件之健康成年女性。兩組各接受系列性評估，包括用手持式徒手肌力測試儀去量測髖部肌力、用電磁運動追蹤系統去量測執行功能性上/下階梯時之下肢運動學變化、用前膝疼痛量表及單層樓上/下樓梯測試來量測受試者其功能性生活表現程度。果：髕股關節疼痛症候群患者較控制組有顯著較差的髖外轉肌及髖伸直肌力（P< .05），髖外展肌肌力亦有較低的趨勢（P= .06）。患者在執行功能性上、下階梯測試時會分別出現較控制組顯著的髖關節內收、及內轉（P< .01）。患者也需花費較控制組長的時間來完成單層樓上、下樓梯的活動測試（P< .01）。在相關性方面，髖關節肌肉力量與運動學參數之間並無顯著相關（P> .05）；量表分數與髖關節肌肉力量及下肢運動學參數之間也無統計顯著相關（P> .05）。然而，髖伸直肌肌力與單層樓上、下樓梯測試所花費的時間有顯著相關（r= - .34~ - .39, P< .03）；執行功能性上樓梯測試時髖內收角度與單層樓上樓梯時間有顯著相關(r= .53, P< .001)；而執行功能性下樓梯測試時髖內轉角度與單層樓下樓梯時間有顯著相關(r= .43, P= .005)。至於多重變相迴歸分析結果如下：上樓梯時間 = 5.99 – 0.04*(髖伸直肌肌力) + 0.25*(上樓梯髖內收角度)；而下樓梯時間 = 3.25 – 0.04*(髖伸直肌肌力) + 0.18*(下樓梯髖內轉角度)。論：年輕的髕股關節疼痛症候群女性患者有較低的髖外轉及髖伸直肌力，並且分別在執行功能性上下階測試時會有較大的髖內收及髖內轉情形。髖伸直肌肌力及髖內收、內轉角度與患者執行日常功能性上、下樓梯的活動表現有相關。

Backgroundatellofemoral pain is a common knee disorder. Conservative treatment could decrease pain and improve function efficiently. However, none of them could totally cure patients. The researcher focus then shift toward the hip joint from patellofemoral joint. Evidence showed decreased hip abductor and external rotator strength existed in patients with patellofemoral pain, however, we have no idea if the deficit of hip muscle strength would influence the lower-extremity kinematics and result in pain. Furthermore, there is no study focus on the relationship between hip muscle strength and kinematics, and the functional activity.The purpose of this study was to investigate the association of hip strength, lower extremity kinematics, and the functional activity among female with and without patellofemoral pain.urpose o compare the hip strength (hip abductor, external rotator, and extensor) and lower extremity kinematics (frontal and transverse plane of hip joint) between female with and without patellofemoral pain, and to investigate the relationship between hip strength and lower extremity kinematics to see if these parameters could predict the functional activity. ethodswenty female subjects with patellofemoral pain, and 20 matched healthy controls participated. All subjects underwent muscle strength testing of hip muscles by hand-held dynamometer, and lower extremity kinematics testing during functional ascend and descend stairs by Fastrak. The functional activity was measured by anterior knee pain scale and ascend/descend stairs.esultsemale subjects with patellofemoral pain showed significantly decreased hip external rotator and extensor strength (P< .05), and lower hip abductor strength (P= .06) compared to the matched control group. They also demonstrated more hip adduction and internal rotation during functional ascend and descend stairs (P< .01) compared to the matched control. The functional activity performance was significantly different between patients and controls (P< .01). There was no relationship between hip strength and lower extremity kinematics (P> .05), and between hip strength, lower extremity kinematics, and anterior knee pain scale (P> .05). However, hip extensor strength was significantly associated with functional activity (r= - .34~ - .39, P< .03). The hip adduction angle during up stairs was correlated with ascend stairs performance (r= .53, P< .001), while the hip internal rotation angle during descend stairs was correlated with descend stairs performance (r= .43, P= .005). Multiple regressions showed ascend stairs time= 5.99 – 0.04* hip extensor strength + 0.25* hip adduction angle; descend stairs time= 3.25 – 0.04* hip extensor strength + 0.18* hip internal rotation angle.onclusionoung female subjects with patellofemoral pain demonstrated decreased hip external rotator and extensor strength, and showed greater hip adduction and internal rotation during functional ascend and descend stairs compared to the healthy controls. Hip extensor strength, hip adduction and internal rotation angle were associated with ascend / descend stairs of functional activity.