髕股關節疼痛症候群之物理治療：近端髖關節與遠端膝關節之關係探討

Abstract

背景：髕股關節疼痛患者在執行承重運動時常出現大腿內塌的情形。股骨貼紮是一新設計，用以矯正前述的動作異常。本研究目的在探討髕股關節疼痛患者與健康控制組間髖、膝關節運動學及肌肉活性，以及動態姿勢控制能力的差異；並且探討股骨貼紮的立即性效果。測試動作包括單腳半蹲與功能性單腳前伸平衡測試。 方法：16位女性髕股關節疼痛患者及8位健康女性控制組參與本實驗。測量站立腳執行單腳半蹲與平衡測試時的髖關節與髕骨三度空間運動學，及髖部臀大肌、臀中肌和大腿部股直肌的肌肉活動。記錄疼痛指數與平衡測試時的最大單腳前伸距離。計算平衡測試時髖關節與髕骨運動學的變異係數，以分析骨盆、股骨、和髕骨的穩定度。 結果：髕股關節疼痛患者在執行單腳半蹲與平衡測試時較控制組有較大的髖內收與較少的髖屈曲。且髕股關節疼痛患者在0-15度單腳半蹲時有較高程度的臀中肌活化與較少的股直肌活動。股骨貼紮可以降低疼痛、減少患者在15-30度單腳半蹲時的股直肌活動，同時將髕骨往較後、下方位移。在平衡測試中，股骨貼紮可以降低髕股關節疼痛患者的疼痛、增加單腳前伸的距離、減少髖內收，且把髕骨內旋、內移，並往較後、下方位移。另外，骨盆和股骨的內外側及上下側穩定度在股骨貼紮後也提高。 結論：股骨貼紮可以改善髕股關節運動學、降低疼痛、改善動態姿勢控制，可用來治療年輕女性髕股關節疼痛患者。

Background: The phenomenon of medial collapse is commonly seen in patients with patellofemoral pain syndrome (PFPS). A femoral rotational taping is designed to correct such abnormality. The purposes of this study were to explore the hip and knee joint kinematics as well as muscle activation, and dynamic postural control between PFPS patients and controls, and to investigate the immediate effect of proximal femoral rotational taping on joint kinematics, muscle activation, postural control, and pain during a single-leg squat (SLS) and the anterior direction of the Star Excursion Balance Test (SEBT). Methods: Sixteen female patients with PFPS, and 8 healthy female controls participated. SLS and SEBT were performed with measurement of 3-dimensional hip and patellar kinematic, and hip (gluteus maximus, Gmax and gluteus medius, Gmed) and thigh (rectus femoris, RF) muscle activation on the stance leg. Pain and maximum excursion distance from SEBT were recorded. The coefficients of variance (CV) of hip and patella kinematics during SEBT were calculated to represent the segmental stability of pelvis, femur and patella. Results: PFPS group had increased peak hip adduction angle and decreased hip flexion compared with the control during SLS and SEBT tasks. Additionally, PFPS group exhibited significant increase of Gmed and decrease of RF activity compared with the control during initial 0-15 degrees of SLS. Application of femoral rotational taping could decrease pain and RF muscle activation during 15-30 degrees of SLS for patient group, as well as shift the patella into more posterior and inferior position. Similarly, during SEBT, femoral rotational taping could decrease pain and increase excursion distance while decreasing the peak hip adduction as well as changing patella kinematics including medial rotation/shift, and posterior/inferior shift in PFPS group. The medial-lateral and proximal-distal stability of pelvis and femur was also increased with femoral taping during SEBT. Conclusion: Femoral rotational taping could alter patellofemoral kinematics, decrease pain, and improve dynamic postural control in treatment of young female patients with PFPS.