行政院國家科學委員會專題研究計畫成果報告:開放鍊與閉鎖鍊運動對退化性膝關節炎患者、健康中老年人，及健康年輕人之下肢功能與行走速度改善之研究

Abstract

背景與目的：由於阻力較大的開放鏈運動(open chain exercise)常會加重退化性膝關節炎患者的臨 床症狀；更因閉鎖鏈運動(closed chain exercise)比 開放鏈運動(open chain exercise)能誘發本體感覺 的刺激，因此在臨床上對本體感覺有缺損的患 者，物理治療師較偏好選擇閉鎖鏈運動來治療這 些患者。退化性膝關節炎患者的肌力、本體感覺 都較差，就理論上而言，閉鎖鏈運動應會比開放 鏈運動提供較佳的臨床效果。但回顧文獻尚未有 人以退化性膝關節炎患者為研究對象，比較開放 鏈與閉鎖鏈運動對他們行走平地、海綿墊、上下 樓梯的速度，本體感覺效果之差異。方法：從臺 大醫院骨科門診挑選61 位退化性膝關節炎的患 者為研究對象，分為開放鏈運動組26 位、閉鎖鏈 運動組19 位與控制組16 位，共三組。控制組不 接受任何治療只有實驗前、後的評估測量，包括 (1) WOMAC 第三部分的功能評估；(2) 行走速度: 快速平地行走；上下樓梯行走；海綿墊上行走； 8 字型行走；(3) 角度配對誤差值，及(4) 膝伸肌、 屈肌等速肌力測試值。結果：接受運動訓練的兩 組受試者在不同角速度下之伸肌、屈肌肌力都有 明顯進步（ P<0.017），且其改善量皆較控制組 大又具統計意義差異（P<0.017）。而兩組之間的 進步量之差異以屈肌較明顯且達統計意義差別 (p<0.05)，閉鎖鏈運動比開放鏈運動效果大。其餘 的各項測試值，除開放鏈運動組未能在海綿墊行 走速度、角度配對誤差值顯示訓練效果外，兩組 受試者在各項改善量皆比控制組具統計意義的好 (p<0.05)。閉鎖鏈運動的患者在海綿墊上，8 字型 行走速度及角度配對誤差值的改善量皆比開放鏈 運動效果大。結論：閉鎖鏈運動對退化性膝關節 炎患者的效果與開放鏈運動在多項評量上都差不 多，但在屈肌肌力、或與本體感覺較相關的海綿 墊上，8 字型行走速度及角度配對誤差值的改善 量則比開放鏈運動效果大。

Background and purpose: High intensity open chain exercise increases the severity of symptoms in osteoarthritis knees. In closed-chain condition, the joints bear body weight and their proprioceptive receptors fire actively and frequently more than open-chain does. The results of earlier serial researches indicate that the proprioception under closed-chain testing model is more accurate than it under open-chain model. However, the information is not sufficient to answer that whether or not the training effect of closed-chain exercise is better than that of open-chain. Therefore, we hypothesize that the effectiveness of exercise in open-chain and closed-chain model could be different in knee disorders (i.e., osteoarthritis). The purpose of this study is to compare the training effect of closed-chain and open-chain exercise program. Methods: Including 61 subjects from NTU hospital and randomized into open chain group (26 subjects), closed chain group (19 subjects) and control group (16 subjects). The evaluation measures to be used are (1) third part of WOMAC functional score, (2) walking speed in 3 routes (straight line, up/down stairs, sponge and figure eight). (3) knee joint reposition sense (proprioception) and (4) isokinetic strength. Result: training groups (open chain and closed chain) improved significantly in all evaluation measures, except walking on sponge and knee joint reposition sense in open chain group. The sponge and figure of eight walking speed, knee joint reposition sense, and flexor muscle strength in closed chain exercise has more effects than open chain. Conclusion: closed chain and open chain exercise training have the same effectiveness in several evaluation measures. But the closed chain exercise training are better than open chain in peoprioceptive related performance such as sponge walking, figure of eight walking and strength of knee flexor.