本研究乃針對全膝關節置換者接受常規物理治療合併PNF 伸展術或被動伸 展術，在立即、出院前及手術後1 個月在膝屈曲角度、屈曲時疼痛分數、膝伸 直肌力、及坐站行走能力及功能分數的影響。住院期間運用PNF 伸展術可以立 即且持續增加膝屈曲角度，在屈曲動作或日常活動時也較不會產生疼痛。同時3 回合的住院訓練即可有效達到出院目標，可以節省治療成本與人力，並且可以 及早達成膝屈曲功能角度的長期目標，其結果可提供臨床應用上有力的實證參 考。
圖
圖3.1 施測者量測受試者膝屈曲角度
圖3.3 施測者量測受試者計時行走測試
診斷：退化性膝關節炎 接受初次全膝人工關節置 換手術 (N=70)
合格的受試者 (N=64)
3名符合排案條件，3名拒 絕測試
隨機分組至實驗組（接受 PNF伸展術）(N=32)
隨機分組至控制組（接受 被動伸展術）(N=32)
受試者完成1個月追蹤 資料 (N=31)
受試者完成1個月追蹤資 料 (N=28)
意向分析 (N=32) 意向分析 (N=32) 1名拒絕
繼續測試
3名拒絕繼 續測試 1名其他原 因住院
圖4.1 受試者收案流程圖
實驗組
0
0 20 40 60 80 100 120 140
介入前 出院前 術後1個月
實驗組 控制組
* *
圖4.6 不同組別間的膝部傷害及膝關節炎預後量表分數之變化
*: 介入二組間有差異 p＜0.05
表
表4.1 量測膝屈曲角度與膝伸肌力的施測者內信度及施測者間信度
施測者內信度ICC（3,1） SEM SRD
膝屈曲角度（°）
施測者1 0.967 2.0° 6.0°
施測者2 0.963 1.6° 4.5°
膝伸肌肌力（kg）
施測者1 0.993 0.47kg 1.30kg
施測者2 0.988 0.45kg 1.25kg
施測者間信度ICC（2,1） SEM SRD
膝屈曲角度（°）
施測者1 與 2 0.969 1.8° 4.8°
膝伸肌肌力（kg）
施測者1 與 2 0.902 1.21kg 3.35kg
註：SEM 代表測量標準誤，SRD 代表最小真正改變量
表4.2 受試者的基本資料 （數值：平均值±標準差）
實驗組(N=32) 控制組(N=32) 性別 24 女 8 男 26 女 6 男
年齡 (ys) 69.9±7.7 71.8±6.6
身高 (cm) 155.8±7.3 154.7±7.8
體重 (kg) 66.9±9.1 65.7±12.9
身體質量指數 (kg/m²) 27.6±3.5 27.4±4.2
術前膝屈曲角度 (°) 113.9±14.2 113.0±20.0
手術側腿圍 (cm) 45.8±3.1 45.0±3.9
非手術側腿圍 (cm) 40.4±3.3 39.8±4.6
註：二組間所有基本資料皆無統計差異 p＞0.05
表4.3 兩組受試者在介入前的療效指標之比較（數值：平均值±標準差）
實驗組(N=32) 控制組(N=32) 膝屈曲角度 (°) 87.8±13.1 84.7±10.5 疼痛分數 6.1±2.0 5.8±1.9
膝伸肌肌力(kg) 6.4±4.4 4.5±3.2
計時行走測試 (s) 62.7±41.7 62.0±29.1 膝部傷害及膝關節炎預後量表分數 97.8±12.7 101.9±17.0
註：二組間所有膝關節變項皆無統計差異 p＞0.05
表4.4 兩組受試者在首次介入前後的療效指標之比較（數值：平均值±標準差）
實驗組(N=32) 控制組(N=32)
介入前 介入後 介入前 介入後
膝屈曲角度 (°) 87.8±13.1 101.0±12.2** 84.7±10.5 94.0±9.9**
疼痛分數 6.1±2.0 5.5±2.3* 5.8±1.9 6.3±2.0 膝伸肌肌力 (kg) 6.4±4.4 7.7±5.3** 4.5±3.2 5.1±3.9
*: 介入前後有差異 p＜0.05, **: 介入前後有差異 p＜0.0001
表4.5 兩組受試者在三次介入後於出院前的療效指標之比較（數值：平均值±標 準差）
實驗組(N=32) 控制組(N=32)
介入前 出院前 介入前 出院前
膝屈曲角度 (°) 87.8±13.1 106.0±11.6** 84.7±10.5 95.8±11.6**
疼痛分數 6.1±2.0 4.9±2.4* 5.8±1.9 6.3±2.3 膝伸肌肌力 (kg) 6.4±4.4 10.0±6.2** 4.5±3.2 6.2±3.8*
計時行走測試(s) 62.7±41.7 43.2±29.0** 62.0±29.1 58.5±30.0 膝部傷害及膝關
節炎預後量表分 數
97.8±12.7 77.8±17.2** 101.9±17.0 92.8±17.0**
*: 介入前與出院前有差異 p＜0.05, **: 介入前與出院前有差異 p＜0.0001
表4.6 兩組受試者在膝部傷害及膝關節炎預後量表副標度分數的療效指標之比 較（數值：平均值±標準差）
實驗組(N=32) 控制組(N=32)
介入前 出院前 1 個月追蹤 介入前 出院前 1 個月追蹤
疼痛 63.0±11.0 73.9±10.3** 80.4±13.6** 57.2±14.2 62.9±15.0* 73.1±14.2**
症狀 55.9±10.8 62.3±11.4* 74.3±12.8** 51.2±12.5 52.9±12.5 61.3±18.5*
日常生活 35.9±10.5 55.0±16.0** 77.4±14.4** 34.3±12.8 43.8±14.7** 66.5±21.7**
生活品質 46.9±19.1 55.6±20.3* 60.3±20.7* 49.3±22.0 49.8±17.3 56.8±18.7
*: 介入前與追蹤時有差異 p＜0.05 ，**: 介入前與追蹤時有差異 p＜0.0001
表5.1 過去文獻中全膝人工關節置換者的術後屈曲角度(平均值)
Mockford, 2008 門診物理治療(N=71) 住院常規物理治療(N=72)
83~85 105~112
表5.2 過去文獻使用 PNF 伸展術介入的參數與屈曲角度的改變
表5.3 過去文獻中使用高屈曲型及標準型全膝關節植入物的術後屈曲角度(平均
註1：標準型植入物為後穩定型(posterior stabilized)，高屈曲型植入物為 NexGen LPS-Flex (Zimmer, Warsaw, Indiana)，本研究採取相同的高屈曲型植入物。
註2：*：高屈曲型與標準型植入物屈曲角度有統計差異 p<0.05，其他研究則發現 二者並無統計差異。
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