재활운동적용이 전방십자인대 재건술 방법에 따른 집단 간 근력, 기능수행능력 및 고유수용감각에 미치는 영향
Effects of Exercise Rehabilitation on Muscle Strength, Functional Performance, and Proprioceptive Sensibility in ACL Reconstruction with or without Preserving Remnant Tissue
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[서론] 이 연구는 잔류조직 보존술을 이용한 전방십자인대 재건술 후 잔류조직을 제거한 재건술 집단과 재활훈련 후 근력, 기능수행능력과 고유수용감각기능을 비교하고자 실시되었다. [방법] 연구대상은 전방십자인대 재건술을 시행 받고 6개월간 재활운동 프로그램에 참여했던 남자 환자 중 잔류조직을 보존하여 재건술을 시행한 20명과 잔류조직보존 없이 재건술을 시행한 20명을 대상으로 하였다. 임상적 평가 항목으로 Lysholm knee score, internation knee documentation committee (IKDC) subjective score, Tegner activity score를 분석하였고 KT-2000을 이용한 관절이완검사와 등속성 최대근력 평가를 실시하였으며, 기능수행능력평가 항목으로 공동수축 검사, 왕복달리기 검사, 카리오카 검사, 외발뛰기 검사와 균형검사를 실시하였다. 또 고유수용감각 평가로 Active joint position sense(JPS)와 Passive joint position sense 검사를 실시하였다. [결과] 임상적 평가와 전후방 안정성 평가 그리고 근력 평가 및 기능적 평가에 있어서 두 군 간에 통계적으로 의미 있는 차이는 보이지 않았다. 하지만 고유수용 감각 검사로 Active JPS 결과에서 잔류조직을 보존한 재건술 집단과 제거한 재건술 집단 간에 유의한 차이를 나타냈으며 Passive JPS 결과에서 폄 시 차이의 경향을 나타내었다(p=.054). [결론] 전방십자인대 손상 후 잔류조직 보존 재건술 방법에 따른 재활운동 프로그램 후 집단 간의 임상적 평가, 최대근력 및 기능수행능력은 차이가 없는 것으로 나타났다. 따라서 적절한 재활운동프로그램의 참여가 환자들의 근력과 기능수행능력을 향상시키는데 도움이 될 것으로 사료된다. 그러나 고유수용 감각 검사에서는 집단 간에 유의한 차이를 나타내었으므로, 잔류조직 보존술이 무릎관절의 고유수용감각기능 회복에는 긍정적인 영향을 미치는 것으로 사료된다.
Abstract
[INTRODUCTION] This study aimed to compare muscle strength, functional fitness, and proprioceptive sensibility in anterior cruciate ligament (ACL) reconstruction with or without preserving remnant tissue. [METHOD] Forty patients who underwent ACL reconstruction between September 2007 and December 2009, twenty each with and without preserved remnant tissue, were evaluated at the 6-month post-operation follow-up. The Lysholm knee score, IKDC subjective score, Tegner activity score, knee joint laxity with KT-2000, isokinetic strength test, and balance test using the Biodex system III were evaluated. For functional performance testing, co-contraction, shuttle run, carioca, one leg hop, and balance tests were performed. The active and passive joint position senses were assessed to evaluate proprioceptive function. [RESULT] In the results of clinical outcomes, namely the AP stability test, isokinetic strength test, and functional performance test, both groups showed no statistically significant difference. The results of active JPS showed significant difference between groups, however, there was no statistically significant difference in the results of passive JPS. [CONCLUSION] We concluded that there was no significant difference in clinical evaluation, isokinetic strength test, and functional performance test in ACL reconstruction with or without preserving remnant tissue, except for in the proprioceptive function test. Therefore, we suggested that patients’ participation in appropriate rehabilitation program can help improve muscle strength and functional performance. However, only the change of joint position sense test was revealed a statistically significant difference in the results between groups. According to the results, the method of ACL reconstruction that preserves remnant tissue may have a positive effect on recovery of proprioceptive function in the knee joint.
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