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HAL Id: dumas-01382474https://dumas.ccsd.cnrs.fr/dumas-01382474
Submitted on 17 Oct 2016
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Intérêt d’un programme de ré-entraînement à l’effortchez les patients artériopathes amputés du membre
inférieurClaire Delpouve
To cite this version:Claire Delpouve. Intérêt d’un programme de ré-entraînement à l’effort chez les patients artériopathesamputés du membre inférieur. Médecine humaine et pathologie. 2016. �dumas-01382474�
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THESE POUR LE
DOCTORAT EN MEDECINE
*DBAEFB(?@GD(:EHIEC==>(?>(EA>DBEC9D>=>DB(J(;@>KKHEB(LM>N(;>O(:CB9>DBO(CEBAE9H:CBM>O(C=:GBAO(?G(=>=PE>(9DKAE9>GE((
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ANNEE UNIVERSITAIRE 2015 - 2016
U.F.R. DE MEDECINE ET DE-PHARMACIE DE ROUEN
-------------------------
DOYEN : Professeur Pierre FREGER
ASSESSEURS : Professeur Michel GUERBET
Professeur Benoit VEBER
Professeur Pascal JOLY
Professeur Stéphane MARRET
I - MEDECINE
PROFESSEURS DES UNIVERSITES – PRATICIENS HOSPITALIERS
Mr Frédéric ANSELME HCN Cardiologie
Mme Isabelle AUQUIT AUCKBUR HCN Chirurgie plastique
Mr Bruno BACHY (surnombre jusque 01/11/15)) HCN Chirurgie pédiatrique
Mr Fabrice BAUER HCN Cardiologie
Mme Soumeya BEKRI HCN Biochimie et biologie moléculaire
Mr Jacques BENICHOU HCN Bio statistiques et informatique médicale
Mr Jean-Paul BESSOU HCN Chirurgie thoracique et cardio-vasculaire
Mme Françoise BEURET-BLANQUART HCN Commission E.P.P. D.P.C. Pôle Qualité
(surnombre)
Mr Guy BONMARCHAND (surnombre) HCN Réanimation médicale
Mr Olivier BOYER UFR Immunologie
Mr François CARON HCN Maladies infectieuses et tropicales
Mr Philippe CHASSAGNE HCN Médecine interne (gériatrie)
Mr Vincent COMPERE HCN Anesthésiologie et réanimation chirurgicale
Mr Antoine CUVELIER HB Pneumologie
Mr Pierre CZERNICHOW HCH Epidémiologie, économie de la santé
Mr Jean-Nicolas DACHER HCN Radiologie et imagerie médicale
Mr Stéfan DARMONI HCN Informatique médicale et techniques de communication
Mr Pierre DECHELOTTE HCN Nutrition
@"
Mme Danièle DEHESDIN (surnombre) HCN Oto-rhino-laryngologie
Mr Frédéric DI FIORE CB Cancérologie
Mr Fabien DOGUET HCN Chirurgie Cardio Vasculaire
Mr Jean DOUCET SJ Thérapeutique - Médecine interne et gériatrie
Mr Bernard DUBRAY CB Radiothérapie
Mr Philippe DUCROTTE HCN Hépato-gastro-entérologie
Mr Frank DUJARDIN HCN Chirurgie orthopédique - Traumatologique
Mr Fabrice DUPARC HCN Anatomie - Chirurgie orthopédique et traumatologique
Mr Eric DURAND HCN Cardiologie
Mr Bertrand DUREUIL HCN Anesthésiologie et réanimation chirurgicale
Mme Hélène ELTCHANINOFF HCN Cardiologie
Mr Thierry FREBOURG UFR Génétique
Mr Pierre FREGER HCN Anatomie - Neurochirurgie
Mr Jean François GEHANNO HCN Médecine et santé au travail
Mr Emmanuel GERARDIN HCN Imagerie médicale
Mme Priscille GERARDIN HCN Pédopsychiatrie
Mr Michel GODIN (surnombre) HB Néphrologie
M. Guillaume GOURCEROL HCN Physiologie
Mr Philippe GRISE (surnombre) HCN Urologie
Mr Dominique GUERROT HCN Néphrologie
Mr Olivier GUILLIN HCN Psychiatrie Adultes
Mr Didier HANNEQUIN HCN Neurologie
Mr Fabrice JARDIN CB Hématologie
Mr Luc-Marie JOLY HCN Médecine d’urgence
Mr Pascal JOLY HCN Dermato - Vénéréologie
Mme Annie LAQUERRIERE HCN Anatomie et cytologie pathologiques
Mr Vincent LAUDENBACH HCN Anesthésie et réanimation chirurgicale
Mr Joël LECHEVALLIER HCN Chirurgie infantile
Mr Hervé LEFEBVRE HB Endocrinologie et maladies métaboliques
Mr Thierry LEQUERRE HB Rhumatologie
Mr Eric LEREBOURS HCN Nutrition
Mme Anne-Marie LEROI HCN Physiologie
Mr Hervé LEVESQUE HB Médecine interne
Mme Agnès LIARD-ZMUDA HCN Chirurgie Infantile
Mr Pierre Yves LITZLER HCN Chirurgie cardiaque
Mr Bertrand MACE HCN Histologie, embryologie, cytogénétique
V"
M. David MALTETE HCN Neurologie
Mr Christophe MARGUET HCN Pédiatrie
Mme Isabelle MARIE HB Médecine interne
Mr Jean-Paul MARIE HCN Oto-rhino-laryngologie
Mr Loïc MARPEAU HCN Gynécologie - Obstétrique
Mr Stéphane MARRET HCN Pédiatrie
Mme Véronique MERLE HCN Epidémiologie
Mr Pierre MICHEL HCN Hépato-gastro-entérologie
Mr Jean-François MUIR HB Pneumologie
Mr Marc MURAINE HCN Ophtalmologie
Mr Philippe MUSETTE HCN Dermatologie - Vénéréologie
Mr Christophe PEILLON HCN Chirurgie générale
Mr Christian PFISTER HCN Urologie
Mr Jean-Christophe PLANTIER HCN Bactériologie - Virologie
Mr Didier PLISSONNIER HCN Chirurgie vasculaire
Mr Gaëtan PREVOST HCN Endocrinologie
Mr Bernard PROUST HCN Médecine légale
Mme Nathalie RIVES HCN Biologie du développement et de la reproduction
Mr Jean-Christophe RICHARD (détachement) HCN Réanimation médicale - Médecine d’urgence
Mr Vincent RICHARD UFR Pharmacologie
Mr Horace ROMAN HCN Gynécologie - Obstétrique
Mr Jean-Christophe SABOURIN HCN Anatomie - Pathologie
Mr Guillaume SAVOYE HCN Hépato-gastrologie
Mme Céline SAVOYE–COLLET HCN Imagerie médicale
Mme Pascale SCHNEIDER HCN Pédiatrie
Mr Michel SCOTTE HCN Chirurgie digestive
Mme Fabienne TAMION HCN Réanimation médicale
Mr Luc THIBERVILLE HCN Pneumologie
Mr Christian THUILLEZ HB Pharmacologie
Mr Hervé TILLY CB Hématologie et transfusion
Mr Olivier TROST HCN Chirurgie Maxillo Faciale
Mr Jean-Jacques TUECH HCN Chirurgie digestive
Mr Jean-Pierre VANNIER HCN Pédiatrie génétique
Mr Benoît VEBER HCN Anesthésiologie - Réanimation chirurgicale
Mr Pierre VERA CB Biophysique et traitement de l’image
Mr Eric VERIN CRMPR Médecine physique et de réadaptation
W"
Mr Eric VERSPYCK HCN Gynécologie obstétrique
Mr Olivier VITTECOQ HB Rhumatologie
Mr Jacques WEBER HCN Physiologie
MAITRES DE CONFERENCES DES UNIVERSITES – PRATICIENS HOSPITALIERS
Mme Noëlle BARBIER-FREBOURG HCN Bactériologie – Virologie
Mr Jeremy BELLIEN HCN Pharmacologie
Mme Carole BRASSE LAGNEL HCN Biochimie
Mme Valérie BRIDOUX HUYBRECHTS HCN Chirurgie Digestive
Mr Gérard BUCHONNET HCN Hématologie
Mme Mireille CASTANET HCN Pédiatrie
Mme Nathalie CHASTAN HCN Physiologie
Mme Sophie CLAEYSSENS HCN Biochimie et biologie moléculaire
Mr Moïse COEFFIER HCN Nutrition
Mr Stéphane DERREY HCN Neurochirurgie
Mr Manuel ETIENNE HCN Maladies infectieuses et tropicales
Mr Serge JACQUOT UFR Immunologie
Mr Joël LADNER HCN Epidémiologie, économie de la santé
Mr Jean-Baptiste LATOUCHE UFR Biologie cellulaire
Mr Thomas MOUREZ HCN Bactériologie
Mme Muriel QUILLARD HCN Biochimie et biologie moléculaire
Mr Mathieu SALAUN HCN Pneumologie
Mme Pascale SAUGIER-VEBER HCN Génétique
Mme Anne-Claire TOBENAS-DUJARDIN HCN Anatomie
PROFESSEUR AGREGE OU CERTIFIE
Mme Dominique LANIEZ UFR Anglais
Mr Thierry WABLE UFR Communication
B"
II - PHARMACIE
PROFESSEURS
Mr Thierry BESSON Chimie Thérapeutique
Mr Jean-Jacques BONNET Pharmacologie
Mr Roland CAPRON (PU-PH) Biophysique
Mr Jean COSTENTIN (Professeur émérite) Pharmacologie
Mme Isabelle DUBUS Biochimie
Mr Loïc FAVENNEC (PU-PH) Parasitologie
Mr Jean Pierre GOULLE Toxicologie
Mr Michel GUERBET Toxicologie
Mme Isabelle LEROUX - NICOLLET Physiologie
Mme Christelle MONTEIL Toxicologie
Mme Martine PESTEL-CARON (PU-PH) Microbiologie
Mme Elisabeth SEGUIN Pharmacognosie
Mr Rémi VARIN (PU-PH) Pharmacie clinique
Mr Jean-Marie VAUGEOIS Pharmacologie
Mr Philippe VERITE Chimie analytique
MAITRES DE CONFERENCES
Mme Cécile BARBOT Chimie Générale et Minérale
Mme Dominique BOUCHER Pharmacologie
Mr Frédéric BOUNOURE Pharmacie Galénique
Mr Abdeslam CHAGRAOUI Physiologie
Mme Marie Catherine CONCE-CHEMTOB Législation pharmaceutique et économie de la santé
Mme Elizabeth CHOSSON Botanique
Mme Cécile CORBIERE Biochimie
Mr Eric DITTMAR Biophysique
Mme Nathalie DOURMAP Pharmacologie
Mme Isabelle DUBUC Pharmacologie
Mr Abdelhakim ELOMRI Pharmacognosie
Mr François ESTOUR Chimie Organique
8"
Mr Gilles GARGALA (MCU-PH) Parasitologie
Mme Najla GHARBI Chimie analytique
Mme Marie-Laure GROULT Botanique
Mr Hervé HUE Biophysique et mathématiques
Mme Laetitia LE GOFF Parasitologie - Immunologie
Mme Hong LU Biologie
Mme Sabine MENAGER Chimie organique
Mr Mohamed SKIBA Pharmacie galénique
Mme Malika SKIBA Pharmacie galénique
Mme Christine THARASSE Chimie thérapeutique
Mr Frédéric ZIEGLER Biochimie
PROFESSEURS ASSOCIES
Mme Cécile GUERARD-DETUNCQ Pharmacie officinale
Mr Jean-François HOUIVET Pharmacie officinale
PROFESSEUR CERTIFIE
Mme Mathilde GUERIN Anglais
ASSISTANT HOSPITALO-UNIVERSITAIRE
Mr Jérémie MARTINET Immunologie
ATTACHES TEMPORAIRES D’ENSEIGNEMENT ET DE RECHERCHE
Mr Romy RAZAKANDRAINIBE Parasitologie
Mr François HALLOUARD Galénique
Mme Caroline LAUGEL Chimie organique
Mr Souleymane ABDOUL-AZIZ Biochimie
Mme Maïté NIEPCERON Microbiologie
7"
LISTE DES RESPONSABLES DES DISCIPLINES PHARMACEUTIQUES
Mme Cécile BARBOT Chimie Générale et minérale
Mr Thierry BESSON Chimie thérapeutique
Mr Roland CAPRON Biophysique
Mr Jean CHASTANG Mathématiques
Mme Marie-Catherine CONCE-CHEMTOB Législation et économie de la santé
Mme Elisabeth CHOSSON Botanique
Mr Jean-Jacques BONNET Pharmacodynamie
Mme Isabelle DUBUS Biochimie
Mr Loïc FAVENNEC Parasitologie
Mr Michel GUERBET Toxicologie
Mr François ESTOUR Chimie organique
Mme Isabelle LEROUX-NICOLLET Physiologie
Mme Martine PESTEL-CARON Microbiologie
Mme Elisabeth SEGUIN Pharmacognosie
Mr Mohamed SKIBA Pharmacie galénique
Mr Philippe VERITE Chimie analytique
6"
III – MEDECINE GENERALE
PROFESSEUR DES UNIVERSITÉS-MÉDECIN GÉNÉRALISTE
Mr Jean-Loup HERMIL UFR Médecine générale
PROFESSEURS ASSOCIES A MI-TEMPS
Mr Emmanuel LEFEBVRE UFR Médecine générale
Mr Philippe NGUYEN THANH UFR Médecine générale
MAITRE DE CONFERENCES ASSOCIE A MI-TEMPS
Mr Pascal BOULET UFR Médecine générale
Mme Elisabeth MAUVIARD UFR Médecine générale
Mme Lucille PELLERIN UFR Médecine générale
Mme Yveline SEVRIN UFR Médecine générale
Mme Marie Thérèse THUEUX UFR Médecine générale
!A"
ENSEIGNANTS MONO-APPARTENANTS
PROFESSEURS
Mr Serguei FETISSOV (med) Physiologie (ADEN)
Mr Paul MULDER (phar) Sciences du Médicament
Mme Su RUAN (med) Génie Informatique
MAITRES DE CONFERENCES
Mr Sahil ADRIOUCH (med) Biochimie et biologie moléculaire (Unité Inserm 905)
Mme Gaëlle BOUGEARD-DENOYELLE (med) Biochimie et biologie moléculaire (UMR 1079)
Mme Carine CLEREN (phar) Neurosciences (Néovasc)
Mme Pascaline GAILDRAT (phar) Génétique moléculaire humaine (UMR 1079)
Mr Nicolas GUEROUT (phar) Chirurgie Expérimentale
Mr Antoine OUVRARD-PASCAUD (med) Physiologie (Unité Inserm 1076)
Mr Frédéric PASQUET Sciences du langage, orthophonie
Mme Isabelle TOURNIER (phar) Biochimie (UMR 1079)
CHEF DES SERVICES ADMINISTRATIFS : Mme Véronique DELAFONTAINE
HCN - Hôpital Charles Nicolle HB - Hôpital de BOIS GUILLAUME
CB - Centre Henri Becquerel CHS - Centre Hospitalier Spécialisé du Rouvray
CRMPR - Centre Régional de Médecine Physique et de Réadaptation SJ – Saint Julien Rouen
!!"
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N=119
Sexe Homme 96
Femme 23
Age à
l'Amputation
< 50 ans 2
50 – 64 ans 47
65 – 74 ans 28
75 – 84 ans 28
> 85 ans 14
Localisation Transtibial 65
Transfémoral 38
Bilatéral 16
Niveau
d’amputation
Non précisé 7
Tiers supérieur 33
Tiers moyen 53
Tiers inférieur 26
Diabète Absent 56
Equilibré 37
Déséquilibré 23
HTA Non 10
Equilibrée 92
Déséquilibrée 17
Insuffisance
Rénale
Chronique
Non 90
Oui 29
Dialyse 5
AVC Non 95
Sans séquelles 8
Avec séquelles 16
Troubles
cognitifs
Non 93
MMS< 20 26
Tabagisme Non 41
Sevré 55
Actif 23
BMI Poids non connu 15
IMC < 25 58
IMC 25 - 30 48
IMC > 30 13
Pathologie
Respiratoire
Non 85
BPCO 19
Autres (dont SAS) 13
Oxygénodépendance 5
Cardiopathie Aucune / non connue 26
Trouble
rythme/conduction
17
Valvulopathie 5
Ischémie 47
Multiple 11
Insuffisance
cardiaque
Non connue/ > 50 % 101
30 – 50 % 13
< 30 % 5
Cardiologue attitré Non 66
Oui 53
Arthrose Non 89
Oui 28
PTG/PTH Non 103
Oui 16
Lombalgies
chroniques
Non 105
Oui 14
Troubles visuels Non 88
Oui 31
Amputation mineure
controlatéral
Non 104
Oui 15
Tumeur Non / bénin 97
En rémission 7
Evolutif 15
Ethylisme chronique Non 94
sevré 23
actif
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Médiane et écart type N Total = 5 Transtibiaux n = 3 Transfémoraux n = 2
VO2 max début REE (ml/kg/min) 14,0 +/- 3,8 16,6 +/- 2,7 11,8 +/- 4,4
VO2 max fin REE (ml/kg/min) 19,5 +/- 6,2 19,5 +/- 6,2 9,1 +/- 2,5
VEMS début REE (l) 2,2 +/- 0,6 2,4 +/- 0,8 2,2 +/- 0,02
VEMS fin REE (l) 2,2 +/_ 0,6 2,4 +/- 0,8 2,2 +/- 0,04
VO2 Seuil ventilatoire début REE
(ml/kg/min)
8,5 +/- 2,2 10,1 +/- 1,6 7,2 +/- 1,7
VO2 Seuil ventilatoire fin REE (ml/kg/min) 10,1 +/- 3,5 12,2 +/- 3,2 6,9 *
Puissance seuil ventilatoire début REE
(Watts)
30 +/- 11,4 30 +/- 11,5 30 +/- 14,1
Puissance seuil ventilatoire fin REE (Watts) 50 +/- 12,6 50 +/- 15,3 50 *
Puissance max début REE (Watts) 55 +/- 26,4 55 +/- 27,5 65 +/- 35,3
Puissance max fin REE (Watts) 70 +/- 24,1 70+/- 26,5 70 +/- 28,3
0!123456!789:;<8=34!:;56!5<!9453!:2>84<>!!
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N=5 Transtibiaux n
= 3
Transfémoraux
n = 2
Médiane
et Ecart
Type
% Médiane
et Ecart
Type
% Médiane
et Ecart
Type
%
Différence VO2 max début REE/fin REE
(ml/kg/min)
2,4 +/-
3,9
17,1 2,9 +/-
1,9
17,5 - 2,7 +/-
1,9
- 22,9
Différence VO2 Seuil ventilatoire début REE /
fin REE (ml/kg/min)
0,8 +/-
1,9
9,42 2,1 +/-
1,6
20,8 -1,5* -20,8
Différence puissance seuil ventilatoire début REE
/ fin REE (Watts)
10 +/-
8,2
33,3 10 +/- 10 33,3 10* 33,3
Différence puissance max début REE / fin REE
(Watts)
10 +/-
5,5
18,2 10 +/-
2,9
18,2 5 +/- 7,1 7,7
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Côté amputé Côté sain Côté amputé Côté sain
60°/s 120°/s 60°/s 120°/
s
60°/s 120°/s 60°/s 120°/s
Différence force musculaire
fléchisseurs hanche entrée
REE/ sortie REE
0,18
+/-
0,1
0,10 +/-
0,2
0,21
+/-
0,1
0,24
+/-
0,2
0,14
+/- 0,1
0,15 +/-
0,02
0,23
+/-
0,1
0,27 +/-
0,1
Différence force musculaire
extenseurs de hanche entrée
REE/ sortie REE
0,47
+/-
0,3
0,33 +/-
0,3
0,21
+/-
0,4
0,13
+/-
0,3
0,09
+/- 0,0
0,12 +/-
0,1
0,16
+/-
0,0
0,06 +/-
0,1
Différence ration F/E entrée
REE / sortie REE
0% +4% +6% +18% +24% - 23% +12% +88%
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Côté amputé Côté sain Côté amputé Côté sain
60°/s 120°/s 60°/s 120°/s 60°/s 120°/s 60°/s 120°/s
force musculaire fléchisseurs
hanche entrée REE
0,61 +/-
0,2
0,55
+/- 0,1
0,75+/ -
0,3
0,68
+/- 0,2
0,14 +/-
0,1
0,11
+/- 0,1
0,43 +/-
0,3
0,53*
force musculaire fléchisseurs
hanche sortie REE
0,90 +/-
0,3
0,65
+/- 0,3
0,96 +/-
0,4
0,92
+/- 0,4
0,28 +/-
0,1
0,25
+/- 0,1
0,65 +/-
0,4
0,54
+/- 0,5
force musculaire extenseurs
de hanche entrée REE
1,19 +/-
0,3
0,94
+/- 0,2
1,22 +/-
0,2
1,06
+/- 0,1
0,28 +/-
0,2
0,20
+/- 0,2
0,65 +/-
0,6
1,06*
force musculaire extenseurs
de hanche sortie REE
1,76 +/-
0,6
1,27
+/-0,4
1,68 +/-
0,7
1,06
+/- 0,3
0,37 +/-
0,2
0,31
+/- 0,1
0,81 +/-
0,7
0,58
+/- 0,6
ration F/E entrée REE 51% 61% 51% 59% 52% 105% 82% 50%*
ration F/E sortie REE 55% 67% 67% 64% 79% 82% 93% 112%
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