高位髌骨对正常行走和快速行走时髌股关节应力的影响。
The influence of patella alta on patellofemoral joint stress during normal and fast walking.
作者信息
Ward Samuel R, Powers Christopher M
机构信息
Musculoskeletal Biomechanics Research Laboratory, Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
出版信息
Clin Biomech (Bristol). 2004 Dec;19(10):1040-7. doi: 10.1016/j.clinbiomech.2004.07.009.
OBJECTIVE
To determine if persons with patella alta exhibit elevated patellofemoral joint stress compared to pain-free controls during normal and fast walking speeds.
SUBJECTS
Twenty-four subjects (13 patella alta, 11 pain-free controls) participated.
METHODS
Sagittal and axial magnetic resonance images of the knee were obtained to quantify subject specific knee extensor mechanics and patellofemoral joint contact area. Instrumented gait analysis was used to quantify knee joint kinematics and kinetics. MRI and gait data were used as input variables into a model of patellofemoral joint stress. Analysis of variance with repeated measures was used to compare group differences and group x gait speed interactions for each dependent variable during stance.
RESULTS
During normal speed gait there were no group differences in peak knee flexion angle, knee extensor moment, joint reaction force, or stress. However, the patella alta group had significantly less contact area. During fast speed gait there were no group differences in peak knee flexion angle, knee extensor moment, or joint reaction force. However, the patella alta group demonstrated significantly less contact area and significantly greater stress compared to controls.
CONCLUSION
Persons with patella alta demonstrated greater calculated patellofemoral stress during fast walking. This was the result of reductions in contact area as joint reaction forces were similar between groups.
RELEVANCE
Persons with patella alta may be predisposed to patellofemoral dysfunction through elevations in joint stress. Therefore, treatments aimed at increasing the load-bearing surface area between the patella and femur, such as bracing, may be beneficial in this patient population.
目的
确定与无痛对照组相比，高位髌骨患者在正常和快速步行速度下是否表现出髌股关节应力升高。
受试者
24名受试者（13名高位髌骨患者，11名无痛对照组）参与研究。
方法
获取膝关节矢状面和横断面磁共振成像，以量化受试者特定的膝关节伸肌力学和髌股关节接触面积。使用仪器化步态分析来量化膝关节运动学和动力学。磁共振成像和步态数据用作髌股关节应力模型的输入变量。采用重复测量方差分析来比较站立期各因变量的组间差异和组×步态速度交互作用。
结果
在正常速度步态期间，膝关节最大屈曲角度、膝关节伸肌力矩、关节反应力或应力方面无组间差异。然而，高位髌骨组的接触面积显著更小。在快速速度步态期间，膝关节最大屈曲角度、膝关节伸肌力矩或关节反应力方面无组间差异。然而，与对照组相比，高位髌骨组的接触面积显著更小且应力显著更大。
结论
高位髌骨患者在快速步行时表现出更大的计算髌股应力。这是由于两组间关节反应力相似但接触面积减小所致。
相关性
高位髌骨患者可能因关节应力升高而易患髌股功能障碍。因此，旨在增加髌骨与股骨之间承重表面积的治疗方法，如支具治疗，可能对该患者群体有益。
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