Mündermann Annegret, Dyrby Chris O, Andriacchi Thomas P
Stanford University Medical Center, Stanford, California 94305-4038, USA.
Arthritis Rheum. 2005 Sep;52(9):2835-44. doi: 10.1002/art.21262.
This study tested the hypothesis that gait changes related to knee osteoarthritis (OA) of varied severity are associated with increased loads at the ankle, knee, and hip.
Forty-two patients with bilateral medial compartment knee OA and 42 control subjects matched for sex, age, height, and mass were studied. Nineteen patients had Kellgren/Lawrence (K/L) radiographic severity grades of 1 or 2, and 23 patients had K/L grades of 3 or 4. Three-dimensional kinematics and kinetics were measured in the hip, knee, and ankle while the subjects walked at a self-selected speed.
Patients with more severe knee OA had greater first peak knee adduction moments than their matched control subjects (P = 0.039) and than patients with less severe knee OA (P < 0.001). All patients with knee OA made initial contact with the ground with the knee in a more extended position than that exhibited by control subjects. An increased axial loading rate was present in all joints of the lower extremity. Patients with more severe knee OA had lower hip adduction moments compared with their matched control subjects.
The secondary gait changes observed among patients with knee OA reflect a potential strategy to shift the body's weight more rapidly from the contralateral limb to the support limb, which appears to be successful in reducing the load at the knee in only patients with less severe knee OA. The increased loading rate in the lower extremity joints may lead to a faster progression of existing OA and to the onset of OA at joints adjacent to the knee. Interventions for knee OA should therefore be assessed for their effects on the mechanics of all joints of the lower extremity.
本研究检验了这样一个假设，即与不同严重程度的膝关节骨关节炎（OA）相关的步态变化与踝关节、膝关节和髋关节负荷增加有关。
对42例双侧内侧间室膝关节OA患者和42例在性别、年龄、身高和体重方面匹配的对照受试者进行了研究。19例患者的凯尔格伦/劳伦斯（K/L）影像学严重程度分级为1或2级，23例患者的K/L分级为3或4级。在受试者以自选速度行走时，测量其髋、膝和踝关节的三维运动学和动力学。
膝关节OA更严重的患者，其首次峰值膝关节内收力矩比匹配的对照受试者更大（P = 0.039），也比膝关节OA较轻的患者更大（P < 0.001）。所有膝关节OA患者在与地面初始接触时，膝关节的伸展程度均大于对照受试者。下肢所有关节的轴向负荷率均增加。膝关节OA更严重的患者与匹配的对照受试者相比，其髋关节内收力矩更低。
在膝关节OA患者中观察到的继发性步态变化反映了一种潜在策略，即更快速地将身体重量从对侧肢体转移到支撑肢体，这似乎仅在膝关节OA较轻的患者中成功减轻了膝关节的负荷。下肢关节负荷率增加可能导致现有OA进展加快，并导致膝关节相邻关节发生OA。因此，对于膝关节OA的干预措施，应评估其对下肢所有关节力学的影响。
