Andriacchi Thomas P, Mündermann Annegret
Department of Mechanical Engineering, Biomechanical Engineering, Stanford University, Stanford, CA 94305, USA.
Curr Opin Rheumatol. 2006 Sep;18(5):514-8. doi: 10.1097/01.bor.0000240365.16842.4e.
This review examines recent in-vivo studies of ambulation and discusses the fundamental role of mechanics of ambulation in the initiation and progression of osteoarthritis at the knee.
Recent studies have supported earlier findings that a high adduction moment at the knee during ambulation was most frequently reported to influence the progression of medial compartment osteoarthritis. In contrast to previous findings in patients with osteoarthritis, recent work on healthy subjects reports that cartilage thickness increases with high ambulatory loads. Kinematic changes were associated with the initiation of osteoarthritis. Recent studies of subjects with high risk factors for knee osteoarthritis (obesity and anterior cruciate ligament injury) reported a relationship between kinematic changes during ambulation and the initiation of osteoarthritis at the knee. This review also contrasts the relative influence on osteoarthritis of knee mechanics measured during ambulatory and nonambulatory activities.
The initiation of osteoarthritis occurs when healthy cartilage experiences some condition (traumatic or chronic) that causes kinematic changes during ambulation at the knee to shift the load-bearing contact location of the joint to a region not conditioned to the new loading. The rate of progression of osteoarthritis is associated with increased load during ambulation.
本综述探讨了近期有关行走的体内研究，并讨论了行走力学在膝关节骨关节炎的发生和发展中的重要作用。
近期研究支持了早期的研究结果，即在行走过程中，膝关节内收力矩过高最常被报告影响内侧间室骨关节炎的进展。与先前对骨关节炎患者的研究结果相反，近期针对健康受试者的研究报告称，高行走负荷下软骨厚度会增加。运动学变化与骨关节炎的发生有关。近期对具有膝关节骨关节炎高风险因素（肥胖和前交叉韧带损伤）的受试者的研究报告了行走过程中的运动学变化与膝关节骨关节炎发生之间的关系。本综述还对比了在行走和非行走活动中测量的膝关节力学对骨关节炎的相对影响。
当健康软骨经历某种情况（创伤性或慢性），导致膝关节在行走过程中的运动学变化将关节的承重接触位置转移到一个不适应新负荷的区域时，骨关节炎就会发生。骨关节炎的进展速度与行走过程中负荷增加有关。
