Heiden Tamika L, Lloyd David G, Ackland Timothy R
School of Sport Science, Exercise and Health, The University of Western Australia, Australia.
Clin Biomech (Bristol). 2009 Dec;24(10):833-41. doi: 10.1016/j.clinbiomech.2009.08.005. Epub 2009 Sep 17.
Compared to matched controls, knee osteoarthritis patients walk with altered, kinematics, kinetics and muscle activity. Studies of osteoarthritis patient gait have focused on individual measures, and findings from these studies differ due to differences in patient levels of disability and age. Therefore, aims of this study were to examine kinematic, kinetic and muscle co-contraction gait variables within a single osteoarthritis patient group, and to determine if alterations in these variables are related to pain, symptom and function measures.
Thirty asymptomatic controls and 54 patients with radiographic evidence of knee osteoarthritis participated. Self-perceived measures of pain and symptoms, and gait (knee joint angles, moments and muscle co-contraction) were analysed and compared.
Osteoarthritis patients had greater self-perceived pain and symptoms on the questionnaires. Gait differences in the knee osteoarthritis patients were greater knee flexion at heel strike and during early stance along with reductions in the peak external knee extension moment in late stance. Co-contraction ratios highlighted greater lateral muscle activation in osteoarthritis patients, which were correlated with the magnitude of their adduction moments. Larger adduction moments were related to lower self-perceived pain and symptoms.
Osteoarthritis patients use predominantly lateral muscle activation during stance which may aid in stabilising the external knee adduction moment. Kinematic alterations in knee osteoarthritis patient gait occur without alterations in knee joint moments. Our results also suggest that adduction moments are lowered to reduce the patients' pain and symptoms.
与匹配的对照组相比，膝关节骨关节炎患者行走时的运动学、动力学和肌肉活动会发生改变。对骨关节炎患者步态的研究主要集中在个体测量上，由于患者残疾程度和年龄的差异，这些研究的结果也有所不同。因此，本研究的目的是在单一骨关节炎患者组中检查运动学、动力学和肌肉协同收缩的步态变量，并确定这些变量的改变是否与疼痛、症状和功能测量相关。
30名无症状对照者和54名有膝关节骨关节炎影像学证据的患者参与了研究。分析并比较了自我感知的疼痛和症状测量以及步态（膝关节角度、力矩和肌肉协同收缩）。
骨关节炎患者在问卷上的自我感知疼痛和症状更严重。膝关节骨关节炎患者的步态差异表现为足跟触地时和早期站立时膝关节屈曲更大，以及后期站立时膝关节最大伸展外力矩减小。协同收缩比率显示骨关节炎患者外侧肌肉激活更强，这与他们内收力矩的大小相关。更大的内收力矩与更低的自我感知疼痛和症状相关。
骨关节炎患者在站立时主要使用外侧肌肉激活，这可能有助于稳定膝关节的外展力矩。膝关节骨关节炎患者步态的运动学改变在膝关节力矩无改变的情况下发生。我们的结果还表明，内收力矩降低以减轻患者的疼痛和症状。
