Piontek Tomasz, Ciemniewska-Gorzela Kinga, Szulc Andrzej, Pyda Andrzej, Dudziński Witold, Hejna Rafał
Katedra i Klinika Ortopedii i Traumatologii Dzieciecej, Uniwersystet Medyczny im. Karola Marcinkowskiego w Poznaniu.
Chir Narzadow Ruchu Ortop Pol. 2009 Nov-Dec;74(6):353-60.
Dysfunction of the knee joint caused by injury of the anterior cruciate ligament is associated not only with mechanical joint destabilization but also damage of receptors in the ligament responsible for joint proprioception. Sensory disorders associated with damage of receptors in the ligaments may produce abnormalities in the posture control. The study aimed at evaluating postural control strategy in patients with chronic anterior cruciate ligament deficiency and determining a relationship between clinical assessment, subjective evaluation of knee joint functioning, and type of postural control.
Postural control with dynamic and static Riva test in one-legged position was assessed in 46 patients (6 women and 40 men), aged between 15 and 52 years (mean 32 years), in whom damage of the anterior cruciate ligament was diagnosed clinically and/or radiologically. Diagnosis was confirmed arthroscopically in all cases. Clinical evaluation was made with the aid of two subjective scales of knee ailments: Lysholm knee scale and subjective knee evaluation form IKDC 2000. Arthrometer Rolimeter by Aircast was used to measure the difference between lower limbs in anterior knee laxity during "anterior drawer" test and Lachman's test. The way of visual proprioceptive control was assessed with both dynamic (DRT) and static (SRT) Riva tests in monopodalic stance. Tests were performed with the DELOS Postural Proprioceptive System (DELOS s.r.l., Corso Lecce, Torino, Italy) in the biomechanical evaluation laboratory at Rehasport Clinic in Poznań.
Strategy of the postural control in both dynamic and static Riva test does not allow differentiating ACL deficient leg from the mechanically stable leg. The obtained results of postural control in dynamic and static Riva test confirm significant value of knee joint mechanical stability for preservation its functional stability. Knee joint extension (hyperextension) may be one of mechanisms maintaining functional knee joint stability.
前交叉韧带损伤导致的膝关节功能障碍不仅与关节机械性不稳定有关,还与负责关节本体感觉的韧带中受体的损伤有关。与韧带中受体损伤相关的感觉障碍可能会导致姿势控制异常。本研究旨在评估慢性前交叉韧带损伤患者的姿势控制策略,并确定临床评估、膝关节功能主观评价与姿势控制类型之间的关系。
对46例患者(6例女性,40例男性)进行了单腿动态和静态里瓦试验姿势控制评估,患者年龄在15至52岁之间(平均32岁),临床和/或放射学诊断为前交叉韧带损伤。所有病例均经关节镜检查确诊。借助两种膝关节疾病主观量表进行临床评估:Lysholm膝关节量表和IKDC 2000主观膝关节评价表。使用Aircast公司的关节测量仪Rolimeter测量“前抽屉”试验和拉赫曼试验中膝关节前侧松弛度下肢之间的差异。在单腿站立姿势下,通过动态(DRT)和静态(SRT)里瓦试验评估视觉本体感觉控制方式。试验在波兹南Rehasport诊所的生物力学评估实验室使用DELOS姿势本体感觉系统(DELOS s.r.l.,意大利都灵科索莱切)进行。
动态和静态里瓦试验中的姿势控制策略无法区分前交叉韧带损伤的腿和机械稳定的腿。动态和静态里瓦试验中获得的姿势控制结果证实了膝关节机械稳定性对维持其功能稳定性的重要价值。膝关节伸展(过度伸展)可能是维持膝关节功能稳定性的机制之一。