Nancy-University, Henri Poincaré University, Balance Control and Motor Performance, UFR STAPS, Villers-lès-Nancy, France.
Gait Posture. 2010 Jun;32(2):155-60. doi: 10.1016/j.gaitpost.2010.04.002. Epub 2010 May 7.
This study aimed to evaluate the role of the knee joint in the neurosensory organization of balance control and the generation of postural sensorimotor strategies. Ten patients, aged over 60 years and having undergone unilateral total knee replacement (TKR) for osteoarthritis, and 20 controls were submitted to static and dynamic posturographic tests and to a sensory organization test (SOT) aiming at evaluating postural control in quiet stance and during movement. The patients were submitted to these evaluations after the disappearance of pain (TKR(1)) and at the end of a 6-week rehabilitation program (TKR(2)). Balance control being greatly improved at TKR2 compared to TKR1, the patients attain a quality of postural regulation similar to that of the controls; some postural abnormalities did however persist for the static test. Moreover, SOT values at TKR(2) close to those of the controls highlighted an improvement in motor response, better management in altered proprioceptive information situations, and greater use of the ankle to control balance. This model of intervention on the knee joint, namely knee replacement due to osteoarthritis, has shown that gradual functional sensorimotor restoration after TKR, due to intrasensory proprioceptive compensation either at knee, or at other joint levels (hip/ankle), improves dynamic balance control. This reacquisition allows the knee joint to recover its corrective compensatory role in postural regulation allowing, through neuroplasticity, the modification of muscular activation sequences and, thus, the implementation of anticipatory sensorimotor strategies.
本研究旨在评估膝关节在平衡控制的神经感觉组织和姿势运动感觉策略的产生中的作用。10 名年龄在 60 岁以上且因骨关节炎行单侧全膝关节置换术（TKR）的患者和 20 名对照者接受了静态和动态姿势描记术测试以及感觉组织测试（SOT），以评估在安静站立和运动期间的姿势控制。患者在疼痛消失后（TKR(1)）和在 6 周康复计划结束后（TKR(2)）接受了这些评估。与 TKR(1)相比，TKR(2)时平衡控制得到了极大改善，患者的姿势调节质量与对照组相似；然而，对于静态测试，一些姿势异常仍然存在。此外，TKR(2)时的 SOT 值接近对照组，这表明运动反应得到了改善，在改变的本体感觉信息情况下更好地管理，并且更有效地使用脚踝来控制平衡。膝关节的这种干预模式，即由于骨关节炎导致的膝关节置换，表明 TKR 后由于膝关节或其他关节水平（髋关节/踝关节）的内感觉本体感觉补偿，逐渐恢复功能感觉运动，从而改善动态平衡控制。这种重新获得使膝关节能够恢复其在姿势调节中的纠正性补偿作用，通过神经可塑性，修改肌肉激活序列，从而实施预期的感觉运动策略。
