National Institute on Aging, Clinical Research Branch, Baltimore, MD 21225, USA.
Gait Posture. 2011 Feb;33(2):205-10. doi: 10.1016/j.gaitpost.2010.11.006. Epub 2010 Dec 8.
Biomechanical analysis of lower extremity activities while walking at different speeds and in challenging conditions may help to identify specific gait patterns associated with knee osteoarthritis (knee-OA). We hypothesized that individuals with asymptomatic knee-OA have lower ankle activity, while individuals with symptomatic knee-OA have similar or higher ankle activity compared to individuals without knee-OA, and that such differences are enhanced during challenging gait tasks. We tested this hypothesis by examining gait characteristics in multiple gait tasks using data from 153 Baltimore Longitudinal Study of Aging (BLSA) participants (112 without knee-OA, 41 with knee-OA; 53-87 years, 52% women). All participants who could walk unassisted were evaluated in the BLSA gait lab while walking at self-selected speed (usual-walking), at maximum speed (fast-walking) and again at self-selected speed after 30-min of walking activities (usual-walking-after-30 min). Knee range of motion was lower for knee-OA participants in the fast-walking and usual-walking-after-30 min tasks (p<0.030). Ankle range of motion for symptomatic knee-OA was greater compared to asymptomatic knee-OA for all walking tasks (p<0.050). Symptomatic knee-OA had greater generative MWE of the ankle compared to asymptomatic knee-OA (p=0.034), while keeping similar absorptive MWE of the knee when compared to no-OA controls (p=0.151). Symptomatic knee-OA individuals seem to adapt an ankle kinematic gait pattern aimed at avoiding knee pain, by enhancing forward propulsion so to minimize knee joint load. Whether these conditions represent subsequent steps in the causal pathway from knee-OA to changes in gait is still not clear.
在不同速度和具有挑战性的条件下行走时对下肢活动的生物力学分析，可能有助于确定与膝骨关节炎（膝 OA）相关的特定步态模式。我们假设无症状膝 OA 患者的踝关节活动度较低，而有症状膝 OA 患者的踝关节活动度与无膝 OA 患者相似或更高，并且在具有挑战性的步态任务中，这种差异会增强。我们通过使用来自 153 名巴尔的摩纵向衰老研究（BLSA）参与者的数据（112 名无膝 OA，41 名膝 OA；53-87 岁，52%为女性），在多个步态任务中检查步态特征来检验这一假设。所有能够独立行走的参与者都在 BLSA 步态实验室进行评估，在自选择速度（通常行走）、最大速度（快速行走）以及 30 分钟行走活动后再次自选择速度（30 分钟后通常行走）下行走。在快速行走和 30 分钟后通常行走任务中，膝 OA 参与者的膝关节活动范围较低（p<0.030）。与无症状膝 OA 相比，有症状膝 OA 的踝关节活动度在所有行走任务中都更大（p<0.050）。与无症状膝 OA 相比，有症状膝 OA 的踝关节产生 MWE 更大（p=0.034），而与无 OA 对照组相比，膝关节吸收 MWE 相似（p=0.151）。有症状的膝 OA 患者似乎通过增强向前推进来适应踝关节运动步态模式，以避免膝关节疼痛，从而最小化膝关节负荷。这些情况是否代表了从膝 OA 到步态变化的因果途径中的后续步骤尚不清楚。
