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内侧膝关节骨关节炎患者单侧和双侧使用带有内侧足弓支撑的外侧楔形鞋垫时伴随的生物力学变化。

Biomechanical changes accompanying unilateral and bilateral use of laterally wedged insoles with medial arch supports in patients with medial knee osteoarthritis.

作者信息

Abdallah Amira A, Radwan Ahmed Y

机构信息

Physical Therapy Program, Cairo University, Egypt.

出版信息

Clin Biomech (Bristol). 2011 Aug;26(7):783-9. doi: 10.1016/j.clinbiomech.2011.03.013. Epub 2011 Apr 16.

Abstract

BACKGROUND

Laterally wedged insoles have controversial effect in treating medial compartment knee osteoarthritis. This study examined the effects of unilateral and bilateral use of insoles having medial arch supports and of different inclinations on the frontal plane external hip, knee, subtalar moments and pelvic alignment.

METHODS

Kinetic and kinematic gait parameters were collected from 21 patients with primary medial knee osteoarthritis. The insoles' inclinations were 0, 6 and 11°, where each of the 6° and 11° was used once unilaterally and another bilaterally while the 0° was used bilaterally as a control.

FINDINGS

The Multivariate Analysis of Variance revealed significant increase in the external subtalar eversion moment using either of the 6° or 11° laterally wedged vs the 0° non-wedged insole conditions (P=0.003). Moreover, there were significant increases in the external eversion moment using the 11° vs the 6° insole conditions (P<0.05). However, there were no significant differences for the remaining tested variables (P>0.05). The bivariate correlations revealed significant negative correlations between the subtalar eversion and knee adduction moments (r=-0.409, P=0.000) and the subtalar eversion and hip adduction moments (r=-0.226, P=0.049), and positive correlation between the hip and knee adduction moments (r=0.268, P=0.019).

INTERPRETATION

The non-significant reduction in the external knee adduction moment may question the efficacy of using wedged insoles having medial arch supports in treating patients with medial knee osteoarthritis. Additionally, using such insoles did not produce appreciable mechanical effects on remote articulations as the hip and pelvis.

摘要

背景

外侧楔形鞋垫在治疗膝关节内侧间室骨关节炎方面的效果存在争议。本研究探讨了单侧和双侧使用具有内侧足弓支撑且不同倾斜度的鞋垫对额状面外展髋关节、膝关节、距下关节力矩及骨盆对线的影响。

方法

收集了21例原发性膝关节内侧骨关节炎患者的动力学和运动学步态参数。鞋垫的倾斜度为0°、6°和11°,其中6°和11°的鞋垫各单侧使用一次,双侧使用一次,0°的鞋垫双侧使用作为对照。

结果

多因素方差分析显示,与0°非楔形鞋垫相比,使用6°或11°外侧楔形鞋垫时距下关节外翻力矩显著增加(P = 0.003)。此外,与6°鞋垫相比,使用11°鞋垫时外展力矩显著增加(P < 0.05)。然而,其余测试变量无显著差异(P > 0.05)。双变量相关性分析显示,距下关节外翻力矩与膝关节内收力矩之间存在显著负相关(r = -0.409,P = 0.000),距下关节外翻力矩与髋关节内收力矩之间存在显著负相关(r = -0.226,P = 0.049),髋关节和膝关节内收力矩之间存在正相关(r = 0.268,P = 0.019)。

解读

膝关节外展力矩无显著降低可能会质疑使用具有内侧足弓支撑的楔形鞋垫治疗膝关节内侧骨关节炎患者的疗效。此外,使用这种鞋垫对髋关节和骨盆等远处关节并未产生明显的力学效应。

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