Baert Isabel A C, Jonkers Ilse, Staes Filip, Luyten Frank P, Truijen Steven, Verschueren Sabine M P
Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Heverlee, Belgium.
Clin Biomech (Bristol). 2013 Jan;28(1):40-7. doi: 10.1016/j.clinbiomech.2012.10.007. Epub 2012 Nov 16.
Based on novel classification criteria using magnetic resonance imaging, a subpopulation of "early knee osteoarthritis patients" was clearly defined recently. This study assessed whether these early osteoarthritis patients already exhibit gait adaptations (knee joint loading in particular) and changes in muscle strength compared to control subjects and established knee osteoarthritis patients.
Fourteen female patients with early knee joint degeneration, defined by magnetic resonance imaging (early osteoarthritis), 12 female patients with established osteoarthritis and 14 female control subjects participated. Specific gait parameters and lower limb muscle strength were analyzed and compared between groups. Within the osteoarthritis groups, association between muscle strength and dynamic knee joint loading was also evaluated.
Early osteoarthritis patients presented no altered gait pattern, no significant increase in knee joint loading and no significant decrease in hamstring muscle strength compared to controls, while established osteoarthritis patients did. In contrast, early osteoarthritis patients experienced significant quadriceps weakness, comparable to established osteoarthritis patients. Within the osteoarthritis groups, muscle strength was not correlated with knee joint loading during gait.
The results suggest that gait changes reflect mechanical overload and are most likely the consequence of structural degeneration in knee osteoarthritis. Quadriceps weakness might however contribute to the onset and progression of the disease. This study supports the relevance of classification of early osteoarthritis patients and assists in identifying their functional characteristics. This helps to understand the trajectory of disease onset and progression and further develop more targeted strategies for prevention and treatment of knee osteoarthritis.
基于使用磁共振成像的新分类标准，最近明确界定了“早期膝关节骨关节炎患者”亚组。本研究评估了这些早期骨关节炎患者与对照组及已确诊的膝关节骨关节炎患者相比，是否已经表现出步态适应性（特别是膝关节负荷）和肌肉力量变化。
14名经磁共振成像定义为膝关节早期退变的女性患者（早期骨关节炎）、12名已确诊骨关节炎的女性患者和14名女性对照者参与研究。分析并比较了各组之间的特定步态参数和下肢肌肉力量。在骨关节炎组内，还评估了肌肉力量与动态膝关节负荷之间的关联。
与对照组相比，早期骨关节炎患者未出现步态模式改变、膝关节负荷未显著增加、绳肌力量未显著下降，而已确诊的骨关节炎患者则出现了这些情况。相比之下，早期骨关节炎患者出现了明显的股四头肌无力，与已确诊的骨关节炎患者相当。在骨关节炎组内，步态期间肌肉力量与膝关节负荷无关。
结果表明，步态改变反映了机械性过载，很可能是膝关节骨关节炎结构退变的结果。然而，股四头肌无力可能会促进疾病的发生和发展。本研究支持对早期骨关节炎患者进行分类的相关性，并有助于确定其功能特征。这有助于了解疾病的发病和进展轨迹，并进一步制定更具针对性的膝关节骨关节炎预防和治疗策略。
