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关节镜下半月板部分切除术对下肢力量和步态的纵向研究。

A longitudinal study of strength and gait after arthroscopic partial meniscectomy.

机构信息

1Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Melbourne, VIC, AUSTRALIA; 2Centre for Musculoskeletal Research, Griffith Health Institute, Griffith University, Gold Coast Campus, QLD, AUSTRALIA; 3School of Psychology and Exercise Science, Murdoch University, Perth, WA, AUSTRALIA; and 4Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, AUSTRALIA.

出版信息

Med Sci Sports Exerc. 2013 Nov;45(11):2036-43. doi: 10.1249/MSS.0b013e318299982a.

Abstract

PURPOSE

Individuals after arthroscopic partial meniscectomy (APM) are at increased risk of developing knee osteoarthritis (OA). Knee muscle weakness and a higher external knee adduction moment (KAM) are potential risk factors for knee OA. This exploratory longitudinal study assessed these risk factors at baseline in an APM group (3 months after surgery) and control group, and again 2 yrs later (follow-up).

METHODS

Eighty-two participants with medial APM and 38 healthy controls were assessed at baseline, with 66 (79%) and 23 (61%), respectively, retested at follow-up. Outcome measures included isokinetic knee muscle strength and medial knee joint load inferred through indices of the KAM during normal and fast-pace walking.

RESULTS

Knee muscle strength was reduced by 14%-16% in the APM leg compared with controls at baseline (P ≤ 0.006). However, strength increased in the APM leg over the 2 yrs such that there were no differences compared with controls at follow-up. KAM impulse was at least 20% higher for the APM group (both legs) when compared with controls at baseline and remained similarly higher 2 yrs later (P ≤ 0.022). At baseline peak, KAM was 18% higher in the APM leg as compared with controls only during fast-pace walking (P = 0.013). The peak KAM increased over the 2 yrs in the APM leg by 8%-9% (P ≤ 0.032), although there were no differences in change in KAM between the APM leg and controls.

CONCLUSION

This study found that although knee muscle strength improved, dynamic medial joint load increased over the 2 yrs after APM surgery. These findings may aid in developing therapeutic interventions aimed to prevent or delay the onset of knee OA after APM.

摘要

目的

关节镜下半月板部分切除术(APM)后,个体患膝关节骨关节炎(OA)的风险增加。膝关节肌肉无力和更高的膝关节外翻力矩(KAM)是膝关节 OA 的潜在危险因素。本探索性纵向研究评估了 APM 组(术后 3 个月)和对照组在基线时的这些危险因素,并在 2 年后(随访时)再次评估。

方法

82 名内侧 APM 患者和 38 名健康对照者在基线时接受评估,分别有 66 名(79%)和 23 名(61%)在随访时接受了重新测试。结局指标包括等速膝关节肌肉力量和通过 KAM 指数推断的膝关节内侧关节负荷在正常和快速行走时。

结果

APM 腿的膝关节肌肉力量比对照组在基线时降低了 14%-16%(P≤0.006)。然而,APM 腿的力量在 2 年内增加,与对照组在随访时无差异。与对照组相比,APM 组(双腿)的 KAM 冲量至少高 20%,在随访时仍然高 20%(P≤0.022)。在基线时的峰值,APM 腿的 KAM 比对照组在快速行走时仅高 18%(P=0.013)。APM 腿的 KAM 在 2 年内增加了 8%-9%(P≤0.032),尽管 APM 腿与对照组之间的 KAM 变化无差异。

结论

本研究发现,尽管膝关节肌肉力量有所改善,但在 APM 手术后的 2 年内,动态内侧关节负荷增加。这些发现可能有助于开发旨在预防或延迟 APM 后膝关节 OA 发生的治疗干预措施。

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