Morgenroth David C, Medverd Jonathan R, Seyedali Mahyo, Czerniecki Joseph M
Rehabilitation Research and Development Center of Excellence, VAPSHCS, Department of Veterans Affairs, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
Department of Radiology, VAPSHCS, Department of Veterans Affairs, Seattle, WA, USA; Department of Radiology, University of Washington, Seattle, WA, USA.
Clin Biomech (Bristol). 2014 Jun;29(6):664-70. doi: 10.1016/j.clinbiomech.2014.04.008. Epub 2014 Apr 24.
While animal study and cadaveric study have demonstrated an association between knee joint loading rate and joint degeneration, the relationship between knee joint loading rate during walking and osteoarthritis has not yet been sufficiently studied in humans.
Twenty-eight participants (14 transfemoral amputees and 14 age and body mass matched controls) underwent knee MRI with subsequent assessment using the semiquantitative Whole-Organ Magnetic Resonance Image Score. Each subject also underwent gait analysis in order to determine knee adduction moment loading rate, peak, and impulse and an exploratory measure, knee adduction moment rate∗magnitude.
Significant correlations were found between medial tibiofemoral joint degeneration and knee adduction moment peak (slope=0.42 [SE 0.20]; P=.037), loading rate (slope=12.3 [SE 3.2]; P=.0004), and rate∗magnitude (slope=437 [SE 100]; P<.0001). These relationships continued to be significant after adjusting for body mass or subject type. The relationship between medial knee semiquantitative MRI score and knee adduction moment loading rate and rate∗magnitude continued to be significant even after adjusting for peak moment (P<.0001), however, the relationship between medial knee semiquantitative MRI score and peak moment was no longer significant after adjusting for either loading rate or rate∗magnitude (P>.2 in both cases).
This study suggests an independent relationship between knee adduction moment loading rate and medial tibiofemoral joint degeneration. Our results support the hypothesis that rate of loading, represented by the knee adduction moment loading rate, is strongly associated with medial tibiofemoral joint degeneration independent of knee adduction moment peak and impulse.
虽然动物研究和尸体研究已经证明膝关节负荷率与关节退变之间存在关联，但在人类中，步行过程中膝关节负荷率与骨关节炎之间的关系尚未得到充分研究。
28名参与者（14名经股骨截肢者和14名年龄及体重匹配的对照组）接受了膝关节MRI检查，随后使用半定量全器官磁共振图像评分进行评估。每位受试者还进行了步态分析，以确定膝关节内收力矩负荷率、峰值和冲量，以及一项探索性指标，即膝关节内收力矩率∗大小。
发现胫股内侧关节退变与膝关节内收力矩峰值（斜率 = 0.42 [标准误0.20]；P = 0.037）、负荷率（斜率 = 12.3 [标准误3.2]；P = 0.0004）和率∗大小（斜率 = 437 [标准误100]；P < 0.0001）之间存在显著相关性。在调整体重或受试者类型后，这些关系仍然显著。即使在调整峰值力矩后，膝关节内侧半定量MRI评分与膝关节内收力矩负荷率和率∗大小之间的关系仍然显著（P < 0.0001），然而，在调整负荷率或率∗大小后，膝关节内侧半定量MRI评分与峰值力矩之间的关系不再显著（两种情况下P均> 0.2）。
本研究表明膝关节内收力矩负荷率与胫股内侧关节退变之间存在独立关系。我们的结果支持这样一种假设，即以膝关节内收力矩负荷率表示的负荷率与胫股内侧关节退变密切相关，且独立于膝关节内收力矩峰值和冲量。
