膝关节骨关节炎患者及关节间歇性不稳主诉患者的胫股关节接触力学和运动学改变。
Altered tibiofemoral joint contact mechanics and kinematics in patients with knee osteoarthritis and episodic complaints of joint instability.
作者信息
Farrokhi Shawn, Voycheck Carrie A, Klatt Brian A, Gustafson Jonathan A, Tashman Scott, Fitzgerald G Kelley
机构信息
Human Movement Research Laboratory, Departments of Physical Therapy & Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.
出版信息
Clin Biomech (Bristol). 2014 Jun;29(6):629-35. doi: 10.1016/j.clinbiomech.2014.04.014. Epub 2014 May 5.
BACKGROUND
To evaluate knee joint contact mechanics and kinematics during the loading response phase of downhill gait in knee osteoarthritis patients with self-reported instability.
METHODS
Forty-three subjects, 11 with medial compartment knee osteoarthritis and self-reported instability (unstable), 7 with medial compartment knee osteoarthritis but no reports of instability (stable), and 25 without knee osteoarthritis or instability (control) underwent Dynamic Stereo X-ray analysis during a downhill gait task on a treadmill.
FINDINGS
The medial compartment contact point excursions were longer in the unstable group compared to the stable (P=0.046) and the control groups (P=0.016). The peak medial compartment contact point velocity was also greater for the unstable group compared to the stable (P=0.047) and control groups (P=0.022). Additionally, the unstable group demonstrated a coupled movement pattern of knee extension and external rotation after heel contact which was different than the coupled motion of knee flexion and internal rotation demonstrated by stable and control groups.
INTERPRETATION
Our findings suggest that knee joint contact mechanics and kinematics are altered during the loading response phase of downhill gait in knee osteoarthritis patients with self-reported instability. The observed longer medial compartment contact point excursions and higher velocities represent objective signs of mechanical instability that may place the arthritic knee joint at increased risk for disease progression. Further research is indicated to explore the clinical relevance of altered contact mechanics and kinematics during other common daily activities and to assess the efficacy of rehabilitation programs to improve altered joint biomechanics in knee osteoarthritis patients with self-reported instability.
背景
评估自我报告有膝关节不稳的膝骨关节炎患者在下坡步态负重反应阶段的膝关节接触力学和运动学。
方法
43名受试者，11名内侧间室膝骨关节炎且自我报告有膝关节不稳（不稳定组），7名内侧间室膝骨关节炎但无膝关节不稳报告（稳定组），25名无膝骨关节炎或膝关节不稳（对照组），在跑步机上进行下坡步态任务时接受动态立体X线分析。
结果
与稳定组（P=0.046）和对照组（P=0.016）相比，不稳定组内侧间室接触点偏移更长。与稳定组（P=0.047）和对照组（P=0.022）相比，不稳定组内侧间室接触点峰值速度也更高。此外，不稳定组在足跟接触后表现出膝关节伸展和外旋的耦合运动模式，这与稳定组和对照组表现出的膝关节屈曲和内旋的耦合运动不同。
解读
我们的研究结果表明，自我报告有膝关节不稳的膝骨关节炎患者在下坡步态负重反应阶段膝关节接触力学和运动学发生改变。观察到的内侧间室接触点偏移更长和速度更高代表了机械性不稳定的客观迹象，这可能使患有关节炎的膝关节疾病进展风险增加。有必要进一步研究以探索在其他常见日常活动中接触力学和运动学改变的临床相关性，并评估康复计划对改善自我报告有膝关节不稳的膝骨关节炎患者关节生物力学改变的疗效。
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