膝骨关节炎患者的膝关节运动变异性：自我报告的不稳定性的影响。
Knee motion variability in patients with knee osteoarthritis: The effect of self-reported instability.
作者信息
Gustafson Jonathan A, Robinson Megan E, Fitzgerald G Kelley, Tashman Scott, Farrokhi Shawn
机构信息
Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.
出版信息
Clin Biomech (Bristol). 2015 Jun;30(5):475-80. doi: 10.1016/j.clinbiomech.2015.03.007. Epub 2015 Mar 10.
BACKGROUND
Knee osteoarthritis has been previously associated with a stereotypical knee-stiffening gait pattern and reduced knee joint motion variability due to increased antagonist muscle co-contractions and smaller utilized arc of motion during gait. However, episodic self-reported instability may be a sign of excessive motion variability for a large subgroup of patients with knee osteoarthritis. The objective of this work was to evaluate the differences in knee joint motion variability during gait in patients with knee osteoarthritis with and without self-reported instability compared to a control group of older adults with asymptomatic knees.
METHODS
Forty-three subjects, 8 with knee osteoarthritis but no reports of instability (stable), 11 with knee osteoarthritis and self-reported instability (unstable), and 24 without knee osteoarthritis or instability (control) underwent Dynamic Stereo X-ray analysis during a decline gait task on a treadmill. Knee motion variability was assessed using parametric phase plots during the loading response phase of decline gait.
FINDINGS
The stable group demonstrated decreased sagittal-plane motion variability compared to the control group (p=0.04), while the unstable group demonstrated increased sagittal-plane motion variability compared to the control (p=0.003) and stable groups (p<0.001). The unstable group also demonstrated increased anterior-posterior joint contact point motion variability for the medial tibiofemoral compartment compared to the control (p=0.03) and stable groups (p=0.03).
INTERPRETATION
The finding of decreased knee motion variability in patients with knee osteoarthritis without self-reported instability supports previous research. However, presence of self-reported instability is associated with increased knee motion variability in patients with knee osteoarthritis and warrants further investigation.
背景
膝关节骨关节炎先前被认为与刻板的膝关节僵硬步态模式相关，并且由于拮抗肌共同收缩增加以及步态中使用的运动弧较小，导致膝关节运动变异性降低。然而，对于一大亚组膝关节骨关节炎患者，发作性自我报告的不稳定性可能是运动变异性过大的一个迹象。本研究的目的是评估有自我报告不稳定性和无自我报告不稳定性的膝关节骨关节炎患者在步态期间膝关节运动变异性与无症状膝关节的老年对照组之间的差异。
方法
43名受试者，8名患有膝关节骨关节炎但无不稳定报告（稳定组），11名患有膝关节骨关节炎且有自我报告的不稳定（不稳定组），24名无膝关节骨关节炎或不稳定（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。在下降步态的负重反应阶段，使用参数相位图评估膝关节运动变异性。
结果
与对照组相比，稳定组矢状面运动变异性降低（p = 0.04），而与对照组（p = 0.003）和稳定组（p < 0.001）相比，不稳定组矢状面运动变异性增加。与对照组（p = 0.03）和稳定组（p = 0.03）相比，不稳定组内侧胫股关节间室的前后关节接触点运动变异性也增加。
解读
无自我报告不稳定性的膝关节骨关节炎患者膝关节运动变异性降低的发现支持了先前的研究。然而，自我报告的不稳定性的存在与膝关节骨关节炎患者膝关节运动变异性增加相关，值得进一步研究。
Zotero 插件