膝关节骨关节炎患者肌肉力量与自我报告的膝关节不稳定相关的跌倒情况

Falls Associated with Muscle Strength in Patients with Knee Osteoarthritis and Self-reported Knee Instability.

作者信息

de Zwart Arjan H, van der Esch Martin, Pijnappels Mirjam A G M, Hoozemans Marco J M, van der Leeden Marike, Roorda Leo D, Dekker Joost, Lems Willem F, van Dieën Jaap H

机构信息

From the Amsterdam Rehabilitation Research Center/Reade; MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam; Department of Rehabilitation Medicine, and Department of Psychiatry, and Department of Rheumatology, VU University Medical Center; Jan van Breemen Research Institute/Reade, Amsterdam, the Netherlands; King Abdulaziz University, Jeddah, Saudi Arabia.A.H. de Zwart, MSc, Amsterdam Rehabilitation Research Center/Reade; M. Pijnappels, PhD, MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam; M. van der Esch, PhD, Amsterdam Rehabilitation Research Center/Reade; M.J. Hoozemans, PhD, MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam; M. van der Leeden, PhD, Amsterdam Rehabilitation Research Center/Reade, and Department of Rehabilitation Medicine, VU University Medical Center; L.D. Roorda, MD, PT, PhD, Amsterdam Rehabilitation Research Center/Reade; J. Dekker, PhD, Amsterdam Rehabilitation Research Center/Reade, and Department of Rehabilitation Medicine and Department of Psychiatry, VU University Medical Center; W.F. Lems, MD, PhD, Department of Rheumatology, VU University Medical Center, and Jan van Breemen Research Institute/Reade; J.H. van Dieën, PhD, MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, and King Abdulaziz University.

出版信息

J Rheumatol. 2015 Jul;42(7):1218-23. doi: 10.3899/jrheum.140517. Epub 2015 May 1.

DOI:10.3899/jrheum.140517

PMID:25934818

Abstract

OBJECTIVE

We aimed to evaluate the associations between knee muscle strength (MS) and falls, controlling for knee joint proprioception, varus-valgus knee joint laxity, and knee pain, among patients with knee osteoarthritis (OA) reporting knee instability.

METHODS

A sample of 301 subjects (203 women, 98 men, 35-82 yrs) with established knee OA and self-reported knee instability was studied. The occurrence of at least 1 fall in the previous 3 months was assessed by questionnaire. Maximum knee extension and flexion strength were measured isokinetically. Additionally, proprioception, varus-valgus laxity, and pain were assessed. Student t tests were used to assess differences between subgroups. The association of muscle strength and falls was calculated using univariate and multivariate logistic regression analysis.

RESULTS

Over 10% of the subjects (31 out of 301) reported a fall in the previous 3 months. High knee extension muscle strength (crude OR 0.3, 95% CI 0.1-0.8, p = 0.022) and high knee flexion muscle strength (crude OR 0.2, 95% CI 0.0-1.0, p = 0.048) were associated with a lower risk of falls. Proprioception and laxity did not confound this relationship. After adjusting for pain, extensor strength had an adjusted OR of 0.5 (95% CI 0.2-1.4, p = 0.212) for falls and flexor strength had an adjusted OR of 0.4 (95% CI 0.1-2.3, p = 0.312).

CONCLUSION

High knee extension and flexion muscle strength decreased the risk of falls in patients with knee OA and self-reported knee instability. After considering the effect of pain, there was insufficient statistical power to detect an association between muscle strength and falls, which might be because of the low number of subjects who fell (n = 31).

摘要

目的

我们旨在评估膝关节骨关节炎（OA）且自述膝关节不稳定的患者中，膝关节肌肉力量（MS）与跌倒之间的关联，并对膝关节本体感觉、膝内翻-膝外翻关节松弛度和膝关节疼痛进行控制。

方法

对301名确诊为膝关节OA且自述膝关节不稳定的受试者（203名女性，98名男性，年龄35 - 82岁）进行了研究。通过问卷调查评估过去3个月内至少发生1次跌倒的情况。等速测量膝关节最大伸展和屈曲力量。此外，还评估了本体感觉、膝内翻-膝外翻松弛度和疼痛情况。采用学生t检验评估亚组间差异。使用单因素和多因素逻辑回归分析计算肌肉力量与跌倒之间的关联。

结果

超过10%的受试者（301名中的31名）报告在过去3个月内有跌倒经历。较高的膝关节伸展肌肉力量（粗比值比0.3，95%置信区间0.1 - 0.8，p = 0.022）和较高的膝关节屈曲肌肉力量（粗比值比0.2，95%置信区间0.0 - 1.0，p = 0.048）与较低的跌倒风险相关。本体感觉和松弛度并未混淆这种关系。在对疼痛进行调整后，伸展肌力量对跌倒的调整比值比为0.5（95%置信区间0.2 - 1.4，p = 0.212），屈曲肌力量对跌倒的调整比值比为0.4（95%置信区间0.1 - 2.3，p = 0.312）。