高动态负荷任务期间重建膝关节和骨关节炎膝关节的支具应用
Bracing of the Reconstructed and Osteoarthritic Knee during High Dynamic Load Tasks.
作者信息
Hart Harvi F, Crossley Kay M, Collins Natalie J, Ackland David C
机构信息
1La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, AUSTRALIA; 2Melbourne School of Engineering and/or Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, AUSTRALIA; and 3School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, AUSTRALIA.
出版信息
Med Sci Sports Exerc. 2017 Jun;49(6):1086-1096. doi: 10.1249/MSS.0000000000001201.
PURPOSE
Lateral compartment osteoarthritis accompanied by abnormal knee biomechanics is frequently reported in individuals with knee osteoarthritis after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to evaluate changes in knee biomechanics produced by an adjusted and unadjusted varus knee brace during high dynamic loading activities in individuals with lateral knee osteoarthritis after ACLR and valgus malalignment.
METHODS
Nineteen participants who had undergone ACLR 5 to 20 yr previously and had symptomatic and radiographic lateral knee osteoarthritis with valgus malalignment were assessed. Quantitative motion analysis experiments were conducted during hopping, stair ascent, and descent under three test conditions: (i) no brace, (ii) unadjusted brace with sagittal plane support and neutral frontal plane alignment, and (iii) adjusted brace with sagittal plane support and varus realignment (valgus to neutral). Sagittal, frontal, and transverse plane knee kinematics, external joint moment, and angular impulse data were calculated.
RESULTS
Relative to an unbraced knee, braced conditions significantly increased knee flexion and adduction angles during hopping (P = 0.003 and P = 0.005; respectively), stair ascent (P = 0.003 and P < 0.001, respectively), and descent (P = 0.009 and P < 0.001, respectively). In addition, the brace conditions increased knee flexion (P < 0.001) and adduction (P = 0.001) angular impulses and knee stiffness (P < 0.001) during hopping, as well as increased knee adduction moments during stair ascent (P = 0.008) and flexion moments during stair descent (P = 0.006). There were no significant differences between the adjusted and the unadjusted brace conditions (P > 0.05).
CONCLUSION
A knee brace, with or without varus alignment, can modulate knee kinematics and external joint moments during hopping, stairs ascent, and descent in individuals with predominant lateral knee osteoarthritis after ACLR. Longer-term use of a brace may have implications in slowing osteoarthritis progression.
目的
在接受前交叉韧带重建（ACLR）后的膝骨关节炎患者中，经常报道伴有异常膝关节生物力学的外侧间室骨关节炎。本研究的目的是评估在ACLR后伴有膝外翻畸形的外侧膝骨关节炎患者进行高动态负荷活动期间，调整和未调整的内翻膝关节支具所产生的膝关节生物力学变化。
方法
评估了19名在5至20年前接受过ACLR且有症状性和影像学外侧膝骨关节炎并伴有膝外翻畸形的参与者。在三种测试条件下进行定量运动分析实验，包括单腿跳、上楼梯和下楼梯：（i）不佩戴支具；（ii）具有矢状面支撑且额状面呈中立位的未调整支具；（iii）具有矢状面支撑且内翻矫正（从外翻到中立）的调整支具。计算矢状面、额状面和横断面的膝关节运动学、外部关节力矩和角冲量数据。
结果
与不佩戴支具的膝关节相比，佩戴支具的情况在单腿跳（分别为P = 0.003和P = 0.005）、上楼梯（分别为P = 0.003和P < 0.001）和下楼梯（分别为P = 0.009和P < 0.001）过程中显著增加了膝关节屈曲和内收角度。此外，佩戴支具的情况在单腿跳过程中增加了膝关节屈曲（P < 0.001）和内收（P = 0.001）角冲量以及膝关节刚度（P < 0.001），在上楼梯过程中增加了膝关节内收力矩（P = 0.008），在下楼梯过程中增加了膝关节屈曲力矩（P = 0.006）。调整后的支具和未调整的支具情况之间无显著差异（P > 0.05）。
结论
对于ACLR后以外侧膝骨关节炎为主的个体，佩戴或不佩戴内翻矫正的膝关节支具都可以在单腿跳、上楼梯和下楼梯过程中调节膝关节运动学和外部关节力矩。长期使用支具可能对减缓骨关节炎进展有意义。
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