Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON N6A 3K7, Canada; School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON N6G 1H1, Canada.
Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON N6A 3K7, Canada; School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON N6G 1H1, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre - University Hospital, London, ON N6A 5B5, Canada.
J Biomech. 2019 Sep 20;94:123-129. doi: 10.1016/j.jbiomech.2019.07.015. Epub 2019 Jul 25.
We investigated the simple and multivariate associations between knee pain and gait biomechanics. 279 patients with medial knee osteoarthritis (OA) and discordant changes in pain between limbs after walking completed bilateral three-dimensional gait analysis. For each limb, patients rated their pain before and after a 6-min walk and the change in pain was recorded as an increase (≥1 points) or not (≤0 points). Among paired limbs, the simple and multivariate associations between an increase in pain and the external moments in each orthogonal plane were evaluated using conditional logistic regression. The analyses were then repeated for knee angles. Univariate analyses demonstrated associations in each plane that varied in both magnitude and direction, with larger associations for the knee moments [Odds Ratio (95% confidence interval) = first peak adduction moment: 2.80 (2.02, 3.88), second peak adduction moment: 2.36 (1.73, 3.24), adduction impulse: 6.65 (3.50, 12.62), flexion moment: 0.46 (0.36, 0.60), extension moment: 0.56 (0.44, 0.71), internal rotation moment: 7.54 (3.32, 17.13), external rotation moment: 0.001 (0.00, 0.04)]. Multivariate analyses with backward elimination resulted in a model including only the adduction impulse [5.35 (2.51, 11.42)], flexion moment [0.32 (0.22, 0.46)] and extension moment [0.28 (0.19, 0.42)]. The varus, flexion and extension angles were included in the final multivariate model for the knee angles. When between-person confounding is lessened by comparing limbs within patients, there are strong independent associations between knee pain and multiple external knee moments that vary in magnitude and direction. While controlling for other knee moments, a greater adduction impulse and lower flexion and extension moments were independently associated with greater odds of an increase in pain.
我们研究了膝关节疼痛与步态生物力学之间的简单和多变量关联。279 例内侧膝关节骨关节炎（OA）患者在行走后出现肢体疼痛不一致变化，完成双侧三维步态分析。对于每条肢体，患者在 6 分钟步行前和步行后评估其疼痛，并记录疼痛变化，增加（≥1 分）或不增加（≤0 分）。在配对肢体中，使用条件逻辑回归评估疼痛增加与每个正交平面中外力矩之间的简单和多变量关联。然后，对于膝关节角度，重复进行分析。单变量分析表明，在每个平面中都存在大小和方向不同的关联，其中膝关节力矩的关联更大[比值比（95%置信区间）= 首次内收峰值力矩：2.80（2.02，3.88），第二次内收峰值力矩：2.36（1.73，3.24），内收冲量：6.65（3.50，12.62），屈曲力矩：0.46（0.36，0.60），伸展力矩：0.56（0.44，0.71），内旋力矩：7.54（3.32，17.13），外旋力矩：0.001（0.00，0.04）]。使用向后消除的多变量分析导致仅包括内收冲量的模型[5.35（2.51，11.42）]，屈曲力矩[0.32（0.22，0.46）]和伸展力矩[0.28（0.19，0.42）]。在膝关节角度的最终多变量模型中包括了内翻、屈曲和伸展角度。当通过比较患者内的肢体来减轻个体间混杂时，膝关节疼痛与多种膝关节外力矩之间存在强烈的独立关联，这些力矩的大小和方向各不相同。在控制其他膝关节力矩的情况下，更大的内收冲量和更低的屈曲和伸展力矩与疼痛增加的可能性更大独立相关。
