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本体感觉功能对前交叉韧带重建后异常步态生物力学的影响。

Somatosensory Function Influences Aberrant Gait Biomechanics Following Anterior Cruciate Ligament Reconstruction.

机构信息

Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, 210 South Rd., CB#8700, Chapel Hill, North Carolina, 27599-8700.

Program in Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

出版信息

J Orthop Res. 2020 Mar;38(3):620-628. doi: 10.1002/jor.24495. Epub 2019 Oct 24.

Abstract

Osteoarthritis is common following anterior cruciate ligament reconstruction (ALCR), and aberrant gait biomechanics are considered a primary contributor. Somatosensory dysfunction potentially alters gait biomechanics, but this association is unclear. Therefore, the purposes of this investigation were to compare somatosensory function between limbs and evaluate associations between somatosensory function and gait biomechanics linked to osteoarthritis development in individuals with ALCR. Seventy-three volunteers with ALCR participated. Gait biomechanics (peak vertical ground reaction force magnitude and loading rate, peak internal knee extension and valgus moments, peak knee flexion and varus angles, and quadriceps/hamstrings co-activation) were assessed as subjects walked at their preferred speed. The somatosensory function was assessed via joint position sense error (knee flexion) and vibratory perception threshold (femoral epicondyles, malleoli, and first metatarsal). Though somatosensory function did not differ between the ACLR and contralateral limbs, poorer joint position sense in the ACLR limb was associated with lower loading rates and internal knee extension moments, and greater co-activation. Poorer vibratory perception at the medial and lateral malleoli and first metatarsal head in the ACLR limb was associated with lower loading rates, greater internal knee valgus moments and varus angles, and greater co-activation. Poorer vibratory perception at the medial malleolus and first metatarsal head in the contralateral limb was associated with greater peak knee varus angles and internal knee valgus moments. These results suggest that future research evaluating rehabilitation approaches for improving somatosensory function is warranted as a potential approach for restoring normal gait biomechanics and reducing osteoarthritis risk. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:620-628, 2020.

摘要

骨关节炎是前交叉韧带重建(ALCR)后的常见并发症,异常的步态生物力学被认为是主要原因。感觉功能障碍可能会改变步态生物力学,但这种关联尚不清楚。因此,本研究的目的是比较 ACLR 患者四肢的感觉功能,并评估感觉功能与与骨关节炎发展相关的步态生物力学之间的关系。共有 73 名 ACLR 志愿者参与了研究。当参与者以自己的速度行走时,评估了步态生物力学(垂直地面反作用力峰值大小和加载率、膝关节内伸和外翻峰值力矩、膝关节最大屈曲和内翻角度、股四头肌/腘绳肌协同激活)。通过关节位置感觉误差(膝关节屈曲)和振动感觉阈值(股骨内外侧髁、内外踝和第一跖骨)评估感觉功能。尽管 ACLR 侧和对侧肢体的感觉功能没有差异,但 ACLR 肢体的关节位置感觉较差与较低的加载率和膝关节内伸力矩以及较大的协同激活有关。ACLR 肢体的内外踝和第一跖骨头的振动感觉较差与较低的加载率、较大的膝关节内翻力矩和内翻角度以及较大的协同激活有关。对侧肢体的内踝和第一跖骨头的振动感觉较差与更大的膝关节最大内翻角度和膝关节内翻力矩有关。这些结果表明,有必要进一步研究评估改善感觉功能的康复方法,作为恢复正常步态生物力学和降低骨关节炎风险的潜在方法。

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