平足灵活型鞋和稳定支撑型鞋在膝内翻对线不良的内侧膝骨关节炎患者中对胫股接触力的影响：一项随机交叉研究。
Tibiofemoral contact force differences between flat flexible and stable supportive walking shoes in people with varus-malaligned medial knee osteoarthritis: A randomized cross-over study.
机构信息
Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
出版信息
PLoS One. 2022 Jun 2;17(6):e0269331. doi: 10.1371/journal.pone.0269331. eCollection 2022.
OBJECTIVE
To compare the effect of stable supportive to flat flexible walking shoes on medial tibiofemoral contact force (MTCF) in people with medial knee osteoarthritis and varus malalignment.
DESIGN
This was a randomized cross-over study. Twenty-eight participants aged ≥50 years with medial knee osteoarthritis and varus malalignment were recruited from the community. Three-dimensional full-body motion, ground reaction forces and surface electromyograms from twelve lower-limb muscles were acquired during six speed-matched walking trials for flat flexible and stable supportive shoes, tested in random order. An electromyogram-informed neuromusculoskeletal model with subject-specific geometry estimated bodyweight (BW) normalized MTCF. Waveforms were analyzed using statistical parametric mapping with a repeated measures analysis of variance model. Peak MTCF, MTCF impulse and MTCF loading rates (discrete outcomes) were evaluated using a repeated measures multivariate analysis of variance model.
RESULTS
Statistical parametric mapping showed lower MTCF in stable supportive compared to flat flexible shoes during 5-18% of stance phase (p = 0.001). For the discrete outcomes, peak MTCF and MTCF impulse were not different between the shoe styles. However, mean differences [95%CI] in loading impulse (-0.02 BW·s [-0.02, 0.01], p<0.001), mean loading rate (-1.42 BW·s-1 [-2.39, -0.45], p = 0.01) and max loading rate (-3.26 BW·s-1 [-5.94, -0.59], p = 0.02) indicated lower measure of loading in stable supportive shoes compared to flexible shoes.
CONCLUSIONS
Stable supportive shoes reduced MTCF during loading stance and reduced loading impulse/rates compared to flat flexible shoes and therefore may be more suitable in people with medial knee osteoarthritis and varus malalignment.
TRIAL REGISTRATION
Australian and New Zealand Clinical Trials Registry (12619000622101).
目的
比较稳定支撑和平整灵活的步行鞋对内侧膝关节骨关节炎和内翻畸形患者内侧胫骨股骨接触力（MTCF）的影响。
设计
这是一项随机交叉研究。从社区招募了 28 名年龄≥50 岁、内侧膝关节骨关节炎和内翻畸形的患者参与本研究。在 6 次速度匹配的步行试验中，分别测试了稳定支撑和平整灵活的鞋子，采集了参与者的三维全身运动、地面反作用力和 12 块下肢肌肉的表面肌电图数据。使用基于肌电图的神经肌肉骨骼模型和个体特定的几何形状来估计体重（BW）归一化的 MTCF。使用重复测量方差分析模型的统计参数映射对波形进行分析。使用重复测量多元方差分析模型评估峰值 MTCF、MTCF 冲量和 MTCF 加载率（离散结果）。
结果
统计参数映射显示，在 5%-18%的站立阶段，稳定支撑鞋的 MTCF 低于平整灵活鞋（p=0.001）。对于离散结果，两种鞋型的峰值 MTCF 和 MTCF 冲量没有差异。然而，加载冲量的均值差异[95%置信区间]（-0.02 BW·s[-0.02，0.01]，p<0.001）、平均加载率（-1.42 BW·s-1[-2.39，-0.45]，p=0.01）和最大加载率（-3.26 BW·s-1[-5.94，-0.59]，p=0.02）表明，稳定支撑鞋的加载负荷测量值低于平整灵活鞋。
结论
与平整灵活的鞋子相比，稳定支撑鞋在负重站立时降低了 MTCF，并降低了加载冲量/速率，因此在患有内侧膝关节骨关节炎和内翻畸形的患者中可能更合适。
试验注册
澳大利亚和新西兰临床试验注册中心（12619000622101）。
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