Fanget Quentin, Verdilos Anargyros, Adelou Samuel, Reynaud Vivien, Boisgard Stéphane, Descamps Stéphane, Pereira Bruno, Richard Ruddy, Coudeyre Emmanuel, Costes Frédéric
CHU Clermont Ferrand, Plateforme d'Exploration de la Mobilité, Pôle MOBEX, Université Clermont Auvergne, Clermont-Ferrand, France.
Service de Médecine Physique et Réadaptation, Pôle MOBEX, UNH, CHU Clermont Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France.
PLoS One. 2024 Dec 27;19(12):e0314524. doi: 10.1371/journal.pone.0314524. eCollection 2024.
In osteoarthritis quadriceps strength is an important outcome to assess exercise capacity and recovery after arthroplasty. However, its measurement is limited due to lack of time and the need for trained personnel and equipment whose accuracy is verified.
To find out the determinants of a reduced quadriceps strength and to establish a score to screen for it.
In an observational prospective study, we evaluated patients presenting with an unilateral knee (KOA) or a hip (HOA) osteoarthritis before a scheduled arthroplasty. We measured body composition, exercise capacity, muscle strength, balance, WOMAC score, quality of life and physical activity. Isometric maximal voluntary quadriceps force (MVCq) was determined on both lower limbs and a reduced strength was retained when at least one measurement was lower than 1 standard deviation of normal value.
We included 376 patients, 247 (66%) with KOA and 129 (34%) with HOA. Their mean age was 67±8 years, and mean BMI 31.4±6.9 kg/m2. MVCq was reduced in 217 (58%). Compared those with a preserved MVCq, these patients had a significant higher BMI and lean mass, a sex ratio (more men), an altered field physical tests and WOMAC score. The best logistic regression model for a decreased quadriceps force included pathology, age, sex, BMI, five sit to stand test (FTSST) and maximal gait speed (AUC was 0.87 [95%CI 0.83-0.90]). We developed a predictive equation for a reduced MVCq as follows: Y = 1/1+ exp[-(-0.051age -1.25max gait speed + 0.09FTSST + 0.16BMI + 1.1 (for KOA) + 2.41 (for male) -1.79].
MVCq is reduced with a high prevalence on patients with KOA or HOA. A low performance in one the selected field physical test associated with age and BMI allows to screen for those in whom a measurement of MVCq could be of interest before arthroplasty.
在骨关节炎中，股四头肌力量是评估关节置换术后运动能力和恢复情况的重要指标。然而，由于时间有限，且需要经过培训的人员以及经过准确性验证的设备，其测量受到限制。
找出股四头肌力量减弱的决定因素，并建立一个用于筛查的评分系统。
在一项前瞻性观察研究中，我们对计划进行关节置换术的单侧膝关节骨关节炎（KOA）或髋关节骨关节炎（HOA）患者进行了评估。我们测量了身体成分、运动能力、肌肉力量、平衡能力、WOMAC评分、生活质量和身体活动情况。在双下肢测定等长最大自主股四头肌力量（MVCq），当至少一次测量值低于正常值的1个标准差时，即认定为力量减弱。
我们纳入了376例患者，其中247例（66%）为KOA患者，129例（34%）为HOA患者。他们的平均年龄为67±8岁，平均体重指数为31.4±6.9kg/m²。217例（58%）患者的MVCq降低。与MVCq正常的患者相比，这些患者的体重指数和瘦体重显著更高，性别比（男性更多），现场体格检查结果异常，WOMAC评分更高。股四头肌力量降低的最佳逻辑回归模型包括疾病类型、年龄、性别、体重指数、五次坐立试验（FTSST）和最大步速（曲线下面积为0.87[95%置信区间0.83 - 0.90]）。我们建立了一个预测MVCq降低的方程如下：Y = 1/1 + exp[-(-0.051×年龄 - 1.25×最大步速 + 0.09×FTSST + 0.16×体重指数 + 1.1（用于KOA） + 2.41（用于男性） - 1.79]。
KOA或HOA患者中MVCq降低的患病率较高。在选定的现场体格检查中表现不佳，同时结合年龄和体重指数，有助于筛查出那些在关节置换术前可能需要测量MVCq的患者。
