FAI和Coper患者踝关节扭伤相关动作中的下肢运动生物力学特征

Biomechanical Characteristics of Lower Limb Movements under Ankle Sprain-Related Motions in FAI and Coper Patients

目的:探讨功能性踝关节不稳定(functional ankle instability,FAI)患者、Coper患者及健康人群在完成踝关节扭伤相关动作时踝关节运动生物力学特征及功能补偿机制的差异,了解与FAI患者重复扭伤相关的运动特征。方法:运用红外光点运动捕捉系统(Nokov Mars2H)和三维测力台(Bertec)获得FAI患者(n=10)、Coper患者(n=10)和健康人群(n=10)完成急停侧切、急停起跳、单腿落地3个动作时的下肢运动学和动力学数据。采用3×3双因素混合设计方差分析检验不同动作和人群对下肢运动生物力学特征的影响。结果:不同动作和人群对踝关节跖屈角(P=0.039)、踝关节内翻角(P=0.001)、髋关节矢状面活动度(range of motion,ROM)(P=0.044)、膝关节矢状面ROM(P=0.045)、垂直地面反作用力(ground reaction force,GRF)峰值(P=0.015)和膝关节能量吸收(P=0.050)的交互作用显著。单腿落地时,FAI患者比Coper患者(P=0.027)和健康人群(P=0.012)表现出更大的踝关节跖屈角。急停侧切时,FAI患者表现出更大的踝关节内翻角速度(Coper患者:P=0.011;健康人群:P=0.017)、膝关节矢状面ROM(Coper患者:P=0.050;健康人群:P=0.002)、膝关节能量吸收(Coper患者:P=0.049;健康人群:P=0.042)。单腿落地时,FAI患者的踝关节矢状面ROM较Coper患者(P=0.001)和健康人群(P=0.004)更大,踝关节能量吸收呈增加趋势(P=0.110)。此外,Coper患者单腿落地时的垂直GRF在11.6%~13.2%动作周期显著低于FAI患者(P=0.037),在9.8%~12.9%动作周期显著低于健康人群(P=0.019)。结论:Coper患者在扭伤后表现出与健康人群类似的运动特征。FAI患者与Coper患者和健康人群相比,在单腿落地和急停侧切时表现出踝关节跖屈角、踝关节内翻角速度、踝关节矢状面ROM、膝关节矢状面ROM和膝关节能量吸收增加等运动特征变化,可能与FAI患者重复扭伤有关。建议FAI患者在训练时除加强踝关节训练外,还需强化膝关节伸肌力量训练,改善下肢着地运动模式,使各关节更有效缓冲GRF。

Objective:To investigate the differences in ankle biomechanical characteristics and functional compensation mechanism of ankle movement among functional ankle instability(FAI)patients,Coper patients,and healthy people when completing ankle sprain-related movements,to clarify the kinetic characteristics associated with repetitive sprains in FAI patients.Methods:The infrared kinematics measurement system(Nokov Mars2H)and a three-dimensional dynamometer(Bertec)were used to collect the lower limb kinematic and kinetic data of FAI patients(n=10),Coper patients(n=10),and healthy participants(n=10)during stop-side-cutting,stop-jumping,and single-leg landing motions.A two-way ANOVA with a 3×3 mixed design was used to analyze the effects of motions and types of subjects on the biomechanical characteristics of lower limb movements.Results:Different motions and types of subjects have significant interactive effects on ankle plantarflexion angle(P=0.039),ankle inversion angle(P=0.001),range of motion(ROM)of the hip sagittal plane(P=0.044),ROM of the knee joint sagittal plane(P=0.045),peak vertical ground reaction force(GRF,P=0.015),and knee energy absorption(P=0.050).During single-leg landing,FAI patients show a greater ankle plantarflexion angle than Coper patients(P=0.027)and the healthy participants(P=0.012).During stop-side cutting,FAI patients show greater ankle inversion angular velocity(Coper patients:P=0.011;healthy participants:P=0.017),ROM of knee joint sagittal plane(Coper patients:P=0.050;healthy participants:P=0.002),and knee joint energy absorption(Coper patients:P=0.049;healthy participants:P=0.042).During single-leg landing,ROM of the ankle sagittal plane is greater in FAI patients compared to Coper patients(P=0.001)and healthy participants(P=0.004),and the ankle energy absorption shows an increasing trend(P=0.110).In addition,the vertical GRF during single-leg landing is significantly lower in Coper patients than in FAI pa‐tients at 11.6%to 13.2%motion circle(P=0.037),and it is significantly lower in Coper patients than in healthy participants at 9.8%to 12.9%motion circle(P=0.019).Conclusions:Coper pa‐tients show similar movement patterns to the healthy participants after the sprain.Compared with Coper patients and healthy participants,FAI patients show changes in movement character‐istics such as increased ankle plantarflexion angle,ankle inversion angular velocity,ROM of the ankle sagittal plane,ROM of the knee sagittal plane,and knee joint energy absorption during single-leg landing and stop-side-cutting,which may be related to repetitive sprains in FAI pa‐tients.It is suggested that in addition to strengthening ankle training,FAI patients should also strengthen knee extensor strength training,improve the lower limb landing movement patterns,and make each joint more effective in buffering GRF.