膝关节面夹角和股胫角对膝骨关节炎患者步态的影响

Influence of knee joint surface angle and femorotibial angle on gait of patients with knee osteoarthritis

目的:探讨膝关节面夹角和股胫角对膝骨关节炎(knee osteoarthritis,KOA)患者步态的影响。方法:纳入KOA患者72例,男34例、女38例,左侧33例、右侧39例,年龄(62. 8±7. 2)岁,病程(12. 54±6. 37)年。拍摄负重位膝关节X线片,测量患侧膝关节面夹角和股胫角;并进行步态分析测试,记录步速及患侧步长、步角、支撑期时间、支撑期百分数等步态参数。分别依据膝关节面夹角和股胫角测量结果将患者分组,对各组患者的步态参数进行比较。结果:72例患者,患侧膝关节面夹角0. 2°～7. 8°,中位数3. 1°(<1. 0°13例,1. 0°～3. 5°34例,3. 6°～8. 0°25例);股胫角170°～186°,中位数178°(170°～176°18例,177°～180°31例,181°～187°23例)。不同膝关节面夹角患者的步角、步速、步长比较,组间差异均有统计学意义[12. 28°±3. 43°,15. 43°±3. 83°,20. 50°±2. 72°,F=18. 571,P=0. 000;(70. 59±9. 88) cm·s^(-1),(62. 15±11. 47) cm·s^(-1),(41. 10±7. 90) cm·s^(-1),F=27. 621,P=0. 000;(55. 71±4. 87) cm,(51. 94±4. 17) cm,(36. 78±7. 14) cm,F=40. 272,P=0. 000]。膝关节面夹角<1. 0°患者的步角小于膝关节面夹角1. 0°～3. 5°和3. 6°～8. 0°的患者(P=0. 030,P=0. 000),膝关节面夹角1. 0°～3. 5°患者的步角小于膝关节面夹角3. 6°～8. 0°的患者(P=0. 001)。膝关节面夹角3. 6°～8. 0°患者的步速、步长均小于膝关节面夹角<1. 0°和1. 0°～3. 5°的患者(P=0. 000,P=0. 000; P=0. 000,P=0. 000),膝关节面夹角<1. 0°患者的步速、步长与膝关节面夹角1°～3. 5°患者相比,差异均无统计学意义(P=0. 053,P=0. 154)。不同膝关节面夹角患者的步态支撑期时间、支撑期百分数的组间差异均无统计学意义[(0. 79±0. 06) s,(0. 86±0. 71) s,(0. 87±0. 12) s,F=0. 811,P=0. 453;(63. 92±6. 34)%,(64. 74±8. 37)%,(66. 74±7. 31)%,F=0. 421,P=0. 660]。不同股胫角患者的步角、步速、步长、支撑期时间、支撑期百分数比较,组间差异均无统计学意义[16. 42°±4. 88°,13. 93°±3. 57°,17. 04°±5. 43°,F=1. 311,P=0. 283;(56. 71±15. 72) cm·s^(-1),(66. 24±11. 13) cm·s^(-1),(55. 38±17. 72) cm·s^(-1),F=1. 983,P=0. 154;(48. 63±9. 92) cm,(53. 51±3. 92) cm,(44. 85±11. 54) cm,F=3. 294,P=0. 051;(0. 90±0. 10) s,(0. 82±0. 08) s,(0. 90±0. 15) s,F=1. 838,P=0. 175;(64. 93±1. 37)%,(64. 54±0. 89)%,(65. 62±1. 64)%,F=1. 851,P=0. 173]。结论:KOA患者患侧膝关节面夹角越大,步角越大、步速越慢、步长越短,步态支撑期时间、支撑期百分数则无明显变化;而股胫角的大小对KOA患者步态无明显影响。

Objective ：To explore the influence of knee joint surface angle and femorotibial angle on gait of patients with knee osteoar- thrifts（KOA）. Methods ：Seventy- two patients with KOA were enrolled in the study and they consisted of 34 males and 38 females. Their ages were 62.8 ＋/- 7.2 years and disease courses were 12.54 ＋/- 6.37 years. The KOA located in left knee for 33 patients and right knee for 39 patients. The X-ray films of affected knee in weight - bearing position were taken, and the knee joint surface angle and femorotibial angle of affected knee were measured on the X-ray films. Moreover, the gait analysis was performed on all patients, and the gait parameters including gait speed, step length, step angle, support phase time and percentage of support phase were measured and recorded. The patients were divided into different groups according to knee joint surface angle and femorotibial angle respectively, and the gait parameters were compared between different groups. Results ：The knee joint surface angle ranged from 0.2 to 7.8 degrees with a median of 3.1 degrees （ 〈 1.0 degree（13）, 1.0- 3.5 degrees（34）,3.6 -8.0 degrees（25））,and the femorotibial angle ranged from 170 to 186 degrees with a median of 178 degrees（ 170 - 176 degrees（ 18）, 177 - 180 degrees（ 31 ）, 181 - 187 degrees（23 ） ）. There was statistical difference in step angle,gait speed and step length between patients with different knee joint surface angles（ 12.28 ＋/-3.43,15.43 ＋/-3.83,20. 50 ＋/- 2.72 degrees,F = 18.571,P =0. 000;70. 59 ＋/-9.88,62.15 ＋/- 11.47,41.10 ＋/-7.90 cm/s,F =27. 621 ,P =0. 000;55.71 ＋/-4.87, 51.94 ＋/-4.17,36.78 ＋/-7.14 cm, F = 40.272,P = 0. 000）. The step angles were smaller in patients with knee joint surface angle of 〈 1.0 degree compared to patients with knee joint surface angles d 1.0 - 3.5 degrees and 3.6 - 8.0 degrees （ P = 0. 030, P = 0. 000） , and were smaller in patients with knee joint surface angle of 1.0 - 3.5 degrees compared to patients with knee joint surface angle of 3.6 - 8.0 de- grees（ P = 0.001 ）. The gait speed and step length were smaller in patients with knee joint surface angle of 3.6 - 8.0 degrees compared to patients with knee joint surface angle of 〈 1.0 degree and 1.0 -3.5 degrees（ P = 0.000, P = 0.000 ;P = 0.000, P = 0.000）, and there was no statistical difference in gait speed and step length between patients with knee joint surface angle of 〈 1.0 degree and patients with knee joint surface angle of 1.0 - 3.5 degrees（P = 0.053,P = 0. 154）. There was no statistical difference in gait support phase time and percent- age of support phase between patients with different knee joint surface angles（0.79 ＋/-0.06,0. 86 ＋/-0.71,0. 87 ＋/-0. 12 seeonds,F = 0. 811 ,P =0. 453 ;63.92 ＋/-6.34,64.74 ＋/- 8.37,66.74 ＋/-7.31% ,F =0. 421 ,P =0.660）. There was no statistical difference in step angle,gait speed, step length, support phase time and percentage of support phase between patients with different femorotibial angles （ 16.42 ＋/-4.88,13.93 ＋/- 3.57,17.04 ＋/- 5.43 degrees, F = 1. 311, P = 0. 283 ;56.71 ＋/- 15.72,66.24 ＋/- 11. 13,55.38 ＋/- 17.72 cm/s, F = 1. 983,P = 0. 154 ; 48.63 ＋/- 9.92,53.51 ＋/- 3.92,44.85 ＋/- 11.54 cm, F = 3. 294, P = 0.051 ; 0.90 ＋/- 0. 10, 0.82 ＋/- 0.08,0.90 ＋/- 0.15 seconds, F = 1. 838, P = 0. 175 ; 64.93 ＋/- 1.37,64.54 ＋/- 0.89,65.62 ＋/- 1.64%, F = 1. 851, P = 0. 173 ）. Conclusion：For patients with KOA,the larger the knee joint surface angle of affected knee is, the larger the step angle is and the slower the gait speed is and the shorter the step length is, and there are no obvious change in gait support phase time and percentage of sup- port phase;while the femorotibial angle has no obvious effect on gait of patients with KOA.