前交叉韧带损伤后膝关节内侧间室有和无创伤后骨关节炎患者的髋关节生物力学研究

Hip biomechanics in patients with non-traumatic and post-traumatic knee osteoarthritis in medial compartment of the knee after anterior cruciate ligament injury

目的探究前交叉韧带(ACL)损伤和重建后早期(5年内)膝关节内侧间室有和无创伤性骨关节炎(OA)患者在髋关节生物力学方面是否存在差异。方法19例ACL损伤患者,在ACL重建手术前初始损伤明显缓释后(基线)、术前康复训练后、术后6个月、术后1年和术后2年共5个时点分别完成标准步态分析,术后5年完成负重膝关节影像学检查以识别是否存在膝关节内侧间室OA。结果19例患者在术后5年进行影像学检查,5例患者呈现患侧膝关节内侧间室OA影像学表现,14例患者无此表现。ACL重建术后5年,有膝OA患者的膝功能结果调查-日常生活能力量表(KOS-ADLS)评分(94.9±3.1)分、国际膝关节文献委员会主观膝部评估表(IKDC)评分(89.9±6.3)分、疼痛视觉模拟评分法(VAS)评分(0.2±0.4)分与无膝OA患者的(98.5±3.1)、(95.9±7.3)、(0.1±0.4)分比较,差异无统计学意义(P>0.05)。有膝OA患者在5个时点测得的髋屈角峰值均值(25.3±2.4)°低于无膝OA患者的(31.3±1.4)°,差异有统计学意义(P<0.05)。有膝OA患者第1年时髋屈角峰值肢间差值为(-2.1±1.3)°,低于无膝OA患者的(1.3±0.8)°,差异有统计学意义(P<0.05)。有膝OA患者在5个时点行走时患肢的不对称性髋关节内收力矩均值(-0.05±0.17)Nm/(kg·m)低于无膝OA患者的(0.09±0.13)Nm/(kg·m),差异有统计学意义(P<0.05)。结论ACL损伤重建后发生膝关节内侧间室OA的患者其髋关节生物力学可能会改变。

Objective To investigate the difference of hip biomechanics in patients with non-traumatic and post-traumatic knee osteoarthritis in medial compartment of the knee(OA)in the early stage(within 5 years)after anterior cruciate ligament(ACL)injury.Methods 19 patients with ACL injury completed standard gait analysis at 5 time points:after the initial injury was significantly relieved before ACL reconstruction(baseline),after preoperative rehabilitation training,6 months,1 year and 2 years after surgery,and weight-bearing knee imaging was completed 5 years after surgery to identify the presence of medial compartment osteoarthritis of the knee.Results 19 patients underwent imaging examination 5 years after surgery.5 patients showed the imaging manifestations of medial compartment osteoarthritis of the affected knee joint,and 14 patients had no such manifestations.5 years after ACL reconstruction,the knee outcome survey-activities of daily living scale(KOS-ADLS)score of patients with knee OA was(94.9±3.1)points,the international knee documentation committee knee evaluation form(IKDC)score was(89.9±6.3)points,and the visual analogue scale(VAS)score was(0.2±0.4)points,which were not statistically significant compared with(98.5±3.1),(95.9±7.3)and(0.1±0.4)points of patients without knee OA(P>0.05).The peak value of hip-flexion angle measured at 5 time points in patients with knee OA was(25.3±2.4)°,which was lower than(31.3±1.4)°in patients without knee OA,and the difference was statistically significant(P<0.05).The inter-limb difference between the peak hip-flexion angle of patients with knee OA at the first year was(-2.1±1.3)°,which was lower than(1.3±0.8)°of patients without knee OA,and the difference was statistically significant(P<0.05).Patients with knee OA had a lower asymmetric hip adduction moment(-0.05±0.17)Nm/(kg·m)in the affected limb than(0.09±0.13)Nm/(kg·m)of patients without knee OA,and the difference was statistically significant(P<0.05).Conclusion The hip biomechanics of patients with medial compartment osteoarthritis of the knee after ACL injury reconstruction.