基于“筋骨失衡”理论探讨膝骨关节炎患者步行时下肢生物力学变化特征

Exploration on the biomechanical characteristic of the patients with knee osteoarthritis during walking based on the ‘Jinggu imbalance’ theory

中医理论认为膝骨关节炎的发生及发展往往由“筋”的功能异常开始,而由“筋伤”所导致的“筋骨失衡”是该病发生和发展的主要因素之一。生物力学研究表明,步行过程中膝关节力学环境异常是膝骨关节炎发病的主要因素,而膝关节周围屈伸肌群的收缩模式的异常变化与关节局部应力增高存在密切联系,两种理论存在相似之处。文章以“筋骨失衡”理论体系为指导,以筋骨相互作用为切入点,从肌动学、动力学、运动学3个不同的角度探讨膝骨关节炎患者步行时下肢的生物力学特征,主要表现为:(1)肌动学:膝关节周围屈伸肌群的协同收缩增加及髋关节外展肌群肌力下降;(2)动力学:膝关节内收力矩峰值、膝关节内收角冲量及膝关节屈曲力矩显著增高;(3)运动学:足跟首次着地瞬间屈膝角度增高,膝关节矢状面活动范围减小,膝关节内翻、外旋以及及支撑相早期内旋角度增高。而这一系列变化都互为联系,且与KOA患者的临床症状关系密切。因此,文章以“筋骨失衡”理论为切入点,借助生物力学技术,探讨膝骨关节炎患者步行时下肢生物力学特征,旨在为膝骨关节炎的防治提供新策略。

Based on the traditional Chinese medicine(TCM) theory,the progression and development of knee osteoarthritis(KOA) were correlated with the impaired of ‘Jin’,moreover,the ‘Jingu imbalance’ caused by the impaired of ‘Jin’was one of the most important risk factors of KOA.Biomechanical studies indicated that the abnormal mechanical environment of the knee joint during walking is the main factor in the pathogenesis of KOA.Additionally,abnormal changes in the contraction pattern of the flexor and extensor groups around the knee joint are closely related to the increased local stress in the joint.There are many similarities between the TCM and the biomechanical theory.Guided by the theoretical system of ‘Jingu imbalance’,the article discusses the biomechanical characteristics of patients with KOA during walking from three different perspectives:kinesiology,kinetic and kinematics,with the interaction of muscles and bones as the starting point,which are mainly as follows:(1)kinesiology:higher flexor and extensor groups co-contraction around knee and decreased hip abductor strength;(2)kinetic:increased peak external knee adduction moment,knee adduction angular impulse,and external knee flexion moment;(3)kinematic:increased knee flexion at initial contact,decreased knee range of motion at sagittal plane,and increased knee adduction,external rotation and internal rotation angle at early stance phase.This series of changes are interrelated and closely related to the clinical symptoms of KOA patients.The purpose of the study was to discuss the kinesiology,kinetics,and kinematics characteristic of the individuals with KOA based on the ‘Jingu imbalance’ TCM theory,which can help to further understand the ‘Jingu imbalance’TCM theory and provide new ideas for the prophylaxis and treatment of KOA.