膝骨关节炎女性伸膝肌力、步态时空参数与峰值膝关节屈曲/内收力矩关系

Correlation of knee extensor muscle strength and spatiotemporal gait parameters with peak knee flexion/adduction moment in female patients with knee osteoarthritis

背景:已有研究表明膝骨关节炎患者的膝关节力矩会发生改变,但对于力矩变化与伸膝肌力及步态时空参数之间的相关性报道较少。目的:探索女性膝骨关节炎患者伸膝肌力及步态时空参数与峰值膝关节屈曲/内收力矩之间的相关性。方法:选取2022年2-8月在北京积水潭医院贵州医院住院治疗的20例单膝患病女性膝骨关节炎患者作为膝骨关节炎组,另外选取20例无肌肉骨骼疾病的女性健康人作为对照组。利用Biodex等速仪测量60(°)/s向心伸膝肌力,并采用意大利BTS红外运动捕捉系统和测力台采集步态时空参数和峰值膝关节屈曲力矩和膝关节内收力矩。通过Pearson相关性分析探索肌力、步态时空参数和峰值膝关节内收力矩和膝关节屈曲力矩的关联,并进一步将与膝关节力矩显著相关的变量纳入多元逐步回归分析。结果与结论:①与对照组相比,膝骨关节炎组60(°)/s向心伸膝肌力、步速、步频、步长以及峰值膝关节屈曲力矩均更低(P<0.05);②Pearson相关性分析结果显示60(°)/s向心伸膝肌力、步速、步频、步长与峰值膝关节屈曲力矩呈正相关,与峰值膝关节内收力矩呈负相关,差异有显著性意义(P<0.05);③多元逐步回归结果显示,步速和60(°)/s向心伸膝肌力是峰值膝关节屈曲力矩的最强预测因子,其中两因素合计的R^(2)值为0.426,表明可解释该参数方差总变异的42.6%;步长和60(°)/s向心伸膝肌力是峰值膝关节内收力矩的最强预测因子,两因素合计的R^(2)值为0.602,表明可解释该参数方差总变异的60.2%;④结果提示,伸膝肌力、步速和步长是影响峰值膝关节内收力矩和膝关节屈曲力矩的主要变量;这些变量可用于临床步态监测和指导,以在膝骨关节炎康复期间改变膝关节负荷。

BACKGROUND:Previous studies have shown that knee joint moment changes in patients with knee osteoarthritis,but there are few reports on the correlation of moment changes with knee extensor muscle strength and gait spatiotemporal parameters.OBJECTIVE:To explore the correlation of knee extensor muscle strength and gait spatiotemporal parameters with peak knee flexion moment and knee adduction moment in female patients with knee osteoarthritis.METHODS:Twenty knee osteoarthritis female patients with single knee disease hospitalized in Guizhou Hospital,Beijing Jishuitan Hospital from February to August 2022 were selected as the knee osteoarthritis group,and an additional 20 healthy females without musculoskeletal disease were selected as the control group.The knee extensor force at 60(°)/s was measured with the Biodex isokinetic instrument.The gait spatiotemporal parameters and peak knee flexion moment and knee adduction moment were collected with the Italian BTS infrared motion capture system and force measuring platform.Pearson correlation analysis was used to explore the correlation of muscle strength and gait spatiotemporal parameters with peak knee adduction moment and knee flexion moment,and the variables significantly related to knee joint moment were further included in the multiple stepwise regression analysis.RESULTS AND CONCLUSION:(1)Compared with the control group,the knee osteoarthritis group had significantly lower knee extensor force,step speed,step frequency,step length,step width,peak knee adduction moment and knee flexion moment at 60(°)/s(P<0.05).(2)Pearson correlation analysis showed that the 60(°)/s centripetal extensor force,step speed,step frequency and step length were positively correlated with the peak knee flexion moment,and negatively correlated with the peak knee adduction moment,with a statistically significant difference(P<0.05).(3)The results of multiple stepwise regression showed that step speed and 60(°)/s knee extensor force were the strongest predictors of peak knee flexion moment,and the total R^(2) value of the two factors was 0.426,indicating that 42.6%of the total variance of this parameter could be explained.Step length and 60(°)/s centripetal extensor force were the strongest predictors of peak knee adduction moment.The total R^(2) value of the two factors was 0.602,indicating that 60.2%of the total variance of this parameter could be explained.(4)It is concluded that knee extensor strength,step speed and step length are the main variables affecting peak knee adduction moment and knee flexion moment.Therefore,these variables can be used for clinical gait monitoring and guidance to change knee joint load during knee osteoarthritis rehabilitation.