髌股关节疼痛对老年人楼梯行走时髌股关节力学特征的影响

Effect of Patellofemoral Joint Pain on the Mechanical Characteristics of Patellofemoral Joint during Stair Walking in the Older Adults

目的:观察髌股关节疼痛(PFP)对老年人楼梯行走时髌股关节力学特征的影响,为PFP老年人制定合理的干预治疗策略提供理论支撑。方法:随机招募健康老年人和PFP老年人各22名,采用Qualisys红外动作捕捉系统和AMTI三维测力台同步采集两组受试者楼梯行走时的运动学和动力学数据,利用髌股关节接触力及冲量、髌股关节应力及冲量对老年人楼梯行走时的髌股关节力学特征进行量化评定。结果:与健康组相比,PFP组在上楼梯时表现出较小的髌股关节接触力冲量(P=0.030)、髌股关节应力(P=0.024)及冲量(P=0.004),在下楼梯时表现出较大的屈膝角度峰值(P=0.022)及较小的髌股关节应力冲量(P=0.067),其余指标未见显著性差异(P>0.05)。结论:PFP老年人在楼梯行走尤其是上楼梯过程中表现出较小的髌股关节力学特征,这可能是PFP老年人为提供足够的下肢支撑能力、降低髌股关节负荷而主动采取的自我保护策略。建议:PFP老年人注重下肢肌肉尤其是股四头肌的锻炼,同时采用更灵敏的髌股关节接触力冲量及应力冲量评价楼梯行走时的髌股关节负荷。

Objectives:This paper observed the effect of patellofemoral pain(PFP)on the mechanical characteristics of patellofemoral joint in the older adults during stair walking,and provided theoretical support for the formulation of reasonable intervention strategies for the elderly with PFP.Methods:Twenty-two healthy older adults and 22 PFP older adults were randomly recruited.The Qualisys Motion Capture System and AMTI OR6 Series were used to simultaneously collect the kinematics and dynamics data of the two groups of subjects during stair walking.The patellofemoral joint contact force and impulse,patellofemoral joint stress and impulse were used to quantitatively evaluate the patellofemoral joint mechanical characteristics of the elderly during stair walking.Results:Compared with the healthy group,the PFP group showed smaller patellofemoral joint contact force impulse(P=0.030),patellofemoral joint stress(P=0.024)and impulse(P=0.004)when going up the stairs,and showed larger knee flexion angle peak(P=0.022)and smaller patellofemoral joint stress impulse(P=0.067)when going down the stairs.There was no significant difference in other indicators(P>0.05).Conclusions:The PFP older adults showed less mechanical characteristics of the patellofemoral joint during stair walking,especially during stair climbing,which may be a self-protection strategy actively adopted by the PFP elderly to provide sufficient lower limb support and reduce the load of the patellofemoral joint.Suggestions:The PFP older adults pay attention to the exercise of lower limb muscles,especially the quadriceps femoris.At the same time,more sensitive patellofemoral joint contact force impulse and stress impulse are used to evaluate the patellofemoral joint load during stair walking.