功能性踝关节不稳男性下蹲跳过程中下肢的生物力学特征

Biomechanical characteristics of lower extremities during counter movement jump in male patients with functional ankle instability

背景:踝关节作为人体的末端承重关节,承受着机体自上而下的压力,这导致踝关节在运动中很容易发生损伤,诱发功能性踝关节不稳,对日常生活造成负面影响。研究功能性踝关节不稳患者在下蹲跳过程中的下肢生物力学表现,对实现科学训练、预防踝关节损伤以及伤后临床康复提供理论参考具有重要意义。目的:探究功能性踝关节不稳患者下蹲跳过程中的下肢运动学与动力学特征。方法:于2023年3-9月在苏州大学招募男性功能性踝关节不稳患者与健康人群各15名,年龄22-28岁,所有受试者均完成下蹲跳试验。采用Vicon红外高速运动捕捉系统和Kistler三维测力台对两组受试者在下蹲跳起跳阶段、离地瞬间时刻、初始着地时刻和垂直地面反作用力峰值时刻的下肢运动学和动力学指标进行同步采集及对比分析。结果与结论:(1)离地瞬间时刻,与健康对照组的匹配侧相比,功能性踝关节不稳组患侧显示出了更小的膝关节内旋力矩(P=0.020)、更小的踝关节内旋力矩(P=0.009)。(2)落地瞬间时刻,与健康对照组的匹配侧相比,功能性踝关节不稳组患侧显示出了更小的髋关节屈曲角度(P=0.039);功能性踝关节不稳组相较于健康对照组显示出了更小的髋关节外展角度(P=0.022)、更小的膝关节内翻角度(P=0.010)、更大的膝关节外旋角度(P=0.021)、更小的踝关节内翻角度(P=0.004)、更小的踝关节外旋角度(P=0.008)。(3)垂直地面反作用力峰值时刻,功能性踝关节不稳组相较于健康对照组显示出了更小的踝关节内翻角度(P=0.044);(4)结果说明,功能性踝关节不稳者在下蹲跳动作中相较于健康人群存在异常的下肢生物力学特征,主要表现为离地与落地瞬间时刻,下肢关节在矢状面和额状面的运动学和动力学指标变化。这些改变反映出功能性踝关节不稳人群在执行下蹲跳时采用了僵硬的起跳与着陆模式,倾向于将患侧踝关节负荷转移至下肢其他关节,并显示出健侧下肢的代偿现象。因此,检测和纠正异常生物力学特征应该成为功能性踝关节不稳者康复训练的一部分。

BACKGROUND:As the end bearing joint of the human body,the ankle joint bears the top-down pressure of the body,which leads to the ankle joint is easy to be damaged in the movement,can induce functional ankle instability,which negatively affects daily life.The study of lower extremity biomechanics in patients with functional ankle instability during counter movement jump is of great significance for scientific training,prevention of ankle injury,and clinical rehabilitation after injury.OBJECTIVE:To investigate the kinetics and kinematics of lower limbs in the longitudinal jumping of functional ankle instability population.METHODS:From March to September 2023,15 male patients with functional ankle instability and 15 healthy people,aged 22-28 years old,were recruited in Soochow University.All subjects completed counter movement jump experiment.Vicon infrared high-speed motion capture system and Kistler three-dimensional force measuring table were used to simultaneously collect the lower limb kinematics and kinetics indexes of the two groups of subjects at the take-off stage of counter movement jump,the instant off the ground,the initial landing moment and the peak moment of vertical ground reaction force.RESULTS AND CONCLUSION:(1)At the instant off the ground,the affected side of the functional ankle instability group showed smaller knee internal rotation moment(P=0.020)and smaller ankle internal rotation moment(P=0.009)compared with the affected side of the healthy control group.(2)At the moment of landing,the affected side of the functional ankle instability group showed a smaller hip flexion angle than the affected side of the healthy control group(P=0.039).Compared with the healthy control group,functional ankle instability group showed smaller hip abduction angle(P=0.022),smaller knee varus angle(P=0.010),larger knee external rotation angle(P=0.021),smaller ankle varus angle(P=0.004),and smaller external ankle rotation angle(P=0.008).(3)At the peak of vertical ground reaction force,functional ankle instability group showed a smaller ankle varus angle than healthy control group(P=0.044).(4)The results showed that the lower limb biomechanical characteristics of the patients with functional ankle instability were abnormal compared with the healthy people during counter movement jump,which mainly showed the changes of the kinematics and kinetics indexes of the lower limb joints in the sagittal plane and the frontal plane at the moment of lift-off and landing.These changes reflect that people with functional ankle instability adopt rigid take-off and landing patterns when performing counter movement jump,tend to transfer the load of the affected ankle joint to other joints of the lower limb,and show compensatory phenomenon of the healthy lower limb.Therefore,detection and correction of abnormal biomechanical features should be a part of rehabilitation training for those with functional ankle instability.