不同海拔世居藏族膝骨关节炎患者足底压力特征研究

Study on plantar pressure characteristics of Tibetan knee osteoarthritis patients living at different altitudes

目的分析不同海拔患者足底压力变化,为高原世居藏族膝骨关节炎患者提供足底压力变化的量化依据。方法选取2023年3—8月西藏自治区第二人民医院进行全膝关节置换的膝骨关节炎患者94例,依据患者长期居住地进行海拔分类,海拔3000~3700 m为29例,3701~4500 m为38例,4501~5500 m为27例。使用LorAn足底压力测试系统进行静态站立和动态行走分析,运用Spearman分析方法分析不同海拔梯度与足底压力之间的相关性。结果患者置换侧与未置换侧拇趾(T1)、足内侧(MH)、足外侧(LH)区域差异有统计学意义(P<0.05);患者静态指标、置换侧与未置换侧足轴角、骨盆旋转度、步行速度及患者关节评分在不同海拔间差异有统计学意义(P<0.05);患者静态站立与动态行走指标与海拔高度呈负相关关系(P<0.05);患者关节评分与海拔高度呈正相关(P<0.05);患者足底T1和第4跖骨(M4)区域足底压强峰值以及第5跖骨(M5)区域受力时间比与海拔高度呈负相关关系(r=-0.287、-0.282、-0.252,P<0.05);患者BMI与足中部和后足部压强峰值呈正相关(r=0.330、0.238、0.226,P<0.05)。结论足底压强峰值的变化可作为监测不同海拔世居藏族膝骨关节发生指标;高海拔地区世居藏族膝骨关节炎患者平衡能力较特高海拔患者差。

Objective To analyze the changes of plantar pressure in patients with different altitudes,and to provide a quantitative basis for the changes of plantar pressure in patients with Tibetan knee osteoarthritis(KOA)living in the plateau.Methods Patients with knee osteoarthritis who underwent total knee arthroplasty in the Second People's Hospital of Tibet Autonomous Region from March to August 2023,were selected according to their long-term residence,and 29 cases were classified according to their long-term residence,29 cases were 3000-3700 m,38 cases were 3701-4500 m,and 27 cases were 4501-5500 m.Static standing and dynamic walking analysis was performed using the LorAn plantar pressure test system,and the correlation between different elevation gradients and plantar pressure were analyzed by Spearman method.Results There were significant differences in T1,MH and LH between the replaced and non-replaced sides(P<0.05).Differences in patient static indices,foot-axis angle between replacement and non-replacement sides,pelvic rotation,walking speed,and patient joint scores were statistically significant between elevations(P<0.05).The static standing and dynamic walking indexes were negatively correlated with altitude(P<0.05),joint scores were positively correlated with altitude(P<0.05),plantar pressure peaks in T1 and M4 regions and stress time ratios in M5 region were negatively correlated with altitude(r=-0.287,-0.282,-0.252,P<0.05),and BMI were positively correlated with mid-foot and post-foot pressure peaks(r=0.330,0.238,0.226,P<0.05).Conclusion The change of the peak plantar pressure can be used as an indicator to monitor the occurrence of knee joints in Tibetan people living at different altitudes.Tibetan patients with osteoarthritis of the knee who live at high altitudes have poor balance compared with patients at very high altitudes.