全膝关节置换术对老年膝关节等速肌力曲线特征的影响

Effect of total knee arthroplasty on isokinetic muscle strength curve in knee joint of the aged

目的探究全膝关节置换术(total knee arthroplasty,TKA)对老年膝关节等速肌力曲线特征的影响。方法采集TKA术后一年和性别、年龄与之相匹配的健康人在180°/s、60°/s角速度下进行等速肌力测试和等长屈伸测试。采集屈伸肌群的峰力矩和腘绳肌/股四头肌比率(H/Q),并采用1°递增的平均力矩结果进行标准化(力矩/体质量)。结果TKA术后患者在180°/s的角速度下患侧屈膝力矩在16°至64°范围内低于健侧,在10°至83°范围内低于健康受试者同侧(P<0.05);60°/s的角速度下患侧屈膝力矩在72°至76°范围内低于健侧,在59°至87°范围内低于健康受试者同侧(P<0.05);患侧与健康受试者同侧等长屈膝力矩无统计学差异(P>0.05)。TKA术后患者在180°/s的角速度下患侧伸膝力矩、峰力矩、H/Q与健康受试者同侧均无统计学差异(P>0.05);60°/s的角速度下患侧伸膝力矩在68°至85°范围内低于健侧,在18°至37°和72°至81°范围内低于健康受试者同侧,患侧H/Q高于健康受试者同侧(P<0.05),两组伸展峰力矩和等长伸膝力矩无统计学差异(P>0.05)。结论TKA术后高速运动及关节活动末低速运动中患侧腘绳肌肌力下降,患侧股四头肌在关节活动起始和终末范围内低速运动中肌力下降。

Objective To explore the influence of total knee arthroplasty(TKA)on the isokinetic muscle strength curve of knee joints in the aged.Methods Patients underwent TKA one year after surgery and healthy people who matched in age and sex were selected.Isometric and isokinetic strength of knee flexion and extension at velocity of 180°/s and 60°/s was tested by isokinetic dynamometer.The peak moment and hamstring/quadriceps ratio(H/Q)of flexion and extension muscles were collected,normalized torqueangle curves(torque/body mass)were generated in steps of 1°.Results At 180°/s for patients after TKA,the flexion moment of the affected side was lower than that of the healthy side in the range of 16°to 64°and lower than that of the same side of the healthy subjects in the range of 10°to 83°(P<0.05);at 60°/s,the flexion moment of the affected side was lower than that of the healthy side in the range of 72°to 76°and lower than that of the healthy subjects in the range of 59°to 87°(P<0.05).There were also no significant differences in knee extension moment,the peak moment and H/Q between the affected side of patients and healthy subjects at 180°/s(P>0.05);at 60°/s,the knee extension moment on the affected side was lower than that on the healthy side in the range of 68°to 85°,and lower than that of the healthy subjects in the range of 18°to 37°and 72°to 81°,the H/Q on the affected side was higher than that of the healthy subjects(P<0.05).There was no significant difference in the peak moment and extension moment of isometric test between the affected side and the healthy subjects(P>0.05).Conclusions After total knee arthroplasty,the hamstring strength of the affected side decreased during high-speed and low-speed within the end range of joint movement,and the quadriceps strength of the affected side decreased during low-speed within the starting range of joint movement.