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

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)；(2)Pearson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...     

对女子手球运动员膝关节屈伸肌群进行等速测试

目的对广东省女子手球队运动员膝关节进行等速向心测试,探讨手球项目运动员膝关节屈伸肌群等速测试特征,为手球项目运动员的力量训练和相关的体育科研提供参考。方法运用CON-TREX等速测试系统对14名广东省女子手球运动员的膝关节进行等速向心测试,选取相对峰力矩、屈伸肌峰力矩比值、平均功率、总功和疲劳指数5个指标来研究手球项目运动员膝关节屈伸肌群的等速测试特征。选取独立样本t检验比较屈肌和伸肌的测试结果。结果膝关节伸肌相对峰力矩值在慢速测试(60°/s)和快速测试(240°/s)时均明显大于屈肌(P<0.01);女手队员膝关节屈伸肌峰力矩比值在快速测试(240°/s)时为76%左右;膝关节屈伸肌平均功率和总功在慢速测试(60°/s)时表现为伸肌大于屈肌(P<0.01),在快速测试(240°/s)时表现为左膝关节伸肌大于屈肌(P<0.05);女手队员膝关节屈伸肌疲劳指数范围在0～0.49之间。结论女手队员膝关节伸肌的最大力量和快速力量大于屈肌;女手队员膝关节屈伸肌峰力矩比值在快速测试(240°/s)时略微偏低,说明女手队员膝关节屈肌快速力量偏低;女手队员膝关节伸肌的快速力量和肌肉工作能力均大于屈肌;女手队员膝关节屈伸肌疲劳指数偏低,说明女手队员膝关节屈伸肌的力量耐力水平比较低。     

人体膝关节的力矩参数

背景：由于人体运动过程复杂,难以用直接的方法来测量膝关节各项力学参数,所以,通常使用模拟或根据逆向动力学推算的方式来求得所需参数值。 目的：总结和比较膝关节力矩参数的测定方法,找出一种合理、可靠性高、实用性广的方法。 方法：应用计算机检索CNKI,万方数据库,Elsevier公司的Science Direct电子期刊关于膝关节力矩参数测试方法的文献,以“膝关节,力矩,等速测力法,拉格朗日建模,神经网络建模”及“knee joint,torque,isokinetic dynamometer,lagrangian modeling,neural network modeling”为检索词进行检索。纳入文章内容与人体膝关节力矩参数相关,同一领域文献则选择近期发表或发表在权威杂志文章。 结果与结论：检索文献量总计123篇,排除重复性研究,初检得到75篇文献,阅读标题和摘要进行初筛,共保留其中的35篇归纳总结。结果表明,等速测力虽是主流方法,但是存在可靠性不够高的问题,且相应的等速测力仪价格昂贵,而朗格朗日建模与神经网络建模可以通过改变各自的模型来达到期望的要求,故有更大的可靠性与实用性,后者有更大的发展前景。     

不同硬度楔形鞋垫对膝关节内翻力矩的影响

目的研究不同硬度楔形鞋垫在步行状态下对膝关节内翻力矩的影响。方法 15名健康成年男性受试者穿着不同硬度楔形鞋垫进行步态测试,通过光学运动捕捉系统和地面测力板收集运动学和动力学数据,经Visual3D软件计算得出膝关节内翻力矩,分析在3种不同步行状况下(仅穿鞋、鞋中放入软、硬楔形鞋垫)膝关节内翻力矩峰值的差异。结果与较软的楔形鞋垫相比,较硬的楔形鞋垫可使膝关节内翻力矩的第1个峰值降低9.3%,第2个峰值降低9.7%,差异具有统计学意义。结论楔形鞋垫增加一定的硬度能更多降低膝关节内侧间室的压力,减轻关节面的磨损,从而可能缓解膝关节炎症状。     

膝骨关节炎与膝关节伸、屈肌群肌力的相关性研究

目的通过研究膝骨关节炎(knee osteoarthritis,KOA)症状及病变阶段与膝关节伸、屈肌群肌力的相关性,探讨KOA患者肌力训练的关键肌群。方法社区募集健康老年人、单膝KOA患者、双膝KOA患者共99位志愿者,应用膝关节等速肌力测试、WOMAC评分、6 min步行测试、CS-30测试,分析志愿者膝关节伸、屈肌群峰力矩与KOA症状、全身有氧运动能力、关节功能等的相关性。结果单膝KOA组患者患侧膝关节伸肌群等速峰力矩显著低于健侧。双膝KOA组患者症状严重侧和症状较轻侧膝关节伸、屈肌群等速峰力矩差异均有统计学意义。双膝KOA组患者膝关节伸肌群等速峰力矩显著低于健康组。KOA患者膝关节伸、屈肌群等速峰力矩与CS-30测试、6 min步行测试均呈正相关,均与年龄呈负相关;膝关节伸肌群等速峰力矩与WOMAC评分的疼痛和功能障碍项呈负相关。结论膝关节伸、屈肌群均与KOA相关,KOA康复过程中不仅需重视股四头肌等伸肌群的训练,而且要兼顾腘绳肌、腓肠肌等屈肌群的训练。     

清创后自体血PRP注射治疗双侧膝关节假体周围感染合并窦道形成1例

人工膝关节置换术(total knee arthroplasty,TKA)已被广泛应用于治疗终末期膝关节骨性关节炎[1].虽然TKA在很大程度上缓解了患者的疼痛,但也可能发生膝关节假体周围感染,目前膝关节假体周围感染国外报道的发生率依然在1.0％左右[2],国内报道的感染率约为1.5％[3],一旦发生假体周围感染,对人...     

小学生膝关节屈伸肌力的等速测试

背景：以往对小学生下肢力量发育的评估,主要局限于立定跳远和纵跳摸高等身体素质的测量,缺乏对其肌肉功能的定量性研究。 目的：通过小学生膝关节屈伸肌力发展现状进行测试分析,正确认识小学生关节肌肉力量发育特征。 方法：运用“Kinitech”等速肌力测试系统对随机抽取石家庄市年龄为9~12岁的54名健康小学生(男25例、女29例)膝关节屈伸肌群进行60,120,240 (°)/s三种速度测试。 结果与结论：小学生膝关节屈、伸肌群峰力矩均呈现随测试速度增加而下降的现象;男、女生左侧屈肌群在60,120 (°)/s时及右侧屈肌群在60 (°)/s时,峰力矩低于伸肌群峰力矩(P < 0.01或P < 0.05)。同一测试速度下,在测试速度为240 (°)/s时,男生左侧屈、伸肌群及右侧屈肌群峰力矩明显高于女生(P < 0.01或P < 0.05)。     

膝骨关节炎患者本体感觉特征

目的 探讨行单髁膝关节置换术(unicondylar knee arthroplasty,UKA) 和全膝关节置换术(total knee arthroplasty,TKA)膝骨关节炎( knee osteoarthritis,KOA)患者术前膝关节本体感觉特征。方法 选取单间室KOA患者29名,15例接受 UKA 治疗（UKA组）,14例接受 TKA 治疗（TKA组）。术前1~3 d进行测试,对比UKA、TKA组KOA患者膝关节学会评分（knee society score, KSS）以及手术组与健康对照组的位置觉和运动觉特征。结果 UKA、TKA组之间KSS评分有显著差异,位置觉和运动觉无显著差异;UKA、TKA组患者术侧腿和未术侧腿之间位置觉和运动觉均无显著差异,对照组左、右腿位置觉和运动觉无显著差异;与对照组相比,UKA、TKA组在60°位置觉时术侧腿和未术侧腿均有显著差异,患者术侧腿和未术侧腿的运动觉也均有显著差异。结论 与健康对照组相比,KOA患者术前的膝关节本体感觉明显减退,但UKA、TKA组患者术前本体感觉特征相近。     

着鞋类型和步速对膝关节载荷的影响

目的探讨着鞋类型(裸足、普通鞋、极简鞋)与步行速度(快步走、常速行走)对膝关节生物力学指标的影响,为科学健身提供理论参考。方法采用Vicon三维运动捕捉系统、Kisler三维测力台同步采集10名男性在裸足、穿着不同鞋常速行走与快步走时下肢运动生物力学指标。采用双因素(2种行走方式×3种着鞋类型)重复测量方差分析对各指标进行统计分析。结果相对于快步走,常速行走时足底压力中心(center of pressure,COP)向外偏移较大,额状面膝关节力臂、膝关节内收外力矩和第1峰值负载率均较小,但额状面膝关节冲量矩较大;相对于穿着普通跑鞋,裸足或穿着极简鞋时,步幅变小,COP向外偏移较大,额状面膝关节力臂、膝关节内收外力矩、第1峰值负载率和额状面膝关节冲量矩较小。结论为降低额状面膝关节冲量矩以及峰值负载率,建议着极简鞋采用小步幅进行快步走锻炼。     

全膝关节置换术后远程自助-互助式功能评估系统

目的 研发一种基于膝关节协会评分(knee society score, KSS)的远程自助-互助式功能评估系统,并验证其对膝关节置换(total knee arthroplasty,TKA)术后患者的有效性。 方法 选取 10 名接受 TKA 手术患者,利用功能评估系统记录其术前以及术后当天(0 d)、4 d 和 30 d 的功能情况。 系统自动计算患者的数据,包括 KSS 得分、屈曲总范围、屈曲挛缩、伸直迟滞、膝关节对线、疼痛和膝关节稳定性。 结果 比较医生凭借经验进行人工 KSS 评分结果与系统评估的 KSS 评分结果发现,二者评分差异无统计学意义,存在一致性。 结论 远程自助-互助式功能评估系统所采集的 KSS 分数与临床医生测评结果一致,该系统为 TKA 术后患者居家评估和远程术后康复指导提供了一种可靠、便捷的方法。     

Relationship between kinematic gait parameters during three gait modifications designed to reduce peak knee abduction moment

PurposeGait modifications designed to change a single kinematic parameter have reduced first peak internal knee abduction moment (PKAM). Prior research suggests unintended temporospatial and kinematic changes occur naturally while performing these modifications. We aimed to investigate i) the concomitant kinematic and temporospatial changes and ii) the relationship between gait parameters during three gait modifications (toe-in, medial knee thrust, and trunk lean gait).MethodsUsing visual real-time biofeedback, we collected 10 trials for each modification using individualized target gait parameters based on participants’ baseline mean and standard deviation. Repeated measures ANOVA was performed to determine significant differences between conditions. Mixed effects linear regression models were then used to estimate the linear relationships among variables during each gait modification. All modifications reduced KAM by at least 5%.ResultsModifications resulted in numerous secondary changes between conditions such as increased knee abduction during toe-in gait and increased knee flexion with medial knee thrust. Within gait modifications, relationships between kinematic parameters were similar for toe-in gait and medial knee thrust (i.e. increased toe-in and decreased knee abduction), while increased trunk lean showed no relationship with any other kinematic parameters during trunk lean trials.ConclusionTwo main mechanisms were found as a result of this investigation; the first being a pattern of toeing-in, knee abduction, flexion, and internal hip rotation, while trunk lean modification presented as a separate gait pattern with limited secondary changes. Future studies should consider providing feedback on multiple linked parameters, as it may feel more natural and optimize KAM reductions.     

Reductions in peak knee abduction moment in three previously studied gait modification strategies

BackgroundFirst peak internal knee abduction moment (KAM) has been associated with knee osteoarthritis. Gait modification including trunk lean, medial knee thrust, and toe-in gait have shown to reduce KAM. Due to heterogeneity between study designs, it remains unclear which strategy is most effective. We compared the effects of these modifications in healthy individuals to determine their effectiveness to reduce KAM, internal knee extension moment (KEM), and medial contact force (MCF).MethodsTwenty healthy individuals volunteered for this study (26.7 ± 4.7 years, 1.75 ± 0.1 m, 73.4 ± 12.4 kg). Using real-time biofeedback, we collected 10 trials for each modification using individualized gait parameters based on participants' baseline mean and standard deviation (SD). Two sizes of each modification were tested: 1–3 SD greater (toe-in and trunk lean) or lesser (knee adduction) than baseline for the first five trials and 3–5 SD greater or lesser than baseline for the last five trials.ResultsA significant main effect was found for KAM and KEM (p < .001). All modifications reduced KAM from baseline by at least five percent; however, only medial knee thrust and small trunk lean resulted in significant KAM reductions. Only medial knee thrust reduced KEM from baseline. MCF was unchanged. Conclusion: Medial knee thrust was superior to trunk lean and toe-in modifications in reducing KAM. Subsequent increases in KEM and variation in individual responses to modification suggests that future interventions should be individualized by type and magnitude to optimize KAM reductions and avoid detrimental effects.     

Residual varus alignment after total knee arthroplasty increases knee adduction moment without improving patient function: A propensity score-matched cohort study

BackgroundTargeting residual varus alignment in total knee arthroplasty may be functionally beneficial to preoperative varus patients.MethodsBilateral TKA patients were enrolled. According to the postoperative hip-knee-ankle axis, patients were allocated into residual varus (3° ± 1°) alignment group or neutral (0° ± 1°) alignment group. Then, 1:2 propensity score matching was used to match preoperative variables. Finally, matched neutral (n = 45) and varus groups (n = 32) were followed-up for two years and compared. The primary outcome was the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes were range of motion (ROM), Knee Society knee score and function score, spatiotemporal gait parameters, dynamic alignment, knee flexion angle, knee adduction moment (KAM) and internal knee extension moment.ResultsAt two years after surgery, the mean difference of WOMAC score was 0.3 (95% CI, [? 3.1, 3.7]) between the two groups. All secondary outcomes, except KAM and dynamic alignment, showed no significant difference between the two groups. Residual varus alignment group showed increased KAM and maximum KAM was 19% higher (P = 0.006).ConclusionsResidual varus alignment showed no clinical benefits, and both groups of patients had a functionally identical knee gait biomechanics, except for increased KAM and varus alignment. The authors consider that even in patients with varus alignment, the first principle is still achieving neutral alignment, which is helpful for reducing the KAM.Level of evidenceIII, retrospective cohort study.     

Predicting dynamic knee joint load with clinical measures in people with medial knee osteoarthritis

Knee joint loading, as measured by the knee adduction moment (KAM), has been implicated in the pathogenesis of knee osteoarthritis (OA). Given that the KAM can only currently be accurately measured in the laboratory setting with sophisticated and expensive equipment, its utility in the clinical setting is limited. This study aimed to determine the ability of a combination of four clinical measures to predict KAM values.Three-dimensional motion analysis was used to calculate the peak KAM at a self-selected walking speed in 47 consecutive individuals with medial compartment knee OA and varus malalignment. Clinical predictors included: body mass; tibial angle measured using an inclinometer; walking speed; and visually observed trunk lean toward the affected limb during the stance phase of walking. Multiple linear regression was performed to predict KAM magnitudes using the four clinical measures. A regression model including body mass (41% explained variance), tibial angle (17% explained variance), and walking speed (9% explained variance) explained a total of 67% of variance in the peak KAM.Our study demonstrates that a set of measures easily obtained in the clinical setting (body mass, tibial alignment, and walking speed) can help predict the KAM in people with medial knee OA. Identifying those patients who are more likely to experience high medial knee loads could assist clinicians in deciding whether load-modifying interventions may be appropriate for patients, whilst repeated assessment of joint load could provide a mechanism to monitor disease progression or success of treatment.     

The association of external knee adduction moment with biomechanical variables in osteoarthritis: A systematic review

ContextOsteoarthritis (OA) is a musculoskeletal disorder primarily affecting the older population and resulting in chronic pain and disability. Biomechanical variables, associated with OA severity such as external knee adduction moment (KAM) and joint malalignment, may affect the disease process by altering the bone-on-bone forces during gait.ObjectiveTo investigate the association between biomechanical variables and KAM in knee OA.MethodA systematic search for published studies' titles and abstracts was performed on Ovid Medline^®, Cumulative index to Nursing and Allied Health, PREMEDLINE, EBM reviews and SPORTDiscus. Fourteen studies met the inclusion criteria and were considered for the review.ResultsThe magnitude and time course of KAM during gait appeared to be consistent across laboratories and computational methods. Only two of the included studies that compared patients with OA to a control group reported a higher peak KAM for the OA group. Knee adduction moment increased with OA severity and was directly proportional to varus malalignment. Classifying the patients on the basis of disease severity decreased the group variability, permitting the differences to be more detectable.ConclusionsBiomechanical variables such as varus malalignment are associated with KAM and therefore may affect the disease process. These variables should be taken into considerations when developing therapeutic interventions for individuals suffering from knee OA.     

Relationships between early postoperative gait biomechanical factors and patient-reported outcome measures 6 months after total knee arthroplasty

BackgroundThis study was focused on the gait parameters of the knee extensor and hip abductor muscle groups, which are believed to contribute to knee joint function improvement in early postoperative TKA. The associations between patient-reported outcome measures (PROMs) 6 months after total knee arthroplasty (TKA) and the early postoperative internal knee extension moment, knee extension negative joint power, and internal hip abduction moment while walking were investigated.MethodsTwenty-one patients who underwent primary TKA for knee osteoarthritis were included. Three weeks after TKA, gait at a comfortable speed was measured by three-dimensional motion analysis. The lower limb joint angle, internal joint moment, and joint power parameters on the operated side while standing were calculated. The PROMs 6 months after TKA were assessed using the Japanese Knee Osteoarthritis Measure (JKOM). The relationship between each gait biomechanical parameter and the JKOM was determined.ResultsThe maximum internal knee extension moment and maximum knee extension negative joint power during the early stance showed moderate negative correlations with the JKOM scores. The maximum internal hip abduction moment was not correlated with the JKOM scores. The maximum internal hip extension moment during the early stance and internal hip flexion moment during the late stance showed moderate negative correlations with the total JKOM scores.ConclusionThe early postoperative internal knee extension moment, maximum knee extension negative joint power, and internal hip extension and flexion moment are associated with patient PROMs 6 months after TKA.     

A non-invasive measurement of the knee contact force using a subject-specific musculoskeletal model to investigate osteotomy

The varus knee has been defined as a Hip-Knee-Ankle alignment of less than 180 degrees. Varus knee alignment increases the load on the medial knee and also the risk of osteoarthritis. High tibial osteotomy has been designed to modify the malalignment of varus knee. The aim of this study was to investigate the osteotomy effects on knee adduction moment (KAM) and contact forces using a musculoskeletal and subject-specific knee model. A patient with varus knee and no symptoms of any other disease or disability participated in this study. The geometry of the multibody knee model has been modified using MR images. The solutions of its finite element model have been used to determine the parameters of the multibody model. The motion data, ground reaction force and kinetic data have been applied to run the subject-specific musculoskeletal model during the stance phase of gait. After osteotomy, the adduction moment decreased, where the maximum values are comparable to other studies. The pattern of KAM did not witness any significant changes. The total and medial contact forces reduced considerably after surgery, but the lateral contact force did not significantly change. The changes in total and medial contact forces and lack of change in lateral contact force could be explained by modification of the gait pattern after surgery.     

Longitudinal changes in knee kinematics and moments following knee arthroplasty: A systematic review

BackgroundKnee arthroplasty (KA) is recognized as an effective treatment of knee joint osteoarthritis and up to 90% of patients experience substantial pain relief. There has been no systematic review synthesizing the longitudinal changes in gait following KA. The aims of this systematic review were to determine the effects of KA on (i) frontal plane and (ii) sagittal plane kinematic and kinetic parameters during the stance phase of gait.MethodsMEDLINE (PubMed), CINAHL, SPORTdiscus (EBSCO), and Cochrane Library (Wiley) were searched until April 10th, 2014. 1,765 articles were identified, of which 19 studies describing 3-dimensional gait analysis pre- and post-KA were included. Study quality was evaluated by two reviewers independently using the Downs and Black checklist.FindingsFollowing KA, in the frontal plane, the maximum knee adduction angle and external knee adduction moment (KAM) tended to decrease. In the sagittal plane, findings suggest that the maximum knee flexion moment is increased. From the ten studies that included a healthy reference group, it was unclear whether gait variables returned to normal following KA.InterpretationOverall, it appears that KA results in a decreased peak KAM and maximum knee adduction angles, an increased peak knee flexion moment and inconsistent changes in the peak knee flexion angle. Knowledge gaps remain due to methodological inconsistencies across studies, limited statistical analysis, and largely heterogeneous sample populations. More research is needed to determine whether KA restores gait patterns to normal, or if additional rehabilitation may be needed to optimize gait following surgery for osteoarthritis.     

Analysis of the factors that correlate with increased knee adduction moment during gait in the early postoperative period following total knee arthroplasty

Background

Analysis of dynamic knee loading during gait is essential to prevent mechanical failures following total knee arthroplasty. External knee adduction moment during gait is the primary factor producing medial joint reaction force, and an increase in the moment is directly related to an increase in the medial compartment load on the knee.