Knee pain and joint loading in subjects with osteoarthritis of the knee
Knee pain and joint loading in subjects with osteoarthritis of the knee
复制标题
DOI：
10.1002/jor.1100180409
复制
发表时间：
2000-07-01
影响因子：
2.8
通讯作者：
Andriacchi, TP
中科院分区：
文献类型：
--
作者：
Hurwitz, DE;Ryals, AR;Andriacchi, TP
尽管膝关节骨关节炎的治疗通常旨在缓解疼痛，但疼痛地图会导致患者改变活动方式以减少关节负荷。膝关节内收力矩是内外侧平台之间载荷分布的主要决定因素。因此，行走过程中疼痛和膝关节外收力矩之间的相互关系对于了解内侧胫股骨关节炎进展相关的力学因素可能尤为重要。研究了53例有膝关节骨关节炎症状性影像学证据的受试者。这些受试者是入组双盲研究的受试者的子集，在该研究中，在抗炎和镇痛治疗2周洗脱后进行步态分析以及影像学和临床评价。然后，受试者服用非甾体抗炎药，对乙酰氨基酚或安慰剂2周，重复步态和临床评估。两次评估之间的峰值外收力矩变化与疼痛变化呈负相关（R = 0.48，p <0.001），并且在疼痛增加（n = 7）、减少（n = 18）或保持不变（n = 28）的患者之间存在显著差异（p = 0.009）。疼痛增加的患者的峰值外收（p = 0.005）和nerve力矩（p = 0.023）显著降低。相反，疼痛减轻的受试者的峰值外收力矩往往增加（p = 0.095），峰值外伸力矩显著增加（p = 0.017）。疼痛无变化的受试者的峰值外收（p = 0.757）、屈曲（p = 0.234）或伸展（p = 0.465）力矩无显著变化。因此，内侧胫股骨关节炎患者的疼痛减轻与关节退行性部分负荷增加有关。需要进行更多的长期前瞻性研究，以确定步行时增加负荷是否真的会加速疾病的进展。
Although treatments for osteoarthritis of the knee are often directed at relieving pain, pain map cause patients to alter how they perform activities to decrease the loads on the joints. The knee-adduction moment is a major determinant of the load distribution between the medial and lateral plateaus. Therefore, the interrelationship between pain and the external knee-adduction moment during walking may be especially important for understanding mechanical factors related to the progression of medial tibiofemoral osteoarthritis. Fifty-three subjects with symptomatic radiographic evidence of osteoarthritis of the knee were studied. These subjects were a subset of those enrolled in a double-blind study in which gait analysis and radiographic and clinical evaluations were performed after a 2-week washout of anti-inflammatory and analgesic treatment. The subjects then took a nonsteroidal anti-inflammatory drug, acetaminophen, or placebo for 2 weeks, and the gait and clinical evaluations were repeated. The change in the peak external adduction moment between the two evaluations was inversely correlated with the change in pain (R = 0.48, p < 0.001) and was significantly different between those whose pain increased (n = 7), decreased (n = 18), or remained unchanged (n = 28) (p = 0.009). Those with increased pain had a significant decrease in the peak external adduction (p = 0.005) and nexion moments (p = 0.023). in contrast, the subjects with decreased pain tended to have an increase in the peak external adduction moment (p = 0.095) and had a significant increase in the peak external extension moment (p = 0.017). The subjects whose pain was unchanged had no significant change in the peak external adduction (p = 0.757), flexion (p = 0.234), or extension (p = 0.465) moments. Thus, decreases in pain among patients with medial tibiofemoral osteoarthritis were related to increased loading of the degenerative portion of the joints. Additional long-term prospective studies are needed to determine whether increased loading during walking actually results in accelerated progression of the disease.