Quadriceps weakness and osteoarthritis of the knee
Quadriceps weakness and osteoarthritis of the knee
复制标题
DOI：
10.7326/0003-4819-127-2-199707150-00001
复制
发表时间：
1997-07-15
影响因子：
39.2
通讯作者：
Wolinsky, FD
中科院分区：
文献类型：
--
作者：
Slemenda, C;Brandt, KD;Wolinsky, FD
背景：股四头肌无力通常与膝骨性关节炎有关，人们普遍认为是由于关节弯曲疼痛继发的废用性萎缩所致。目的：探讨股四头肌无力与膝骨性关节炎的关系。设计：横断面患病率研究。地点：以人群为基础，随机数字拨号招募。参与者：462名65岁及以上的志愿者。测量：膝关节的X光片对骨关节炎的存在进行分级。用西安大略和麦克马斯特大学关节炎指数评估膝关节疼痛和功能，用等速测力法评估小腿屈伸肌的力量，用双能X线骨密度仪评估小腿瘦组织质量。结果：在患有骨性关节炎的参与者中，股四头肌无力是常见的，但腿肌无力并不常见。患有放射学骨性关节炎的患者的伸肌力量与体重的比率比无放射性骨性关节炎的患者低约20%。值得注意的是，在患有胫股骨性关节炎的女性中，在没有膝关节疼痛的情况下出现伸肌无力，并出现在下肢瘦体重正常的参与者中(患骨性关节炎患者的伸肌强度为30.1Ib-ft，非骨性关节炎患者为34.8Ib-ft；P<；0.001)。在调整了体重、年龄和性别后，股四头肌的力量仍然预示着膝关节的放射学和症状性骨关节炎(每10磅力量丧失的优势比为0.8[95%CI，0.71~0.90]，对于症状性骨关节炎为0.71[CI，0.51~0.87])。结论：有骨关节炎但没有膝关节疼痛或肌肉萎缩的患者可能存在股四头肌无力，这表明这种无力可能是由于肌肉功能障碍所致。这些数据与股四头肌无力是膝关节疼痛、残疾和膝关节骨性关节炎患者关节损害进展的主要危险因素的可能性一致。
Background: The quadriceps weakness commonly associated with osteoarthritis of the knee is widely believed to result from disuse atrophy secondary to pain in the in volved joint. However, quadriceps weakness may be an etiologic factor in the development of osteoarthritis.Objective: To explore the relation between lower-extremity weakness and osteoarthritis of the knee.Design: Cross-sectional prevalence study.Setting: Population-based, with recruitment by random-digit dialing.Participants: 462 volunteers 65 years of age or older. Measurements: Radiographs of the knee were graded for the presence of osteoarthritis. Knee pain and function were assessed with the Western Ontario and McMaster Universities Arthritis Index, the strength of leg flexors and extensors was assessed with isokinetic dynamometry, and lower-extremity lean tissue mass was assessed with dual-energy x-ray absorptiometry. Results: Among participants with osteoarthritis, quadriceps weakness, but not hamstring weakness, was common. The ratio of extensor strength to body weight was approximately 20% lower in those with than in those without radiographic osteoarthritis. Notably, among women with tibiofemoral osteoarthritis, extensor weakness was present in the absence of knee pain and was seen in participants with normal lower-extremity lean mass (extensor strength, 30.1 Ib-ft for those with osteoarthritis and 34.8 Ib-ft for those without osteoarthritis; P < 0.001). After adjustment for body weight, age, and sex, lesser quadriceps strength remained predictive of both radiographic and symptomatic osteoarthritis of the knee (odds ratio for prevalence of osteoarthritis per 10 Ib-ft loss of strength, 0.8 [95% CI, 0.71 to 0.90] for radiographic osteoarthritis and 0.71 [CI, 0.51 to 0.87] for symptomatic osteoarthritis).Conclusion: Quadriceps weakness may be present in patients who have osteoarthritis but do not have knee pain or muscle atrophy; this suggests that the weakness may be due to muscle dysfunction. The data are consistent with the possibility that quadriceps weakness is a primary risk factor for knee pain, disability, and progression of joint damage in persons with osteoarthritis of the knee.