Thrust during ambulation and the progression of knee osteoarthritis
Thrust during ambulation and the progression of knee osteoarthritis
复制标题
DOI：
10.1002/art.20657
复制
发表时间：
2004-12-01
影响因子：
--
通讯作者：
Sharma, L
中科院分区：
文献类型：
--
作者：
Chang, A;Hayes, K;Sharma, L
目标。为了确定在基线水平内翻的存在是否增加了内侧胫股骨性关节炎(OA)的进展风险，推力是否有更大的内收力矩，推力是否对静态内翻上方有任何额外的影响，以及推力是否与较差的身体功能结果相关。237例膝关节骨性关节炎(明确的骨赘和症状)患者接受了基线步态观察以评估内翻推力，并通过全身X线片评估对齐情况。这237名患者中的64名还接受了定量步态分析，以确定最大的膝关节内收时刻。230名患者(97%)在18个月后复诊。在基线和18个月时，230名参与者接受了半屈、透视确认的膝关节X线片(进展定义为内侧关节间隙等级恶化)；自我报告和基于表现的功能测量也进行了评估。在排除了没有进展风险的膝关节后，使用Logistic回归和广义估计方程来估计内侧骨关节炎进展的优势比(OR)。401个膝关节中有67个膝关节存在内翻推力。推力增加了4倍(年龄、性别、体重指数和疼痛调整后的OR 3.96，95%可信区间[95%CI]2.11-7.43)中间进展的几率，在进一步调整内翻对齐严重程度后有所降低。在内翻对齐的膝关节中，推力使OA进展的几率增加3倍(调整后的OR为3.17，95%CI为1.60-6.31)。在步态的子研究中，与没有推力的膝盖相比，有推力的膝盖的内收力矩更大。两个膝盖与两个膝盖的推力相比，身体功能不良的OR增加了2倍(P不显著)。内翻推力是一个潜在的危险因素，通过简单的步态观察可以确定，内侧间隙是膝盖骨关节炎最常见的受累部位，疾病进展。内翻推力也可能预示着较差的身体功能结果。内翻推进增加了单独考虑的内翻对齐的膝关节的进展几率，这表明内翻对齐的膝盖是内翻对齐的膝盖的一个子集，发生OA的风险特别高。
Objective. To determine whether the presence of varus thrust at baseline increases the risk of progression of medial tibiofemoral osteoarthritis (OA), whether knees with thrust have a greater adduction moment, whether thrust has any additional impact on top of static varus, and whether thrust is associated with poor physical function outcome.Methods. Two hundred thirty-seven patients with knee OA (definite osteophytes and symptoms) underwent baseline gait observation to assess varus thrust and full-limb radiography to assess alignment. Sixty-four of these 237 patients also underwent quantitative gait analysis to determine the maximum knee adduction moment. Two hundred thirty patients (97%) returned for followup at 18 months. At baseline and 18 months, the 230 participants had semiflexed, fluoroscopically confirmed knee radiographs (with progression defined as worsening of medial joint space grade); self-reported and performance-based measures of function were also assessed. Logistic regression with generalized estimating equations was used to estimate odds ratios (ORs) for medial OA progression, after excluding knees that were not at risk for progression.Results. Varus thrust was present in 67 of 401 knees. Thrust increased 4-fold (age-, sex-, body mass index-, and pain-adjusted OR 3.96, 95% confidence interval [95% CI] 2.11-7.43) the odds of medial progression, with some reduction after further adjustment for varus alignment severity. In varus-aligned knees, thrust increased the odds of OA progression 3-fold (adjusted OR 3.17, 95% CI 1.60-6.31). In the gait substudy, the adduction moment was greater in knees with a thrust compared with knees without a thrust. Having a thrust in both knees versus neither knee was associated with a 2-fold increase in the OR for poor physical function outcome (P not significant).Conclusion. Varus thrust is a potent risk factor, identifiable by simple gait observation, for disease progression in the medial compartment, the most common site of OA involvement at the knee. Varus thrust may also predict poor physical function outcome. Varus thrust increased the odds of progression among varus-aligned knees considered separately, suggesting that knees with a thrust are a subset of varus-aligned knees at particularly high risk for progression of OA.