Secondary gait changes in patients with medial compartment knee osteoarthritis -: Increased load at the ankle, knee, and hip during walking
Secondary gait changes in patients with medial compartment knee osteoarthritis -: Increased load at the ankle, knee, and hip during walking
复制标题
DOI：
10.1002/art.21262
复制
发表时间：
2005-09-01
影响因子：
--
通讯作者：
Andriacchi, TP
中科院分区：
文献类型：
--
作者：
M端ndermann, A;Dyrby, CO;Andriacchi, TP
客观的。这项研究检验了以下假设：与不同严重程度的膝骨关节炎 (OA) 相关的步态变化与踝关节、膝关节和髋关节的负荷增加有关。方法。研究人员对 42 名双侧膝关节内侧间室 OA 患者和 42 名性别、年龄、身高和体重相匹配的对照受试者进行了研究。 19 名患者的 Kellgren/Lawrence (K/L) 放射学严重程度等级为 1 或 2 级，23 名患者的 K/L 等级为 3 或 4 级。当受试者以自行选择的速度行走时，测量髋部、膝部和踝部的三维运动学和动力学。结果。膝关节 OA 较严重的患者比其匹配的对照受试者 (P = 0.039) 和膝关节 OA 较轻的患者 (P < 0.001) 具有更大的第一峰值膝内收力矩。所有膝关节骨关节炎患者最初接触地面时，膝关节都处于比对照受试者更伸展的位置。下肢所有关节的轴向负荷率均增加。与匹配的对照受试者相比，患有较严重膝关节骨关节炎的患者髋部内收力矩较低。结论。在膝关节骨关节炎患者中观察到的继发性步态变化反映了一种潜在的策略，可以将身体的重量更快地从对侧肢体转移到支撑肢体，这似乎仅在膝骨关节炎不太严重的患者中成功地减轻了膝关节的负荷。下肢关节负荷率的增加可能导致现有骨关节炎的进展更快，并导致膝关节附近的骨关节炎发生。因此，应评估膝关节骨关节炎的干预措施对下肢所有关节力学的影响。
Objective. This study tested the hypothesis that gait changes related to knee osteoarthritis (OA) of varied severity are associated with increased loads at the ankle, knee, and hip.Methods. Forty-two patients with bilateral medial compartment knee OA and 42 control subjects matched for sex, age, height, and mass were studied. Nineteen patients had Kellgren/Lawrence (K/L) radiographic severity grades of 1 or 2, and 23 patients had K/L grades of 3 or 4. Three-dimensional kinematics and kinetics were measured in the hip, knee, and ankle while the subjects walked at a self-selected speed.Results. Patients with more severe knee OA had greater first peak knee adduction moments than their matched control subjects (P = 0.039) and than patients with less severe knee OA (P < 0.001). All patients with knee OA made initial contact with the ground with the knee in a more extended position than that exhibited by control subjects. An increased axial loading rate was present in all joints of the lower extremity. Patients with more severe knee OA had lower hip adduction moments compared with their matched control subjects.Conclusion. The secondary gait changes observed among patients with knee OA reflect a potential strategy to shift the body's weight more rapidly from the contralateral limb to the support limb, which appears to be successful in reducing the load at the knee in only patients with less severe knee OA. The increased loading rate in the lower extremity joints may lead to a faster progression of existing OA and to the onset of OA at joints adjacent to the knee. Interventions for knee OA should therefore be assessed for their effects on the mechanics of all joints of the lower extremity.