Trunk lean gait modification and knee joint load in people with medial knee osteoarthritis: The effect of varying trunk lean angles
Trunk lean gait modification and knee joint load in people with medial knee osteoarthritis: The effect of varying trunk lean angles
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DOI：
10.1002/acr.21724
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发表时间：
2012-10-01
影响因子：
4.7
通讯作者：
Wrigley, Tim V.
中科院分区：
文献类型：
--
作者：
Simic, Milena;Hunt, Michael A.;Wrigley, Tim V.
目的评价内侧膝关节骨关节炎（OA）患者在步态过程中躯干外侧向症状下肢倾斜的增加是否会立即改变症状或内侧膝关节负荷（通过膝关节外收力矩（KAM）测量）。方法内侧膝关节OA参与者（n = 22）接受三维步态分析，以测量KAM峰值（站立早期和晚期）和KAM脉冲。自然步态分析后，参与者被训练在同侧站立期间在3个随机排序的条件下（6度，9度和12度倾斜）将躯干倾斜到有症状的腿。投影屏幕显示实时躯干角度和目标水平。在不同条件下测量膝关节、髋关节和背部的疼痛/不适。使用线性混合模型研究了增加精益幅度的负荷修改效果。评估了峰值倾斜时间和参与者特征（疼痛和对线不良）的中介作用。结果躯干倾斜度的增加降低了所有KAM测量值（P < 0.001），倾斜角度越大，降低的幅度越大。对于KAM的所有测量，负荷降低的功效随着峰值稀燃定时的推迟而提高。参与者的特征并没有介导躯干倾斜对KAM的影响，症状在不同条件下没有变化（P > 0.05）。结论躯干倾斜度的增加可降低膝关节内侧负荷，且呈剂量-反应关系。稍晚实现峰值躯干倾斜改善了这种步态策略的负荷修改效果。未发现即刻症状变化。未来的研究应该确定长期实施这种步态策略是否可行，以及它是否可以改善疾病症状和OA进展。
Objective To evaluate whether increased lateral trunk lean toward the symptomatic lower extremity during gait in people with medial knee osteoarthritis (OA) immediately alters symptoms or medial knee load, as measured by the external knee adduction moment (KAM). Methods Participants with medial knee OA (n = 22) underwent 3-dimensional gait analysis to measure KAM peaks (early and late stance) and KAM impulse. Following the analysis of natural gait, participants were trained to lean their trunk toward the symptomatic leg during ipsilateral stance over 3 randomly ordered conditions (6 degrees, 9 degrees, and 12 degrees lean). A projection screen displayed real-time trunk angles and target levels. Pain/discomfort in the knees, the hip, and the back were measured across conditions. Load-modifying effects of increasing lean magnitudes were investigated using linear mixed models. Mediating effects of peak lean timing and participant characteristics (pain and malalignment) were evaluated. Results Increased trunk lean reduced all KAM measures (P < 0.001), with larger lean angles achieving greater reductions. Efficacy of load reduction improved with later peak lean timing for all measures of the KAM. Participant characteristics did not mediate the effect of trunk lean on the KAM, and symptoms did not change across conditions (P > 0.05). Conclusion Increased trunk lean reduced medial knee load in a dose-response manner. Slightly later achievement of peak trunk lean improved the load-modifying effect of this gait strategy. No immediate symptomatic changes were identified. Future research should determine if long-term implementation of this gait strategy is feasible and whether it can modify disease symptoms and OA progression.