Quadriceps weakness in knee osteoarthritis: the effect on pain and disability
Quadriceps weakness in knee osteoarthritis: the effect on pain and disability
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DOI：
10.1136/ard.57.10.588
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发表时间：
1998-10-01
影响因子：
27.4
通讯作者：
Doherty, M
中科院分区：
文献类型：
--
作者：
O'Reilly, SC;Jones, A;Doherty, M
目的-（1）确定股四头肌力量、结构变化和心理状态在社区膝关节疼痛方面的重要性。(2)为了确定股四头肌功能，结构变化和心理状态的相对重要性，残疾在受试者膝关节pains.Methods - 300名男性和女性疼痛和300名对照组没有疼痛（年龄40-79岁）。测量等长股四头肌力量（MVC），并通过抽搐叠加评估肌肉激活。残疾（西安大略麦克马斯特骨关节炎指数（WOMAC））和焦虑和抑郁进行了评估（医院焦虑和抑郁指数（HAD））。拍摄胫股和髌股关节的X线片，计算每个膝关节的骨赘、狭窄和硬化的总评分。结果：膝关节疼痛的受试者的随意股四头肌力量低于无疼痛的受试者（p < 0.005）。股四头肌激活也较低（p < 0.005），但不能完全解释力量的降低。当通过多元逻辑回归分析时：股四头肌力量（MVC ≤ 10 kgF的比值比18.8，CI 4.8，74.1）;抑郁（对于HAD评分大于或等于8，添加比率2.4，CI 1.0，5.5）;和放射学改变（比值比4.1，CI 1.9，放射学评分大于或等于4的8.6）与疼痛独立相关。在膝关节疼痛的患者中，残疾与股四头肌力量独立相关（MVC小于或等于10 kgF的比值比8.2，CI 1.5，44.4）和抑郁症（HAD评分≥ 8的比值比6.2，CI 2.1，18.0）;但与放射学评分无关。结论-在社区中，股四头肌力量与膝关节疼痛和残疾密切相关，即使考虑到激活和心理因素。这具有重要的治疗意义。
Objectives - (1) To determine the importance of quadriceps strength, structural change, and psychological status in terms of knee pain in the community. (2) To determine the relative importance of quadriceps function, structural change, and psychological status with respect to disability in subjects with knee pain.Methods - 300 men and women with pain and 300 controls without pain (aged 40-79) were seen. Isometric quadriceps strength (MVC) was measured and, muscle activation was assessed by twitch superimposition. Disability (Western Ontario McMaster Osteoarthritis Index (WOMAC)) and anxiety and depression were assessed (Hospital Anxiety and Depression Index (HAD)). Radiographs were obtained of the tibiofemoral and patellofemoral joints and total score for osteophyte, narrowing, and sclerosis calculated for each knee.Results - Subjects with knee pain had lower voluntary quadriceps strength than those without pain (p < 0.005). Quadriceps activation was also lower (p < 0.005),but did not fully explain the reduction in strength. When analysed by multiple logistic regression: quadriceps strength (odds ratio 18.8, CI 4.8, 74.1 for MVC less than or equal to 10 kgF); depression (adds ratio 2.4, CI 1.0, 5.5 for HAD score greater than or equal to 8); and radiographic change (odds ratio 4.1, CI 1.9, 8.6 for radiographic score greater than or equal to 4) were independently associated with pain. In those with knee pain, disability was independently associated with quadriceps strength (odds ratio 8.2, CI 1.5, 44.4 for MVC less than or equal to 10 kgF) and depression (odds ratio 6.2, CI 2.1, 18.0 for HAD score greater than or equal to 8); but not with radiographic score.Conclusions - Quadriceps strength is strongly associated with knee pain and disability in the community, even when activation and psychological factors are taken into account. This has important therapeutic implications.