Co-contraction in RA patients with a mobile bearing total knee prosthesis during a step-up task.
Co-contraction in RA patients with a mobile bearing total knee prosthesis during a step-up task.
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DOI：
10.1007/s00167-008-0537-7
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发表时间：
2008-08
影响因子：
3.8
通讯作者：
Harlaar, Jaap
中科院分区：
文献类型：
--
作者：
Garling, Eric H.;Wolterbeek, Nienke;Velzeboer, Sanne;Nelissen, Rob G. H. H.;Valstar, Edward R.;Doorenbosch, Caroline A. M.;Harlaar, Jaap
据假设，与使用固定平台全膝关节假体（FB）的类风湿性关节炎（RA）患者相比，使用允许关节面（MB）轴向旋转的全膝关节假体的RA患者在逐步提升任务期间将显示出更多的协同收缩以稳定膝关节，而固定平台全膝关节假体（FB）在关节几何形状相同的情况下不存在这种旋转自由度。分别记录MB组（n = 5）、FB组（n = 4）和对照组（n = 8）的膝关节表面肌电、运动学和动力学。大腿肌肉的表面EMG水平通过在测力计上的等速收缩被校准到膝关节屈曲或伸展力矩。在升压任务共收缩指数确定从肌电力模型。对照组在递增任务期间的主动ROM高于患者组，分别为96°和88°（P = 0.007）。在对照组中，观察到单肢支撑阶段的平均肌肉伸展、屈曲和净力矩高于患者组。在单肢支撑的20-60%间隔期间，MB患者显示出显著更高水平的屈肌活动，导致更低的净关节力矩，但是共收缩水平没有差异。与对照组相比，关节成形术患者在此期间的共收缩水平高出40%（P = 0.009）。对照受试者使用更高的伸展力矩，导致更高的净关节力矩。目视分析显示MB组和FB组之间存在时间差异。FB组似乎比MB组晚约20%的共同合同。全膝关节置换术后的RA患者表现出较低的净膝关节力矩和较高的共收缩比对照组表明避免净关节负荷和膝关节的主动稳定。MB和FB患者的共收缩水平没有差异，尽管FB的时间比MB受试者更接近对照组。由于视觉分析显示MB和FB组之间的时间差异，这可能表示协调补偿。RA患者的康复计划除了肌肉力量训练外，还应包括肌肉协调训练。
It was hypothesized that rheumatoid arthritis (RA) patients with a total knee prosthesis that allows axial rotation of the bearing (MB) will show more co-contraction to stabilize the knee joint during a step-up task than RA patients with a fixed bearing total knee prosthesis (FB) where this rotational freedom is absent while having the same articular geometry. Surface EMG, kinematics and kinetics about the knee were recorded during a step-up task of a MB group (n = 5), a FB group (n = 4) and a control group (n = 8). Surface EMG levels of thigh muscles were calibrated to either knee flexion or extension moments by means of isokinetic contractions on a dynamometer. During the step-up task co-contraction indices were determined from an EMG-force model. Controls showed a higher active ROM during the step-up task than the patient group, 96° versus 88° (P = 0.007). In the control group higher average muscle extension, flexion and net moments during single limb support phase were observed than in the patient group. During the 20–60% interval of the single limb support, MB patients showed a significant higher level of flexor activity, resulting in a lower net joint moment, however co-contraction levels were not different. Compared to the control group arthroplasty patients showed a 40% higher level of co-contraction during this interval (P = 0.009). Control subjects used higher extension moments, resulting in a higher net joint moment. Visual analysis revealed a timing difference between the MB and FB group. The FB group seems to co-contract approximately 20% later compared to the MB group. RA patients after total knee arthroplasty show a lower net knee joint moment and a higher co-contraction than controls indicating avoidance of net joint load and an active stabilization of the knee joint. MB and FB patients showed no difference in co-contraction levels, although timing in FB is closer to controls than MB subjects. Since visual analysis revealed a timing difference between the MB and FB group, this may express compensation by coordination. Rehabilitation programs for RA patients should include besides muscle strength training, elements of muscle-coordination training.
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通讯作者：
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