Hip abduction moment and protection against medial tibiofemoral osteoarthritis progression
Hip abduction moment and protection against medial tibiofemoral osteoarthritis progression
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DOI：
10.1002/art.21406
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发表时间：
2005-11-01
影响因子：
--
通讯作者：
Sharma, L
中科院分区：
文献类型：
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作者：
Chang, A;Hayes, K;Sharma, L
Objective.为了验证一个假设，即更大的峰值内髋外展力矩与同侧内侧胫股骨关节炎（OA）进展的可能性降低有关。对57名膝关节OA患者（通过明确的骨赘存在和症状）进行了评价。基线评估包括运动学和动力学步态参数，通过光电摄像系统和测力平台获得，使用逆动力学计算关节处的三维力矩;疼痛，使用每个膝关节的单独视觉模拟量表，以及对齐，使用全肢X光片。在基线和18个月后拍摄膝关节半屈曲位的X线片，并通过荧光镜确认胫骨边缘对线。疾病进展定义为内侧关节间隙狭窄程度恶化。在排除基线时关节间隙分级最差的膝关节（不能进展）后，使用广义估计方程获得的Logistic回归来估计每单位髋关节外展力矩进展的比值比（OR）。57名患有轻度至中度OA的参与者（63%为女性）的平均年龄为67岁，平均体重指数为29。步态期间较大的内部髋关节外展力矩与内侧胫股OA进展的可能性降低相关，OR/单位髋关节外展力矩为0.52，95%置信区间（95% CI）为0.32-0.85。在校正年龄、性别、步行速度、膝关节疼痛严重程度、体力活动、内翻畸形严重程度、髋关节OA存在和髋关节OA症状存在后，这种保护作用持续存在，校正OR为0.43，95%CI为0.22- 0.81。从基线到18个月，基线步态期间更大的髋关节外展力矩可以防止同侧内侧OA进展。每增加1个单位的髋关节外展力矩，内侧胫股OA进展的可能性降低50%。
Objective. To test the hypothesis that a greater peak internal hip abduction moment is associated with a reduced likelihood of ipsilateral medial tibiofemoral osteoarthritis (OA) progression.Methods. Fifty-seven persons with knee OA (by definite osteophyte presence and symptoms) were evaluated. Baseline assessments included kinematic and kinetic gait parameters, obtained with an optoelectronic camera system and force platform, with inverse dynamics used to calculate 3-dimensional moments at the joints; pain, using a separate visual analog scale for each knee, and alignment, using full-limb radiographs. Radiographs of the knee in a semiflexed position, with fluoroscopic confirmation of tibial rim alignment, were obtained at baseline and 18 months later. Disease progression was defined as worsening of the grade of medial joint space narrowing. Logistic regression obtained with generalized estimating equations was used to estimate odds ratios (ORs) for progression per unit of hip abduction moment, after excluding knees with the worst joint space grade at baseline (which could not progress).Results. The 57 participants (63% women) with mild to moderate OA had a mean age of 67 years and a mean body mass index of 29. A greater internal hip abduction moment during gait was associated with a reduced likelihood of medial tibiofemoral OA progression, with OR/unit hip abduction moment of 0.52 and a 95% confidence interval (95% Cl) of 0.32-0.85. This protective effect persisted after adjustment for age, sex, walking speed, knee pain severity, physical activity, varus malalignment severity, hip OA presence, and hip OA symptom presence, with an adjusted OR of 0.43 a 95% CI of 0.22-0.81.Conclusion. A greater hip abduction moment during gait at baseline protected against ipsilateral medial OA progression from baseline to 18 months. The likelihood of medial tibiofemoral OA progression was reduced 50% per 1 unit of hip abduction moment.