Biomechanical mechanism of lateral trunk lean gait for knee osteoarthritis patients
Biomechanical mechanism of lateral trunk lean gait for knee osteoarthritis patients
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DOI：
10.1016/j.jbiomech.2017.10.016
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发表时间：
2018-01-03
影响因子：
2.4
通讯作者：
Shinkoda, Koichi
中科院分区：
文献类型：
--
作者：
Tokuda, Kazuki;Anan, Masaya;Shinkoda, Koichi
采用躯干外侧倾斜步态减少膝骨关节炎患者膝关节外收力矩的生物力学机制尚不清楚。这种机制可能与质心（COM）运动有关。此外，躯干侧倾步态可能会影响COM位移的运动控制。不受控流形分析（UCM）是一种用于了解运动控制和运动任务变异性的评价指标。在这里，我们的目的是澄清生物力学机制，以减少KAM在躯干侧倾步态和运动变异性如何控制COM位移。20例膝关节OA患者在两种情况下行走：正常和躯干侧倾步态条件。对冠状面中的COM位移进行UCM分析。我们还确定了如何将COM位移作为性能变量来构造可变性。躯干侧倾步态下KAM峰值低于正常步态。在站立相，膝关节中心向内侧移动，压力中心到膝关节中心的距离缩短，膝关节地面反作用力杠杆臂的距离缩短。膝关节骨性关节炎患者躯干外侧倾斜步态可以保持运动学协同作用，利用更大的节段配置的变化，以性能变量。然而，躯干侧倾步态的COM位移变异性大于正常步态。我们的研究结果可能提供临床见解，以有效地评估和规定膝关节骨性关节炎患者的步态调整训练。(C)2017爱思唯尔有限公司版权所有
The biomechanical mechanism of lateral trunk lean gait employed to reduce external knee adduction moment (KAM) for knee osteoarthritis (OA) patients is not well known. This mechanism may relate to the center of mass (COM) motion. Moreover, lateral trunk lean gait may affect motor control of the COM displacement. Uncontrolled manifold (UCM) analysis is an evaluation index used to understand motor control and variability of the motor task. Here we aimed to clarify the biomechanical mechanism to reduce KAM during lateral trunk lean gait and how motor variability controls the COM displacement. Twenty knee OA patients walked under two conditions: normal and lateral trunk lean gait conditions. UCM analysis was performed with respect to the COM displacement in the frontal plane. We also determined how the variability is structured with regards to the COM displacement as a performance variable. The peak KAM under lateral trunk lean gait was lower than that under normal gait. The reduced peak ICAM observed was accompanied by medially shifted knee joint center, shortened distance of the center of pressure to knee joint center, and shortened distance of the knee ground reaction force lever arm during the stance phase. Knee OA patients with lateral trunk lean gait could maintain kinematic synergy by utilizing greater segmental configuration variance to the performance variable. However, the COM displacement variability of lateral trunk lean gait was larger than that of normal gait. Our findings may provide clinical insights to effectively evaluate and prescribe gait modification training for knee OA patients. (C) 2017 Elsevier Ltd. All rights reserved.