基于筋骨和合理论研究手法与功法协同治疗膝骨关节炎的生物力学调控机制

膝骨关节炎关键的生物力学病理机制是源自地面反作用力的外力矩和由肌肉收缩力产生的内力矩之间失衡。既往研究显示，手法针对膝部筋出槽骨错缝治疗可降低异常升高的肌张力；习练太极拳能够降低膝关节内侧间室应力。本项目拟选取内侧间室膝骨关节炎受试者，分别以手法、功法和二者协同进行治疗，运用三维运动捕捉系统、表面肌电等技术，采集下肢运动学、动力学、肌动学参数，分析膝关节屈伸肌群协同收缩比、内侧间室应力应变等力学参数与病情变化之间的相关关系。以期回答如下关键科学问题：膝关节屈伸肌群协同收缩模式异常是否是引发膝骨关节炎筋出槽骨错缝的关键力学环节？手法治疗是否可以减少屈伸肌群的异常激活而改善内力矩？功法治疗是否能够调节膝关节内侧间室应力应变而改善外力矩？手法与功法协同治疗重建筋骨和合平衡功能态的力学机制是否是通过调衡内力矩与外力矩而实现的？预期结果将丰富和发展手法、功法治疗膝骨关节炎的生物力学作用机制新认识。

The biomechanical mechanism of the knee osteoarthritis (KOA) was the imbalance between the external moment (created by ground reaction force) and the internal moment (created by the muscles contraction). Previous studies indicated that the manipulation can help to decrease the muscle tone and the exercise of the Taichi can help to decreased the loading at the medial compartment in individual with knee OA (“Jing Chu Cao Gu Cuo Feng”). In this study, three-dimensional motion capture system and wireless surface electromyography will be used to analysis the kinetics, kinematics and kinesology of lower extremity in the individual with knee OA, the results can help to investigate effectiveness of manipulation and exercise in the management of medial knee OA. Besides, the relationship between joint loading, muscle co-contraction and the development and progression of the knee OA will also be investigated. .The purpose of the study was designed to answer the following scientific questions: ①If the muscle co-contraction played critical role in the development and progression of the knee OA? ②If the manipulation can help to decrease the internal moment via improving the muscle co-contraction condition? ③If the exercise can help to decrease the external moment via improving the loading in the medial compartment of the knee? ④If the biomechanical mechanism of the combination of manipulation and exercise to rebuilt the balance of the bone and muscles was achieved via rebuilding the balance between the internal and external moment. The results of the study may help to explore the biomechanics effectiveness of the manipulation and exercise in the management of knee OA.