北京生物醫(yī)學(xué)工程

單側(cè)膝內(nèi)翻型膝骨關(guān)節(jié)炎患者足底壓力分布特征研究

Plantar pressure distribution in patients with unilateral varus knee osteoarthritis

作者：王子堅(jiān) 閆松華李偉劉艷成全海英曾紀(jì)洲張寬

單位：首都醫(yī)科大學(xué)生物醫(yī)學(xué)工程學(xué)院(北京 100069) 首都醫(yī)科大學(xué)臨床生物力學(xué)應(yīng)用基礎(chǔ)研究北京市重點(diǎn)實(shí)驗(yàn)室(北京 100069) 首都醫(yī)科大學(xué)附屬北京康復(fù)醫(yī)院康復(fù)診療中心(北京 100144) 天津醫(yī)院脊柱外科(天津 300211) 首都醫(yī)科大學(xué)附屬北京潞河醫(yī)院骨關(guān)節(jié)外科(北京 101149)

關(guān)鍵詞：膝骨關(guān)節(jié)炎；膝內(nèi)翻；步態(tài)；足底壓力分布；步態(tài)周期

分類號(hào)：R318.01

出版年·卷·期（頁(yè)碼）：2019·38·2（151-158）

摘要：

目的對(duì)比分析單側(cè)膝內(nèi)翻型膝骨關(guān)節(jié)炎（knee osteoarthritis, KOA）患者和健康人在步態(tài)周期中的足底壓力分布特征的差異，為KOA患者的康復(fù)治療評(píng)估提供量化參考。方法利用Footscan足底壓力測(cè)試系統(tǒng)對(duì)40名單側(cè)膝內(nèi)翻型KOA患者（Kellgren-Lawrence評(píng)分符合Ⅰ~Ⅲ級(jí)KOA，左右膝各20人）及20名健康人自然行走時(shí)的步態(tài)進(jìn)行測(cè)試，采集受試者足底各區(qū)域的壓力峰值、受力時(shí)間百分比、沖量，及單足支撐期參數(shù)和足軸角等參數(shù)，并進(jìn)行對(duì)比分析。結(jié)果對(duì)于足中部區(qū)域所受沖量，左KOA患者(左足98.57 N·s±38.58 N·s)和右KOA患者(右足65.11 N·s±32.52 N·s)均比健康人(左足45.53 N·s±12.69 N·s，右足39.58 N·s±15.74 N·s)大60%以上(P＜0.05）；患者第1趾區(qū)域壓力峰值比健康人減小40%以上(P＜0.001）；患者足跟內(nèi)外側(cè)壓力峰值比健康人減小27%以上(P＜0.001)。與健康人相比，患者足軸角、足底各區(qū)域受力時(shí)間百分比、整足支撐階段時(shí)間百分比均增大(P＜0.05)，足跟著地階段時(shí)間百分比和前足離地階段時(shí)間百分比減小(P＜0.05)。結(jié)論單側(cè)膝內(nèi)翻型膝骨關(guān)節(jié)炎患者與健康人相比足底壓力分布特征有顯著差異，足軸角明顯增大，整足支撐期階段時(shí)間延長(zhǎng)，第1趾和足跟內(nèi)外側(cè)壓力峰值及足中部所受沖量差異尤為顯著，這些指標(biāo)可為KOA患者的康復(fù)療效評(píng)估提供量化參考。

Objective To compare and analyze the distribution of plantar pressure in patients with unilateral varus knee osteoarthritis (UVKOA) and healthy people, and to provide quantitative reference for rehabilitation assessment of knee osteoarthritis patients. Methods Contact time percentage, peak pressure and contact time-pressure integral of each area, single foot support phase parameters and foot axis angle from 40 patients with UVKOA patients（Kellgren-Lawrence scores in accordance with grade I-III knee osteoarthritis, 20 left knees and 20 right knees）and 20 healthy people were measured by Footscan plantar pressure measurment system. Results The contact time-pressure integral in mid foot area of left UVKOA patients（left foot 98.57 N·s±38.58 N·s）and right UVKOA patients（right foot 65.11 N·s±32.52 N·s）increased than healthy people（left foot 45.53 N·s±12.69 N·s, right foot 39.58 N·s±15.74 N·s）by 60% (P＜0.05). Compared with healthy people, the peak pressure of UVKOA patients decreased in toe 1st area by 40% (P＜0.001) and heel（lateral and medial）area by 27% (P＜0.001). Compared with healthy people, foot axis angle, contact time percentage of each area and foot flat phase percentage of UVKOA patients increased (P＜0.05), while initial contact phase and forefoot push off phase percentage decreased (P＜0.05). Conclusions Compared with healthy people, the UVKOA patients showed significant differences in the plantar pressure distribution, the foot axis angle significantly increased and foot flat phase was significantly prolonged. Peak pressures in toe 1st area, heel lateral area and heel medial area reduced, while contact time-pressure integral in mid foot area significantly increased. These indicators provide a quantitative reference for the assessment of the efficacy of knee osteoarthritis rehabilitation.

參考文獻(xiàn)：

[1] 胥少汀，葛寶豐，徐印坎. 實(shí)用骨科學(xué). 4版[M]. 北京：人民軍醫(yī)出版社，2012.

Xu ST，Ge BF，Xu YK. Practical orthopedics[M]. 4th ed. Beijing：People's Military Medical Publishing House, 2012.

[2] 陳能，陳國(guó)材，劉文剛，等. 膝骨關(guān)節(jié)炎內(nèi)翻畸形影響因素及治療的研究進(jìn)展 [J]. 風(fēng)濕病與關(guān)節(jié)炎，2017，6（5）: 73-76,80.

[3] 陸艷紅，石曉兵. 膝骨關(guān)節(jié)炎國(guó)內(nèi)外流行病學(xué)研究現(xiàn)狀及進(jìn)展 [J]. 中國(guó)中醫(yī)骨傷科雜志，2012,20（6）: 81-84.

[4] Anbarian M, Esmaeili H. Effects of running-induced fatigue on plantar pressure distribution in novice runners with different foot types[J]. Gait & Posture, 2016, 48: 52-56.

[5] 夏清，曹娟娟，曹曉光. 腰椎間盤(pán)突出癥患者足底壓力的分布特征及重測(cè)信度 [J]. 中國(guó)康復(fù)理論與實(shí)踐，2015，21（3）: 307-310.

Xia Q，Cao JJ，Cao XG. Features and test-retest reliability of plantar pressure distribution in patients with lumbar disc herniation in walking[J]. Chinese Journal of Rehabilitation Theory and Practice，2015，21（3）: 307-310.

[6] 黃萍，錢(qián)念東，齊進(jìn)，等. 膝骨關(guān)節(jié)炎患者膝關(guān)節(jié)置換術(shù)后足底壓力研究 [J]. 中國(guó)運(yùn)動(dòng)醫(yī)學(xué)雜志，2018,37（3）: 197-201.

Huang P, Qian ND, Qi J, et al. Plantar pressure in patient with knee osteoarthritis after knee joint replacement surgery[J]. Chinese Journal of Sports Medicine, 2018,37（3）: 197-201.

[7] Fernandes WC, Machado á, Borella C, et al. Influence of gait speed on plantar pressure in subjects with unilateral knee osteoarthritis [J]. Revista Brasileira de Reumatologia (English Edition), 2014, 54（6）: 441-445.

[8] Lidtke RH, Muehleman C, Kwasny M, et al. Foot center of pressure and medial knee osteoarthritis [J]. Journal of the American Podiatric Medical Association, 2010, 100(3): 178-184.

[9] 邊薔. 雙膝骨性關(guān)節(jié)炎患者與正常人群的足底壓力研究 [D]. 北京: 北京中醫(yī)藥大學(xué)，2012.

Bian Q. Research on plantar pressure in patients with knee osteoarthritis and normal people [D]. Beijing: Beijing University of Chinese Medicine，2012.

[10] 付海燕，楊海韻. 膝骨性關(guān)節(jié)炎患者與正常青年人步態(tài)的對(duì)照[J]. 中國(guó)組織工程研究與臨床康復(fù)，2011，15（22）: 4115-4118.

Fu HY，Yang HY. Gait comparison between normal young people and knee osteoarthritis patients[J]. Journal of Clinical Rehabilitative Tissue Engineering Research, 2011, 15（22）: 4115-4118.

[11] 張永祥，張文潔，邵戰(zhàn)海. 膝關(guān)節(jié)骨性關(guān)節(jié)炎患者足底壓力分布規(guī)律分析 [J]. 中華臨床醫(yī)師雜志(電子版)，2012，6(11): 2955-2958.

Zhang YX, Zhang WJ, Shao ZH. The analysis of the regularity of dynamic and static plantar pressure in patients with osteoarthritis of knee [J].Chinese Journal of Clinicians (Electronic Edition), 2012，6(11):2955-2958.

[12] 夏清，袁海，曹娟娟. 膝骨性關(guān)節(jié)炎患者膝關(guān)節(jié)疼痛指數(shù)與足底壓力變化的相關(guān)性研究 [J]. 安徽醫(yī)學(xué)， 2015， 36（11）: 1358-1360.

Xia Q， Yuan H， Cao JJ. Impaction of knee pain index on plantar pressure in patients with knee osteoarthritis [J]. Anhui Medical Journal，2015，36（11）: 1358-1360.

[13] 張慶來(lái)，宋紹興，董杰. 健康大學(xué)生足底壓力分布參數(shù)特征[J]. 中國(guó)學(xué)校衛(wèi)生，2007，28（9）:

814-816.

Zhang QL，Song SX，Dong J. Parameter features of foot pressure in healthy university students [J]. Chinese Journal of School Health，2007，28（9）: 814-816.

[14] 李立，陳玉娟，翟鳳鳴，等. 老年人與青年人足底壓力分布特征比較 [J]. 中國(guó)老年學(xué)雜志，2011，31（23）: 4574-4576.

[15] 梁玉，霍洪峰，楊靜怡，等. 老年人步行時(shí)足底壓力及步態(tài)特征的增齡性變化 [J]. 中國(guó)老年學(xué)雜志，2013，33（13）: 3038-3040.

[16] Yan SH, Zhang K, Tan GQ, et al. Effects of obesity on dynamic plantar pressure distribution in chinese prepubescent children during walking [J]. Gait & Posture, 2013, 37(1): 37-42.

[17] Messier SP, Loeser RF, Hoover JL, et al. Osteoarthritis of the knee: effects on gait, strength, and flexibility[J]. Archives Physical Medicine and Rehabilitation, 1992, 73(1): 29-36.

[18] 樂(lè)意，金榮疆，陽(yáng)楊，等.從下肢生物力學(xué)來(lái)解析膝骨關(guān)節(jié)炎[J]. 中國(guó)康復(fù)理論與實(shí)踐，2013,19(6): 505-509.

Le Y, Jin RJ, Yang Y, et al. Relationship between knee osteoarthritis and lower limb biomechanics[J]. Chinese Journal of Rehabilitation Theory and Practice, 2013, 19(6): 505-509.

[19] 李偉，汪宗保，李國(guó)平，等. 膝關(guān)節(jié)骨性關(guān)節(jié)炎患者步態(tài)運(yùn)動(dòng)學(xué)參數(shù)的研究[J]. 中國(guó)康復(fù)醫(yī)學(xué)雜志, 2008, 23(1): 11-13.

Li W, Wang ZB, Li GP, et al. The research of fait kinematics parameters in the knee osteoarthritis patients [J]. Chinese Journal of Rehabilitation Medicine, 2008, 23(1): 11-13.

[20] Elbaz A, Mor A, Segal G, et al. Novel classification of knee osteoarthritis severity based on spatiotemporal gait analysis [J]. Osteoarthritis and Cartilage，2014，22（3）: 457-463.

[21] 應(yīng)充亮，萬(wàn)雷. 足弓破壞法醫(yī)臨床學(xué)鑒定的影像學(xué)理論與實(shí)踐[J]. 中國(guó)司法鑒定，2012（3）: 67-70.

Ying CL，Wan L. The theory and practice of arch destruction imaging examination in clinical forensic medicine[J]. Chinese Journal of Forensic Sciences, 2012(3): 67-70.

[22] 李峰，王常海，張蓉，等. 膝骨性關(guān)節(jié)炎功能評(píng)價(jià)步態(tài)指標(biāo)研究——足底壓力各階段時(shí)間分布及地面垂直反力[J].中國(guó)康復(fù)理論與實(shí)踐, 2007, 13(12): 1165-1167.

Li F, Wang CH, Zhang R, et al. Study of knee osteoarthritis gait index on function evaluation-time distribution at sole and the vertical rebound force at stand phase[J]. Chinese Journal of Rehabilitation Theory and Practice, 2007, 13(12): 1165-1167.

[23] 張昊華，閆松華，劉志成. footscan-SCSI高頻平板測(cè)試不同膝骨關(guān)節(jié)炎患者自然行走步態(tài)的生物力學(xué)比較[J]. 中國(guó)組織工程研究與臨床康復(fù),2010,14(43): 8019-8023.

Zhang HH, Yan SH, Liu ZC. Comparison in gait biomechanics of naturally walking patients with different knee osteoarthritis using footscan-SCSI high frequency plate system[J]. Journal of Clinical Rehabilitative Tissue Engineering Research, 2010, 14(43): 8019-8023.

[24] 鐘慧敏，黃萍. 不同體質(zhì)量指數(shù)正常人的足底壓力特征[J].中國(guó)組織工程研究，2017，21（23）: 3730-3735.

Zhong HM, Huang P. Plantar pressure of normal people with different body mass index[J]. Chinese Journal of Tissue Engineering Research，2017，21（23）: 3730-3735.

[25] 錢(qián)競(jìng)光，宋雅偉，葉強(qiáng)，等. 步行動(dòng)作的生物力學(xué)原理及其步態(tài)分析 [J]. 南京體育學(xué)院學(xué)報(bào)(自然科學(xué)版), 2006, 5(4): 1-7, 39.

Qian JG, Dong YW, Ye Q, et al. The biomedical principle of walking and analysis on gaits[J]. Journal of Nanjing Institute of Physical Education (Natural Science)，2006，5（4）: 1-7, 39.

[26] 吳寶平，閆松華，張寬，等. 大學(xué)生不同運(yùn)動(dòng)方式下的足底壓力分布研究 [J]. 北京生物醫(yī)學(xué)工程，2016，35（2）: 161-166, 179.

Wu BP, Yan SH, Zhang K, et al. Plantar pressure distribution of college students in different movement patterns [J]. Beijing Biomedical Engineering，2016，35（2）: 161-166, 179.

[27] 吳寶平，宋紅芳，王輝，等. 體質(zhì)不同的大學(xué)生自然行走時(shí)足底壓力特征的差異性分析 [J]. 北京生物醫(yī)學(xué)工程， 2018,37(3): 252-258.

Wu BP, Song HF, Wang H, et al. Analysis on the differences of natural plantar pressure feature among college students with different physical condition[J]. Beijing Biomedical Engineering, 2018,37(3): 252-258.

[28] Velotta J, Weyer J, Ramirez A, et al. Relationship between leg dominance tests and type of task[J]. Portuguese Journal of Sport Sciences, 2011, 11(Suppl. 2): 1035-1038.

[29] 付燾，于長(zhǎng)禾，張洋，等. 膝骨關(guān)節(jié)炎臨床研究中結(jié)局評(píng)價(jià)指標(biāo)的應(yīng)用現(xiàn)況[J]. 中國(guó)醫(yī)藥導(dǎo)報(bào), 2018, 15(29): 21-24, 28.

Fu T, Yu CH, Zhang Y, et al. Status of application of outcome measures in the clinical studies of knee osteoarthritis[J].China Medical Herald,2018,15(29):21-24, 28.

服務(wù)與反饋：

【文章下載】【加入收藏】

提示：您還未登錄，請(qǐng)登錄！點(diǎn)此登錄

51黑料吃瓜在线观看,51黑料官网|51黑料捷克街头搭讪_51黑料入口最新视频