两种不同矫形器对早期内侧间室膝关节骨性关节炎步态的影响

关键词：生物力学  膝关节骨性关节炎  矫形器  步态分析

Keywords:biomechanics  knee  osteoarthritis  orthoses  gait analysis

摘要：

      摘要 目的: 比较早期内侧间室膝关节骨性关节炎（OA）患者在佩戴膝关节外翻矫形器与外侧楔形角矫形鞋垫后所产生的下肢生物力学变化及差异，探讨不同矫形器在早期内侧间室膝关节骨性关节炎患者康复中的应用价值。 方法: 采用Vicon三维步态分析系统及Kislter测力台分别测评32例早期内侧间室型膝关节骨性关节炎患者在佩戴定制外侧楔形角矫形鞋垫（倾斜角5°）、膝关节外翻矫形器及无佩戴任何矫形器（测试期间均穿标准鞋）三种条件下的下肢关节运动学、动力学及时间空间参数。 结果: 相较于未佩戴任何矫形器情况，佩戴2种矫形器后膝关节内侧间室压力（膝关节内翻力矩，膝关节内翻角冲量）均明显降低（P<0.05），此外佩戴外侧楔形角矫形鞋垫后患者踝关节外翻角度明显增加，足底压力中心明显向外侧偏移（P<0.05）。 结论: 两种不同的矫形器均有助于降低早期内侧间室型膝关节骨性关节炎患者在步行过程中膝内侧间室所产生的压力，两者治疗效果未见明显差异。

Abstract:

      Abstract Objective： To compare the biomechanics changes at lower limb joints when early stage medial compartment knee osteoarthritis (OA) subjects wore the knee bracing and lateral wedges insole during walking, and to investigate the clinical value of different orthoses in early stage medial compartment knee OA rehabilitation. Method：Thirty-two patents with early stage medial compartment knee OA were recruited from the rehabilitation department of Shanghai 6th Peoples' Hospital (China). Kinematics, dynamics and temporal-spatial parameters were collected by Vicon 612 three dimensional gait analysis system and the kinetics changes were examined by two Kislter force platforms at the same time under three conditions：①With a custom-made lateral wedge of 5°(in standard shoes),②With a valgus knee bracing (in standard shoes),③with control condition (in standard shoes). Result：During wore both lateral wedge and knee bracing, the knee loading patterns (knee adduction moment and knee adduction angular impulse) at the knee joint decreased(P<0.05). The decreased loading on OA knee in wedge condition was associated with increasing of ankle valgus degrees and moment as well as laterally shifted location of the centre of pressure at the same foot (P<0.05). There was no significant difference of loading at knee between these two orthoses conditions. Conclusion：Under dynamic condition, valgus knee bracing and lateral wedge could decrease the loading in the medial compartment at knee. Lateral wedge was as effective as valgus knee bracing in the treatment of early stage medial compartment knee OA.