基于多通道表面肌电探讨不同角速度下膝骨关节炎患者生物力学基础的研究

关键词：膝骨关节炎  股四头肌  表面肌电图  回归分析  伸膝力矩

Keywords:knee osteoarthritis  quadriceps femoris  surface electromyography  regressive analysis  knee extensor moment

摘要：

      摘要 目的：应用表面肌电图观察和分析膝骨关节炎（knee osteoarthritis， KOA）患者股四头肌表面肌电活动。 方法：采用全无线肌电测试系统评测30例KOA患者（KOA组）和30例健康受试者（CON组）在不同角速度（60°/s、90°/s、180°/s）膝关节屈伸运动等速肌力测试下，股内侧肌、股直肌和股外侧肌的表面肌电图，并记录KOA组受试者股内侧肌、股直肌和股外侧肌肌肉厚度与膝痛程度，以评估肌电数据和临床指标的相关性。 结果：KOA患者和健康受试者在各不同角速度60°/s（P<0.001）、90°/s（P<0.01）、180°/s（P<0.01）膝关节屈伸运动中屈膝最大力矩与伸膝最大力矩均具有显著性意义，且KOA组膝关节屈伸最大力矩平均值均低于CON组。在角速度为60°/s等速肌力测试时，KOA组股外侧肌的中值频率差值率（P<0.05）、股直肌的均方根值（P<0.01）与相应对照组具有显著性意义；在角速度为90°/s等速肌力测试时，两组受试者的股直肌均方根值存在显著性差异（P<0.05）；在角速度为180°/s时，两组的股直肌中值频率差值率（P<0.05）和均方根值（P<0.05）存在显著性差异。在多元线性回归与基于随机森林算法的数据回归分析中，无论是肌肉厚度还是膝痛程度，与临床指标关系最显著的肌电特征均为伸膝运动时的最大力矩。 结论：KOA患者股四头肌肌力下降，需要更多的肌肉协同收缩才能完成动作，容易造成肌肉疲劳。伸膝力矩与股四头肌肌肉厚度和膝周疼痛密切相关，有望作为KOA诊断的重要指标。

Abstract:

      Abstract Objective： To observe and analyze the surface electromyography activity of quadriceps femoris of knee osteoarthritis （KOA） patients. Method： The surface electromyography of vastus lateralis， rectus femoris， and vastus medialis were recorded and analyzed in 30 KOA patients and 30 normal people during isokinetic knee flexion or extension at velocities of 60 °/s， 90 °/s or 180 °/s. We also record clinical indicators （muscle thickness and degree of knee pain） of the KOA group and evaluate the correlation between electromyographic data and clinical indicators. Result： Compared with the healthy control group， the KOA group had significantly lower knee extensor moment during isokinetic knee flexion or extension at velocities of 60°/s （P<0.001）， 90°/s （P<0.01）， or 180°/s （P<0.01）. Statistics showed that there were significant differences in the median frequency difference rate of vastus lateralis （P<0.05） and root mean square value of rectus femoris （P<0.01） between the healthy control group and the KOA group under 60°/s angular velocities. There was a significant difference in the root mean square value of rectus femoris （P<0.05） between the two groups at velocities of 90°/s. Statistics revealed that the median frequency difference rate （P<0.05） and root mean square value （P<0.05） of rectus femoris had changed significantly at the velocities of 180°/s. The results of both multiple regression and random forest algorithm showed that knee extensor moment was the strongest predictor between electromyographic characteristics and clinical indicators. Conclusion： The strength of quadriceps femoris in KOA patients was decreased. Thus，the patient may need more muscles to complete the same action， which was easy to cause muscle fatigue. The knee extensor moment was closely related to the quadriceps femoris thickness and the degree of knee pain. It offers important advantages for the diagnosis and assessing the severity， which may provide the way for the future study of KOA.