中老年女性膝骨关节炎患者坐-站转换及上下台阶中膝周肌肉激活的观察性研究

关键词：膝骨关节炎  肌肉激活  共同收缩  表面肌电图

Keywords:knee osteoarthritis  muscle activation  common contraction  surface electromyography

摘要：

      摘要 目的：采用表面肌电图观察女性膝骨关节炎（knee osteoarthritis， KOA）患者在坐站、上下台阶活动中膝周肌肉的激活和共同收缩策略。 方法：招募2023年3月—2024年1月于西南医科大学附属医院就诊的KOA女性患者，通过表面肌电图采集KOA患者患侧从站到坐、从坐到站、上台阶、下台阶过程中股内侧肌、股二头肌、股外侧肌、半腱肌和股直肌的积分肌电值和均方根值，并与无KOA的对照人群进行对比，观察膝周肌肉的激活和共同收缩策略的变化。 结果：招募KOA 35例，对照组20例；从坐到站时，KOA组股二头肌、半腱肌的均方根值（root mean square， RMS）和积分肌电值（integrated electromyography， iEMG）激活显著低于对照组（|Z|>3.097，P<0.005），腘绳/股四头肌共同收缩下降（|Z|=4.164，P<0.001）。从站到坐时，KOA患者股四头肌与腘绳肌肌肉激活明显更高（|Z|>3.009，P<0.005），内侧/外侧共同收缩降低（|Z|=2.310， P<0.001）。上台阶启动阶段，KOA组股外侧肌、股二头肌、半腱肌的iEMG高于对照组（|Z|>2.899， P<0.005）；跟随阶段，股外侧肌、股直肌的iEMG高于对照组（|Z|>2.110， P<0.005）。下台阶启动阶段，KOA组股外侧肌、股二头肌、半腱肌的iEMG高于对照组（|Z|>2.092， P<0.005）；跟随阶段，股外侧肌、股直肌的iEMG高于对照组（|Z|>2.606， P<0.005）。在上下台阶活动中，腘绳肌和股四头肌，内侧肌和外侧肌的共同收缩均无明显差异（P>0.05）。 结论：中老年女性KOA患者在功能性活动中呈现肌肉激活强度与共同收缩策略的改变，其具体变化因任务类型（坐-站，站-坐，台阶活动）而异。

Abstract:

      Abstract Objective： Surface electromyography was used to observe the activation and co-contraction strategies of muscles surrounding the knee in female patients with knee osteoarthritis（KOA） during sitting， standing and stepping. Method： Female KOA patients admitted to the Affiliated Hospital of Southwest Medical University from March 2023 to January 2024 were recruited. Surface electromyography was used to collect the integral EMG and root mean square values of the vastus medialis， biceps femoris， lateralis femoris， semitendinosus and rectus femoris of the affected side of KOA patients during the process of standing to sitting， sitting to standing， ascending and descending steps. The activation of peri-knee muscles and the change of co-contraction strategy were observed in the control group without KOA. Result： Thirty-five KOA patients and 20 control patients were recruited. From sitting to standing， the root mean square（RMS）and integrated electromyography （iEMG）activation of biceps femoris and semitendinosus in KOA group were significantly lower than those in control group（|Z|>3.097，P<0.005）， and the co-contraction of hamstring/quadriceps muscle decreased（|Z|=4.164，P<0.001）. From standing to sitting， KOA patients had significantly higher quadriceps and hamstring muscle activation（|Z|>3.009，P<0.005） and decreased medial/lateral co-contraction（|Z|=2.310，P<0.001）. During the stair ascent initiation phase， the iEMG levels of lateral femoris， biceps femoris and semitendinosus in KOA group were higher than those in control group（|Z|>2.899，P<0.005）. In the following stage，iEMG levels of lateral femoris muscle and rectus femoris muscle were higher than those of control group（|Z|>2.110，P<0.005）. During the stair descent initiation phase， the iEMG levels of lateral femoris， biceps femoris and semitendinosus in KOA group were higher than those in control group（|Z|>2.092，P<0.005）. In the following stage，iEMG levels of lateral femoris muscle and rectus femoris muscle were higher than those of control group（|Z|>2.606，P<0.005）. During stair ascent and descent activities， there was no significant difference in the co-contraction of hamstring and quadriceps， medial and lateral muscles （P>0.05）. Conclusion： Middle-aged and elderly women with KOA showed changes in muscle activation intensity and common contraction strategies during functional activities， which varied according to the type of task （sit-stand， stand-sit， stairs activity）.