老年膝骨关节炎患者步态支撑期下肢生物力学研究

发布时间：2018-07-13 14:29

【摘要】：研究背景与目的:膝关节骨性关节炎是下肢最为常见的退行性骨关节病。膝骨关节炎会引起患者下肢运动学和动力学、负载模式以及平衡控制等多方面的改变,对患者的运动能力产生影响,增加其跌倒风险,严重降低患者的生活质量。本研究选取步行过程中主要活动平面——矢状面,基于前人关于膝骨关节炎矢状面内力学因素探究的少量结果,利用传统运动学、动力学测试手段配合环节互动动力学分析方法,深入了解和挖掘老年膝骨关节炎患者在步态支撑期,下肢髋、膝、踝三关节运动学参数以及主动肌肉力矩和被动力矩的大小和配比变化,以期获取评价膝骨关节炎的运动生物力学敏感步态指标,为老年膝骨关节炎的预防和临床康复、管理等提供生物力学理论依据。研究方法:使用Vicon 16摄像头红外运动捕捉系统和2块Kistler三维测力台同步采集13名患膝骨关节炎的受试者(65.9±4.1岁、58.1±8.6公斤)和13名下肢健康的受试者(对照组)(63.4±2.3岁、55.4±5.8公斤)步行过程中的运动学参数以及地面反作用力。在常规运动学和动力学分析基础上,建立人体下肢髋、膝、踝三关节环节互动动力学模型,并利用同向比和冲量矩等分析方法对两组受试者左侧下肢三关节在矢状面内主动肌肉力矩及多种被动力矩进行分析,所有力矩值均为身高体重标准化后数据。本研究统计学分析采用独立样本T检验对各项生物力学指标进行组间对比,显著性水平定为α=0.05。研究结果:1.步行过程中,膝骨关节炎受试者步幅小于健康对照组,组间存在显著性差异(P0.05);步速显著慢于健康对照组(P0.05)。2.在支撑期触地时刻(heel strike,hs)、支撑末期(terminal stance,ts),膝骨关节炎患者膝关节最大屈角显著大于健康受试者(P hs0.05;P ts0.05);此外,膝骨关节炎受试者在足跟触地阶段,伸膝关节力矩明显小于健康对照组(P0.05);研究结论:由于罹患膝骨关节炎,使得患者下肢主要屈、伸肌群力量以及活动情况发生改变,进而造成支撑期中特别是足跟触地阶段和支撑末期膝关节屈角峰值显著大于健康人,足跟触地阶段伸膝关节肌肉力矩峰值显著小于健康人,笔者认为上述指标可作为临床判断膝骨关节炎疾病的一种无创性、有效的生物力学指标。
[Abstract]:Background & AIM: osteoarthritis of knee joint is the most common degenerative osteoarthritis of lower extremities. Knee osteoarthritis can cause changes in lower limb kinematics and dynamics, load mode and balance control, which has an impact on patients' motor ability, increases the risk of falling down, and seriously reduces the quality of life of patients. In this study, the main active plane-sagittal plane in walking process was selected, and based on a few results of previous researches on the mechanical factors in the sagittal plane of knee osteoarthritis, the traditional kinematics was used. The dynamic test method combined with the tache interactive dynamic analysis method was used to deeply understand and excavate the elderly patients with knee osteoarthritis during gait support period, lower extremity hip and knee. In order to obtain the biomechanical sensitive gait index for evaluation of knee osteoarthritis, the kinematic parameters, the size and the ratio of active muscle moment and passive moment were obtained to prevent and rehabilitate the senile knee osteoarthritis. Management provides a theoretical basis for biomechanics. Methods: 13 subjects with knee osteoarthritis (65.9 卤4.1 years old, 58.1 卤8.6 kg) and 13 lower extremity healthy subjects (control group) (63.4 卤2.3 years old, 55.4 卤5.8 males) were collected simultaneously by using Vicon 16 camera infrared motion capture system and two Kistler three dimensional force measuring table. Kinematics parameters and ground reaction forces during walking. On the basis of routine kinematics and dynamics analysis, an interactive dynamic model of the hip, knee and ankle joints of the lower extremities was established. The active muscle torque and various passive moments in sagittal plane of the three joints of the left lower extremity were analyzed by the same direction ratio and impulse moment analysis method. All the torque values were the height and weight standardized data. In this study, independent sample T test was used to compare the biomechanical indexes among groups, and the significant level was 伪 -0.05. The result of the study was: 1. During walking, the walking size of knee osteoarthritis subjects was smaller than that of the healthy control group, and there was significant difference between the two groups (P0.05), and the walking speed was significantly slower than that of the healthy control group (P0.05). 2. At the heel strike-hs during the support period, the maximal knee flexion angle of the patients with knee osteoarthritis was significantly higher than that of the healthy subjects (P HS 0.05 P ts0.05), and the knee osteoarthritis subjects were at the foot contact stage. The torque of extensor knee joint was significantly lower than that of healthy control group (P0.05). Conclusion: because of knee osteoarthritis, the main flexion, extensor muscle group strength and activity of lower extremity were changed in patients with knee osteoarthritis. Therefore, the peak value of knee joint flexion angle in the supporting period, especially in the foot contact stage and the end stage of the support, was significantly higher than that in the healthy person, and the peak value of the knee joint muscle moment in the heel touching stage was significantly lower than that in the healthy person. The authors believe that the above indexes can be used as a noninvasive and effective biomechanical index for clinical diagnosis of knee osteoarthritis.
【学位授予单位】：上海体育学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：G804.6

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