老年与青年下肢关节生物力学特征研究
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摘要
目的应用三维步态分析系统评估日常活动中老年人与青年人的差异性,分别为其提供针对性的日常生活指导。方法老年组10例健康老年人,其中男3例,女7例;年龄平均(69±12.42)岁。青年组10例健康青年人,其中男6例,女4例;年龄平均(26.29±2.29)岁。应用Vicon运动分析系统与骨肌多体动力学软件比较运动学和动力学参数。结果老年组水平行走时步行周期较青年组增大,跨距减小(P<0.01)。水平行走过程中老年组个体间差异较大(P>0.05),老年组的踝关节合力峰值大于青年组(P<0.05)。结论三维步态分析在指导老年人日常生活保护有较好的实用价值。老年人应适当增加运动锻炼,可行步态矫正训练与矫形鞋垫等超早期干预。
Objective To evaluate the differences between the elderly and young people in daily activities with a three-dimensional gait analysis system and provide them subject-specific guidance.Methods The elderly group consisted of ten healthy elderly people.The young group consisted of ten young healthy people.The kinematics and kinetic parameters were compared using the Vicon 3-dimensional motion analysis system and the skeletal muscle multi-body dynamics software.Results The walking cycle of the elderly group was higher than that of the young group when walking horizontally,and the span decreased(P<0.01).Individual differnce for kinematic/kinetic parameters occurred among elderly people.The maximal ankle contact forces were higher than the young group(P<0.05).Conclusion The threedimensional gait analysis has a better predictive value for the risk of osteoarthritis in the middle-aged and the elderly.Older people should increase physical exercise,feasible early gait modification training program and orthopedic insoles.
Objective To evaluate the differences between the elderly and young people in daily activities with a three-dimensional gait analysis system and provide them subject-specific guidance.Methods The elderly group consisted of ten healthy elderly people.The young group consisted of ten young healthy people.The kinematics and kinetic parameters were compared using the Vicon 3-dimensional motion analysis system and the skeletal muscle multi-body dynamics software.Results The walking cycle of the elderly group was higher than that of the young group when walking horizontally,and the span decreased(P<0.01).Individual differnce for kinematic/kinetic parameters occurred among elderly people.The maximal ankle contact forces were higher than the young group(P<0.05).Conclusion The threedimensional gait analysis has a better predictive value for the risk of osteoarthritis in the middle-aged and the elderly.Older people should increase physical exercise,feasible early gait modification training program and orthopedic insoles.
引文
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[12]张曼,庞坚,陈博,等.步态矫正训练治疗膝骨关节炎的研究进展[J].中国康复医学杂志,2017,32(9):1078-1081.
[13]张曼,马峥,江澜,等.不同外侧楔形矫形鞋垫对内侧间室膝骨关节炎步态的影响[J].中国康复,2015,30(1):61-63.
[14] Barrios JA,Butler RJ,Crenshaw JR,et al.Mechanical effectiveness of lateral foot wedging in medial knee osteoarthritis after one year of wear[J].J Orthop Res,2013,31(5):659-664.
[15] Hsu WC,Jhong YC,Chen HL,et al.Immediate and long-term efficacy of laterally-wedged insoles on persons with bilateral medial knee osteoarthritis during walking[J].Biomed Eng Online,2015,14(14):43.
[16] Parkes MJ,Maricar N,Lunt M,et al.Lateral wedge insoles as a conservative treatment for pain in patients with medial knee osteoarthritis:a meta-analysis[J].JAMA,2013,310(7):722-730.
[17] Duivenvoorden T,van Raaij TM,Horemans HL,et al.Do laterally wedged insoles or valgus braces unload the medial compartment of the knee in patients with osteoarthritis?[J].Clin Orthop Relat Res,2015,473(1):265-274.
[18] Phinyomark A,Osis ST,Hettinga BA,et al.Gender differences in gait kinematics for patients with knee osteoarthritis[J].BMC Musculoskelet Disord,2016(17):157.
[2] Ibrahim SA,Blum M,Lee GC,et al.Effect of a decision aid on access to total knee replacement for black patients with osteoarthritis of the knee a randomized clinical trial[J].JAMA Surg,2017,152(1):e164225.
[3] Felson DT.Osteoarthritis of the Knee[J].N Engl J Med,2006,354(8):841-848.
[4] Murray CJ,Atkinson C,Bhalla K,et al.The state of US health,1990-2010:Burden of diseases,injuries,and risk factors[J].JAMA,2013,310(6):591-608.
[5] Vos T,Flaxman AD,Naghavi M,et al.Years lived with disability(YLDs)for 1160sequelae of 289diseases and injuries 1990-2010:A systematic analysis for the Global Burden of Disease Study 2010[J].Lancet,2012,380(9859):2163-2196.
[6] Robinson WH,Lepus CM,Wang Q,et al.Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis[J].Nat Rev Rheumatol,2016,12(10):580-592.
[7] Sharma L,Song J,Felson DT,et al.The role of knee alignment in disease progression and functional decline in knee osteoarthritis[J].JAMA,2001,286(2):188-195.
[8] Clifford AG,Gabriel SM,O’Connell M,et al.The kine spring(R)knee implant system:an implantable joint-unloading prosthesis for treatment of medial knee osteoarthritis[J].Med Devices(Auckl),2013,17(6):69-76.
[9] Sharma L.Osteoarthritis Year in Review 2015:Clinical[J].Osteoarthritis Cartilage,2016,24(1):36-48.
[10] Varady NH,Grodzinsky AJ.Osteoarthritis Year in Review 2015:Mechanics[J].Osteoarthritis Cartilage,2016,24(1):27-35.
[11]梁玉,霍洪峰,杨静怡,等.老年人步行时足底压力及步态特征的增龄性变化[J].中国老年学杂志,2013,33(13):3038-3040.
[12]张曼,庞坚,陈博,等.步态矫正训练治疗膝骨关节炎的研究进展[J].中国康复医学杂志,2017,32(9):1078-1081.
[13]张曼,马峥,江澜,等.不同外侧楔形矫形鞋垫对内侧间室膝骨关节炎步态的影响[J].中国康复,2015,30(1):61-63.
[14] Barrios JA,Butler RJ,Crenshaw JR,et al.Mechanical effectiveness of lateral foot wedging in medial knee osteoarthritis after one year of wear[J].J Orthop Res,2013,31(5):659-664.
[15] Hsu WC,Jhong YC,Chen HL,et al.Immediate and long-term efficacy of laterally-wedged insoles on persons with bilateral medial knee osteoarthritis during walking[J].Biomed Eng Online,2015,14(14):43.
[16] Parkes MJ,Maricar N,Lunt M,et al.Lateral wedge insoles as a conservative treatment for pain in patients with medial knee osteoarthritis:a meta-analysis[J].JAMA,2013,310(7):722-730.
[17] Duivenvoorden T,van Raaij TM,Horemans HL,et al.Do laterally wedged insoles or valgus braces unload the medial compartment of the knee in patients with osteoarthritis?[J].Clin Orthop Relat Res,2015,473(1):265-274.
[18] Phinyomark A,Osis ST,Hettinga BA,et al.Gender differences in gait kinematics for patients with knee osteoarthritis[J].BMC Musculoskelet Disord,2016(17):157.