老年膝骨关节炎患者膝关节肌力与骨密度相关性分析
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摘要
目的探讨老年膝骨关节炎(knee osteoarthritis,KOA)患者膝关节肌力与骨密度(bone mineral density,BMD)的相关关系。方法采用多关节等速力量测试与训练系统测试老年KOA患者膝关节肌力;采用双能X线骨密度仪检测老年KOA患者BMD,并分析两者之间的关系。结果 (1)老年KOA患者主患侧伸膝肌群峰力矩、相对峰力矩均显著低于对侧。(2)老年KOA患者双侧膝关节肌力部分指标与BMD相关,在等长等速模式下,伸膝肌群峰力矩与髋关节以及L1-L4 BMD呈正相关;屈膝肌群峰力矩与股骨颈、髋关节以及L1-L4 BMD呈正相关。(3)老年KOA患者主患侧膝关节肌力部分指标与BMD有一定相关性,在等速模式下,屈膝肌群峰力矩以及相对峰力矩与主患侧髋关节以及股骨颈BMD呈正相关;在等长等速模式下,伸膝以及屈膝肌群峰力矩与L1-L4 BMD呈正相关。结论老年KOA患者膝关节肌力与骨密度之间存在相关性。加强膝关节肌力锻炼,特别要加强主患侧屈膝肌群肌力锻炼,可能会提高髋关节、股骨颈以及腰椎BMD,从而预防骨质疏松。
Objective To study the correlation between knee muscle strength and bone mineral density(BMD) in elderly knee osteoarthritis(KOA) patients. Methods The knee muscle strength and BMD of elderly KOA patients were measured respectively by multi-joint isokinetic force test and training system and dual-energy X-ray bone densitometer. Then the relationship between them were analyzed. Results(1) The peak torque(PT) and PT/body weight(BW) of the extensor knee muscle on the main affected side of elderly KOA patients were significantly lower than those on the opposite side.(2) Some indexes of bilateral knee muscle strength in elderly KOA patients were correlated with BMD. In the isokinetic and constant speed mode, the PT of knee extension muscle was positively correlated with total hip and L1-L4 BMD. The PT of knee flexion muscle was positively correlated with femoral neck, total hip and L1-L4 BMD.(3) There was certain correlation between the muscle strength of the main affected knee joint side and BMD in elderly KOA patients. In the isokinetic mode, the PT and PT/BW of flexion muscle were positively correlated with hip and femoral neck BMD at the main affected side. In the isokinetic and constant speed mode, the PT of knee extension and flexion muscles was positively correlated with L1-L4 BMD. Conclusion There were correlations between knee muscle strength and bone mineral density in elderly KOA patients. Exercises that strengthen knee muscle strength, especially knee muscle of the main affected side, may improve hip, femoral neck and lumbar spine BMD, therefore preventing osteoporosis.
Objective To study the correlation between knee muscle strength and bone mineral density(BMD) in elderly knee osteoarthritis(KOA) patients. Methods The knee muscle strength and BMD of elderly KOA patients were measured respectively by multi-joint isokinetic force test and training system and dual-energy X-ray bone densitometer. Then the relationship between them were analyzed. Results(1) The peak torque(PT) and PT/body weight(BW) of the extensor knee muscle on the main affected side of elderly KOA patients were significantly lower than those on the opposite side.(2) Some indexes of bilateral knee muscle strength in elderly KOA patients were correlated with BMD. In the isokinetic and constant speed mode, the PT of knee extension muscle was positively correlated with total hip and L1-L4 BMD. The PT of knee flexion muscle was positively correlated with femoral neck, total hip and L1-L4 BMD.(3) There was certain correlation between the muscle strength of the main affected knee joint side and BMD in elderly KOA patients. In the isokinetic mode, the PT and PT/BW of flexion muscle were positively correlated with hip and femoral neck BMD at the main affected side. In the isokinetic and constant speed mode, the PT of knee extension and flexion muscles was positively correlated with L1-L4 BMD. Conclusion There were correlations between knee muscle strength and bone mineral density in elderly KOA patients. Exercises that strengthen knee muscle strength, especially knee muscle of the main affected side, may improve hip, femoral neck and lumbar spine BMD, therefore preventing osteoporosis.
引文
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[13] 潘晓雨,傅维杰,武勰,等.老年女性膝骨关节炎患者膝屈伸等速肌力及其与BMI的相关性研究[J].中国运动医学杂志,2016,35(4):317-320.
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[16] Wallace BA,Cumming RG.Systematic review of randomized trials of the effect of exercise on bone mass in pre- and postmenopausal women[J].Calcified Tissue Int,2000,67(1):10-18.
[17] 张颖,裴育,齐云.男性骨密度测量中不同部位骨质疏松检出率差异的比较[J].中国骨质疏松杂志,2010,16(1):45-47.
[18] 左自强.腘绳肌的解剖生理弱点及其损伤的运动干预[J].宜春学院报,2009,31(2):148-150.
[19] 王昭琦,王立恒,王媚.老年骨质疏松患者肌力与骨密度等指标的相关性研究及不同干预方法的疗效评价[J].中国骨质疏松杂志,2014,20(7):815-819.
[20] Pocock NA,Eisman JA,Yeates MG,et al.Physical fitness is a major determinant of femoral neck and lumbar spine bone mineral density[J].J Chin Invest,1986,78(3):618-621.
[21] Frost HM.On our age-related bone loss:insights from a new paradigm[J].J Bone Miner Res,1997,12(10):1539-1546.
[2] Tang X,Wang S,Zhan S,et al.The prevalence of symptomatic knee osteoarthritis in China:results from the China health and retirement longitudinal study[J].Arthitis Rheumatology,2016,68(3):648-653.
[3] Fisher NM,Pendergast DR,Gresham GE,et al.Muscle rehabilitation:its effect on muscular and functional performance of patients with knee osteoarthritis[J].Arch Phys Med Rehab,1991,72(6):367-374.
[4] Oiestad BE,Juhl CB,Eitzen I,et al.Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis.A systematic review and meta-analysis[J].Osteoarthr Cartilage,2015,23(2):171-177.
[5] Slemenda C,Heilman DK,Brandt KD,et al.Reduced quadriceps strength relative to body weight:a risk factor for knee osteoarthritis in women?[J].Arthritis Rheumatol,1998,41(11):1951-1959.
[6] 周志雄,郑陆,叶鸣,等.健康绝经妇女髋关节和腰背肌力与骨密度的关系[J].中国运动医学杂志,2011,30(3):236-240.
[7] Tan J,Cubukcu S,Sepici V.Relationship between bone mineral density of the proximal femur and strength of hip muscles in postmenopausal women[J].AM J Phts Med Rehab,1998,77(6):477-482.
[8] Rychel JK.Diagnosis and treatment of osteoarthritis[J].Top Companion Anim M Medicine,2010,25(1):20-25.
[9] 洪海平,卫晓恩,陈勇,等.膝骨关节炎患者股四头肌肌张力与膝关节功能的关系研究[J].中医正骨,2014,26(10):32-34.
[10] 俞捷,左群.老年人健身走对下肢肌力的影响[J].中国体育科技,2008,44(2):76-80.
[11] Tan J,Balci N,Sepici V,et al.Isokinetic and isometric strength in osteoarthrosis of the knee.A comparative study with healthy women[J].AM J Phts Med Rehab,1995,74(5):364-369.
[12] 王剑雄,周谋望,宫萍,等.膝骨关节炎患者膝屈伸肌群等速肌力及其与功能的相关性[J].中国康复理论与实践,2014,20(12):1105-1108.
[13] 潘晓雨,傅维杰,武勰,等.老年女性膝骨关节炎患者膝屈伸等速肌力及其与BMI的相关性研究[J].中国运动医学杂志,2016,35(4):317-320.
[14] Patsika G,Kellis E,Kofotolis N,et al.Synergetic and antagonist muscle strength and activity in women with knee osteoarthritis[J].Geriatr Phys Ther,2014,37(1):17-23.
[15] 杨莉丽,于雪梅,陈培红,等.健康中年男性人体成分对骨密度的影响[J].中国骨质疏松杂志,2014,20(3):242-246.
[16] Wallace BA,Cumming RG.Systematic review of randomized trials of the effect of exercise on bone mass in pre- and postmenopausal women[J].Calcified Tissue Int,2000,67(1):10-18.
[17] 张颖,裴育,齐云.男性骨密度测量中不同部位骨质疏松检出率差异的比较[J].中国骨质疏松杂志,2010,16(1):45-47.
[18] 左自强.腘绳肌的解剖生理弱点及其损伤的运动干预[J].宜春学院报,2009,31(2):148-150.
[19] 王昭琦,王立恒,王媚.老年骨质疏松患者肌力与骨密度等指标的相关性研究及不同干预方法的疗效评价[J].中国骨质疏松杂志,2014,20(7):815-819.
[20] Pocock NA,Eisman JA,Yeates MG,et al.Physical fitness is a major determinant of femoral neck and lumbar spine bone mineral density[J].J Chin Invest,1986,78(3):618-621.
[21] Frost HM.On our age-related bone loss:insights from a new paradigm[J].J Bone Miner Res,1997,12(10):1539-1546.