单侧膝内翻型膝骨关节炎患者足底压力分布特征研究
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摘要
目的对比分析单侧膝内翻型膝骨关节炎(knee osteoarthritis,KOA)患者和健康人在步态周期中的足底压力分布特征的差异,为KOA患者的康复治疗评估提供量化参考。方法利用Footscan足底压力测试系统对40名单侧膝内翻型KOA患者(Kellgren-Lawrence评分符合Ⅰ～Ⅲ级KOA,左右膝各20人)及20名健康人自然行走时的步态进行测试,采集受试者足底各区域的压力峰值、受力时间百分比、冲量,及单足支撑期参数和足轴角等参数,并进行对比分析。结果对于足中部区域所受冲量,左KOA患者(左足98. 57 N·s±38. 58 N·s)和右KOA患者(右足65. 11 N·s±32. 52 N·s)均比健康人(左足45. 53 N·s±12. 69 N·s,右足39. 58 N·s±15. 74 N·s)大60%以上(P<0. 05);患者第1趾区域压力峰值比健康人减小40%以上(P<0. 001);患者足跟内外侧压力峰值比健康人减小27%以上(P<0. 001)。与健康人相比,患者足轴角、足底各区域受力时间百分比、整足支撑阶段时间百分比均增大(P<0. 05),足跟着地阶段时间百分比和前足离地阶段时间百分比减小(P<0. 05)。结论单侧膝内翻型膝骨关节炎患者与健康人相比足底压力分布特征有显著差异,足轴角明显增大,整足支撑期阶段时间延长,第1趾和足跟内外侧压力峰值及足中部所受冲量差异尤为显著,这些指标可为KOA患者的康复疗效评估提供量化参考。
Objective To compare and analyze the distribution of plantar pressure in patients with unilateral varus knee osteoarthritis( UVKOA) and healthy people,and to provide quantitative reference for rehabilitation assessment of knee osteoarthritis patients. Methods Contact time percentage,peak pressure and contact time-pressure integral of each area,single foot support phase parameters and foot axis angle from 40 patients with UVKOA patients( Kellgren-Lawrence scores in accordance with grade I-III knee osteoarthritis,20 left knees and 20 right knees) and 20 healthy people were measured by Footscan plantar pressure measurment system.Results The contact time-pressure integral in mid foot area of left UVKOA patients( left foot 98. 57 N·s±38. 58 N·s) and right UVKOA patients( right foot 65. 11 N · s ± 32. 52 N · s) increased than healthy people( left foot 45. 53 N·s±12. 69 N·s,right foot 39. 58 N·s±15. 74 N·s) by 60%( P<0. 05).Compared with healthy people,the peak pressure of UVKOA patients decreased in toe 1 st area by 40%( P<0. 001) and heel( lateral and medial) area by 27%( P<0. 001).Compared with healthy people,foot axis angle,contact time percentage of each area and foot flat phase percentage of UVKOA patients increased( P < 0. 05),while initial contact phase and forefoot push off phase percentage decreased( P<0. 05). Conclusions Compared with healthy people,the UVKOA patients showed significant differences in the plantar pressure distribution,the foot axis angle significantly increased and foot flat phase was significantly prolonged.Peak pressures in toe 1 st area,heel lateral area and heel medial area reduced,while contact time-pressure integral in mid foot area significantly increased. These indicators provide a quantitative reference for the assessment of the efficacy of knee osteoarthritis rehabilitation.
Objective To compare and analyze the distribution of plantar pressure in patients with unilateral varus knee osteoarthritis( UVKOA) and healthy people,and to provide quantitative reference for rehabilitation assessment of knee osteoarthritis patients. Methods Contact time percentage,peak pressure and contact time-pressure integral of each area,single foot support phase parameters and foot axis angle from 40 patients with UVKOA patients( Kellgren-Lawrence scores in accordance with grade I-III knee osteoarthritis,20 left knees and 20 right knees) and 20 healthy people were measured by Footscan plantar pressure measurment system.Results The contact time-pressure integral in mid foot area of left UVKOA patients( left foot 98. 57 N·s±38. 58 N·s) and right UVKOA patients( right foot 65. 11 N · s ± 32. 52 N · s) increased than healthy people( left foot 45. 53 N·s±12. 69 N·s,right foot 39. 58 N·s±15. 74 N·s) by 60%( P<0. 05).Compared with healthy people,the peak pressure of UVKOA patients decreased in toe 1 st area by 40%( P<0. 001) and heel( lateral and medial) area by 27%( P<0. 001).Compared with healthy people,foot axis angle,contact time percentage of each area and foot flat phase percentage of UVKOA patients increased( P < 0. 05),while initial contact phase and forefoot push off phase percentage decreased( P<0. 05). Conclusions Compared with healthy people,the UVKOA patients showed significant differences in the plantar pressure distribution,the foot axis angle significantly increased and foot flat phase was significantly prolonged.Peak pressures in toe 1 st area,heel lateral area and heel medial area reduced,while contact time-pressure integral in mid foot area significantly increased. These indicators provide a quantitative reference for the assessment of the efficacy of knee osteoarthritis rehabilitation.
引文
[1]胥少汀,葛宝丰,徐印坎.实用骨科学[M]. 4版.北京:人民军医出版社,2012.
[2]陈能,陈国材,刘文刚,等.膝骨关节炎内翻畸形影响因素及治疗的研究进展[J].风湿病与关节炎,2017,6(5):73-76,80.
[3]陆艳红,石晓兵.膝骨关节炎国内外流行病学研究现状及进展[J].中国中医骨伤科杂志,2012,20(6):81-84.
[4] Anbarian M,Esmaeili H. Effects of running-induced fatigue on plantar pressure distribution in novice runners with different foot types[J]. Gait&Posture,2016,48:52-56.
[5]夏清,曹娟娟,曹晓光.腰椎间盘突出症患者足底压力的分布特征及重测信度[J].中国康复理论与实践,2015,21(3):307-310.Xia Q,Cao JJ,Cao XG. Features and test-retest reliability of plantar pressure distribution in patients with lumbar disc herniation in walking[J]. Chinese Journal of Rehabilitation Theory and Practice,2015,21(3):307-310.
[6]黄萍,钱念东,齐进,等.膝骨关节炎患者膝关节置换术后足底压力研究[J].中国运动医学杂志,2018,37(3):197-201.Huang P,Qian ND,Qi J,et al. Plantar pressure in patient with knee osteoarthritis after knee joint replacement surgery[J].Chinese Journal of Sports Medicine,2018,37(3):197-201.
[7] Fernandes WC,Machadoá,Borella C,et al. Influence of gait speed on plantar pressure in subjects with unilateral knee osteoarthritis[J]. Revista Brasileira de Reumatologia(English Edition),2014,54(6):441-445.
[8] Lidtke RH,Muehleman C,Kwasny M,et al. Foot center of pressure and medial knee osteoarthritis[J]. Journal of the American Podiatric Medical Association,2010,100(3):178-184.
[9]边蔷.双膝骨性关节炎患者与正常人群的足底压力研究[D].北京:北京中医药大学,2012.Bian Q. Research on plantar pressure in patients with knee osteoarthritis and normal people[D]. Beijing:Beijing University of Chinese Medicine,2012.
[10]付海燕,杨海韵.膝骨性关节炎患者与正常青年人步态的对照[J].中国组织工程研究与临床康复,2011,15(22):4115-4118.Fu HY,Yang HY. Gait comparison between normal young people and knee osteoarthritis patients[J]. Journal of Clinical Rehabilitative Tissue Engineering Research,2011,15(22):4115-4118.
[11]张永祥,张文洁,邵战海.膝关节骨性关节炎患者足底压力分布规律分析[J].中华临床医师杂志(电子版),2012,6(11):2955-2958.Zhang YX,Zhang WJ,Shao ZH. The analysis of the regularity of dynamic and static plantar pressure in patients with osteoarthritis of knee[J].Chinese Journal of Clinicians(Electronic Edition),2012,6(11):2955-2958.
[12]夏清,袁海,曹娟娟.膝骨性关节炎患者膝关节疼痛指数与足底压力变化的相关性研究[J].安徽医学,2015,36(11):1358-1360.Xia Q,Yuan H,Cao JJ. Impaction of knee pain index on plantar pressure in patients with knee osteoarthritis[J]. Anhui Medical Journal,2015,36(11):1358-1360.
[13]张庆来,宋绍兴,董杰.健康大学生足底压力分布参数特征[J].中国学校卫生,2007,28(9):814-816.Zhang QL,Song SX,Dong J. Parameter features of foot pressure in healthy university students[J]. Chinese Journal of School Health,2007,28(9):814-816.
[14]李立,陈玉娟,翟凤鸣,等.老年人与青年人足底压力分布特征比较[J].中国老年学杂志,2011,31(23):4574-4576.
[15]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.
[16] Yan SH,Zhang K,Tan GQ,et al. Effects of obesity on dynamic plantar pressure distribution in chinese prepubescent children during walking[J]. Gait&Posture,2013,37(1):37-42.
[17] Messier SP,Loeser RF,Hoover JL,et al. Osteoarthritis of the knee:effects on gait,strength,and flexibility[J]. Archives Physical Medicine and Rehabilitation,1992,73(1):29-36.
[18]乐意,金荣疆,阳杨,等.从下肢生物力学来解析膝骨关节炎[J].中国康复理论与实践,2013,19(6):505-509.Le Y,Jin RJ,Yang Y,et al. Relationship between knee osteoarthritis and lower limb biomechanics[J]. Chinese Journal of Rehabilitation Theory and Practice,2013,19(6):505-509.
[19]李伟,汪宗保,李国平,等.膝关节骨性关节炎患者步态运动学参数的研究[J].中国康复医学杂志,2008,23(1):11-13.Li W,Wang ZB,Li GP,et al. The research of fait kinematics parameters in the knee osteoarthritis patients[J]. Chinese Journal of Rehabilitation Medicine,2008,23(1):11-13.
[20] Elbaz A,Mor A,Segal G,et al. Novel classification of knee osteoarthritis severity based on spatiotemporal gait analysis[J].Osteoarthritis and Cartilage,2014,22(3):457-463.
[21]应充亮,万雷.足弓破坏法医临床学鉴定的影像学理论与实践[J].中国司法鉴定,2012(3):67-70.Ying CL,Wan L. The theory and practice of arch destruction imaging examination in clinical forensic medicine[J]. Chinese Journal of Forensic Sciences,2012(3):67-70.
[22]李峰,王常海,张蓉,等.膝骨性关节炎功能评价步态指标研究———足底压力各阶段时间分布及地面垂直反力[J].中国康复理论与实践,2007,13(12):1165-1167.Li F,Wang CH,Zhang R,et al. Study of knee osteoarthritis gait index on function evaluation-time distribution at sole and the vertical rebound force at stand phase[J]. Chinese Journal of Rehabilitation Theory and Practice,2007,13(12):1165-1167.
[23]张昊华,闫松华,刘志成. footscanSCSI高频平板测试不同膝骨关节炎患者自然行走步态的生物力学比较[J].中国组织工程研究与临床康复,2010,14(43):8019-8023.Zhang HH,Yan SH,Liu ZC. Comparison in gait biomechanics of naturally walking patients with different knee osteoarthritis using footscanSCSI high frequency plate system[J]. Journal of Clinical Rehabilitative Tissue Engineering Research,2010,14(43):8019-8023.
[24]钟慧敏,黄萍.不同体质量指数正常人的足底压力特征[J].中国组织工程研究,2017,21(23):3730-3735.Zhong HM,Huang P. Plantar pressure of normal people with different body mass index[J]. Chinese Journal of Tissue Engineering Research,2017,21(23):3730-3735.
[25]钱竞光,宋雅伟,叶强,等.步行动作的生物力学原理及其步态分析[J].南京体育学院学报(自然科学版),2006,5(4):1-7,39.Qian JG,Dong YW,Ye Q,et al. The biomedical principle of walking and analysis on gaits[J]. Journal of Nanjing Institute of Physical Education(Natural Science),2006,5(4):1-7,39.
[26]吴宝平,闫松华,张宽,等.大学生不同运动方式下的足底压力分布研究[J].北京生物医学工程,2016,35(2):161-166,179.Wu BP,Yan SH,Zhang K,et al. Plantar pressure distribution of college students in different movement patterns[J]. Beijing Biomedical Engineering,2016,35(2):161-166,179.
[27]吴宝平,宋红芳,王辉,等.体质不同的大学生自然行走时足底压力特征的差异性分析[J].北京生物医学工程,2018,37(3):252-258.Wu BP,Song HF,Wang H,et al. Analysis on the differences of natural plantar pressure feature among college students with different physical condition[J]. Beijing Biomedical Engineering,2018,37(3):252-258.
[28] Velotta J,Weyer J,Ramirez A,et al. Relationship between leg dominance tests and type of task[J]. Portuguese Journal of Sport Sciences,2011,11(Suppl. 2):1035-1038.
[29]付焘,于长禾,张洋,等.膝骨关节炎临床研究中结局评价指标的应用现况[J].中国医药导报,2018,15(29):21-24,28.Fu T,Yu CH,Zhang Y,et al. Status of application of outcome measures in the clinical studies of knee osteoarthritis[J]. China Medical Herald,2018,15(29):21-24,28.
[2]陈能,陈国材,刘文刚,等.膝骨关节炎内翻畸形影响因素及治疗的研究进展[J].风湿病与关节炎,2017,6(5):73-76,80.
[3]陆艳红,石晓兵.膝骨关节炎国内外流行病学研究现状及进展[J].中国中医骨伤科杂志,2012,20(6):81-84.
[4] Anbarian M,Esmaeili H. Effects of running-induced fatigue on plantar pressure distribution in novice runners with different foot types[J]. Gait&Posture,2016,48:52-56.
[5]夏清,曹娟娟,曹晓光.腰椎间盘突出症患者足底压力的分布特征及重测信度[J].中国康复理论与实践,2015,21(3):307-310.Xia Q,Cao JJ,Cao XG. Features and test-retest reliability of plantar pressure distribution in patients with lumbar disc herniation in walking[J]. Chinese Journal of Rehabilitation Theory and Practice,2015,21(3):307-310.
[6]黄萍,钱念东,齐进,等.膝骨关节炎患者膝关节置换术后足底压力研究[J].中国运动医学杂志,2018,37(3):197-201.Huang P,Qian ND,Qi J,et al. Plantar pressure in patient with knee osteoarthritis after knee joint replacement surgery[J].Chinese Journal of Sports Medicine,2018,37(3):197-201.
[7] Fernandes WC,Machadoá,Borella C,et al. Influence of gait speed on plantar pressure in subjects with unilateral knee osteoarthritis[J]. Revista Brasileira de Reumatologia(English Edition),2014,54(6):441-445.
[8] Lidtke RH,Muehleman C,Kwasny M,et al. Foot center of pressure and medial knee osteoarthritis[J]. Journal of the American Podiatric Medical Association,2010,100(3):178-184.
[9]边蔷.双膝骨性关节炎患者与正常人群的足底压力研究[D].北京:北京中医药大学,2012.Bian Q. Research on plantar pressure in patients with knee osteoarthritis and normal people[D]. Beijing:Beijing University of Chinese Medicine,2012.
[10]付海燕,杨海韵.膝骨性关节炎患者与正常青年人步态的对照[J].中国组织工程研究与临床康复,2011,15(22):4115-4118.Fu HY,Yang HY. Gait comparison between normal young people and knee osteoarthritis patients[J]. Journal of Clinical Rehabilitative Tissue Engineering Research,2011,15(22):4115-4118.
[11]张永祥,张文洁,邵战海.膝关节骨性关节炎患者足底压力分布规律分析[J].中华临床医师杂志(电子版),2012,6(11):2955-2958.Zhang YX,Zhang WJ,Shao ZH. The analysis of the regularity of dynamic and static plantar pressure in patients with osteoarthritis of knee[J].Chinese Journal of Clinicians(Electronic Edition),2012,6(11):2955-2958.
[12]夏清,袁海,曹娟娟.膝骨性关节炎患者膝关节疼痛指数与足底压力变化的相关性研究[J].安徽医学,2015,36(11):1358-1360.Xia Q,Yuan H,Cao JJ. Impaction of knee pain index on plantar pressure in patients with knee osteoarthritis[J]. Anhui Medical Journal,2015,36(11):1358-1360.
[13]张庆来,宋绍兴,董杰.健康大学生足底压力分布参数特征[J].中国学校卫生,2007,28(9):814-816.Zhang QL,Song SX,Dong J. Parameter features of foot pressure in healthy university students[J]. Chinese Journal of School Health,2007,28(9):814-816.
[14]李立,陈玉娟,翟凤鸣,等.老年人与青年人足底压力分布特征比较[J].中国老年学杂志,2011,31(23):4574-4576.
[15]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.
[16] Yan SH,Zhang K,Tan GQ,et al. Effects of obesity on dynamic plantar pressure distribution in chinese prepubescent children during walking[J]. Gait&Posture,2013,37(1):37-42.
[17] Messier SP,Loeser RF,Hoover JL,et al. Osteoarthritis of the knee:effects on gait,strength,and flexibility[J]. Archives Physical Medicine and Rehabilitation,1992,73(1):29-36.
[18]乐意,金荣疆,阳杨,等.从下肢生物力学来解析膝骨关节炎[J].中国康复理论与实践,2013,19(6):505-509.Le Y,Jin RJ,Yang Y,et al. Relationship between knee osteoarthritis and lower limb biomechanics[J]. Chinese Journal of Rehabilitation Theory and Practice,2013,19(6):505-509.
[19]李伟,汪宗保,李国平,等.膝关节骨性关节炎患者步态运动学参数的研究[J].中国康复医学杂志,2008,23(1):11-13.Li W,Wang ZB,Li GP,et al. The research of fait kinematics parameters in the knee osteoarthritis patients[J]. Chinese Journal of Rehabilitation Medicine,2008,23(1):11-13.
[20] Elbaz A,Mor A,Segal G,et al. Novel classification of knee osteoarthritis severity based on spatiotemporal gait analysis[J].Osteoarthritis and Cartilage,2014,22(3):457-463.
[21]应充亮,万雷.足弓破坏法医临床学鉴定的影像学理论与实践[J].中国司法鉴定,2012(3):67-70.Ying CL,Wan L. The theory and practice of arch destruction imaging examination in clinical forensic medicine[J]. Chinese Journal of Forensic Sciences,2012(3):67-70.
[22]李峰,王常海,张蓉,等.膝骨性关节炎功能评价步态指标研究———足底压力各阶段时间分布及地面垂直反力[J].中国康复理论与实践,2007,13(12):1165-1167.Li F,Wang CH,Zhang R,et al. Study of knee osteoarthritis gait index on function evaluation-time distribution at sole and the vertical rebound force at stand phase[J]. Chinese Journal of Rehabilitation Theory and Practice,2007,13(12):1165-1167.
[23]张昊华,闫松华,刘志成. footscanSCSI高频平板测试不同膝骨关节炎患者自然行走步态的生物力学比较[J].中国组织工程研究与临床康复,2010,14(43):8019-8023.Zhang HH,Yan SH,Liu ZC. Comparison in gait biomechanics of naturally walking patients with different knee osteoarthritis using footscanSCSI high frequency plate system[J]. Journal of Clinical Rehabilitative Tissue Engineering Research,2010,14(43):8019-8023.
[24]钟慧敏,黄萍.不同体质量指数正常人的足底压力特征[J].中国组织工程研究,2017,21(23):3730-3735.Zhong HM,Huang P. Plantar pressure of normal people with different body mass index[J]. Chinese Journal of Tissue Engineering Research,2017,21(23):3730-3735.
[25]钱竞光,宋雅伟,叶强,等.步行动作的生物力学原理及其步态分析[J].南京体育学院学报(自然科学版),2006,5(4):1-7,39.Qian JG,Dong YW,Ye Q,et al. The biomedical principle of walking and analysis on gaits[J]. Journal of Nanjing Institute of Physical Education(Natural Science),2006,5(4):1-7,39.
[26]吴宝平,闫松华,张宽,等.大学生不同运动方式下的足底压力分布研究[J].北京生物医学工程,2016,35(2):161-166,179.Wu BP,Yan SH,Zhang K,et al. Plantar pressure distribution of college students in different movement patterns[J]. Beijing Biomedical Engineering,2016,35(2):161-166,179.
[27]吴宝平,宋红芳,王辉,等.体质不同的大学生自然行走时足底压力特征的差异性分析[J].北京生物医学工程,2018,37(3):252-258.Wu BP,Song HF,Wang H,et al. Analysis on the differences of natural plantar pressure feature among college students with different physical condition[J]. Beijing Biomedical Engineering,2018,37(3):252-258.
[28] Velotta J,Weyer J,Ramirez A,et al. Relationship between leg dominance tests and type of task[J]. Portuguese Journal of Sport Sciences,2011,11(Suppl. 2):1035-1038.
[29]付焘,于长禾,张洋,等.膝骨关节炎临床研究中结局评价指标的应用现况[J].中国医药导报,2018,15(29):21-24,28.Fu T,Yu CH,Zhang Y,et al. Status of application of outcome measures in the clinical studies of knee osteoarthritis[J]. China Medical Herald,2018,15(29):21-24,28.