摘要
目的:比较单侧单纯前交叉韧带(anterior cruciate ligament,ACL)断裂和ACL断裂合并半月板损伤患者的三维步态特征,分析ACL断裂继发膝骨关节炎的可能机制,为制定ACL断裂康复方案以及膝关节炎防治提供依据。方法:3组受试者分别为单侧单纯前交叉韧带断裂组(ACL组)、合并半月板损伤的前交叉韧带断裂组(ACL+M组)、健康对照组(C组),每组各13名,同步采集步行过程中的运动学和动力学参数,计算膝关节的三维角度和关节净力矩。结果:(1)ACL+M组和C组的屈膝角度峰值均大于ACL组(均P=0.001),但ACL+M组和C组间无显著差异(P=0.847)。(2)健侧膝关节屈伸活动范围、垂直地面反作用力第1峰值、水平向后地面反作用力峰值、内源性伸膝力矩峰值显著大于患侧(P=0.006,P=0.001,P<0.001,P=0.001)。(3)ACL+M组产生的膝外展力矩峰值大于ACL组和C组(P=0.045,P=0.014),ACL组和C组之间的膝外展力矩峰值无显著差异(P=0.616)。结论:ACL断裂患者健侧受到的地面反作用力大于患侧,这种受力不均衡改变了下肢受力模式,长期持续会增加ACL断裂者发生膝骨关节炎的风险。与单纯ACL断裂患者相比,合并半月板损伤的ACL断裂者产生较大的内源性膝外展力矩,可能是发生膝骨关节炎的危险因素。
Objective To identify the differences of three-dimensional knee kinematics of unilateralanterior cruciate ligament（ACL） deficient patients with and without the meniscus injury. Methods Atotal of 39 subjects including unilateral isolate ACL-deficient patients（ACL group,n=13）,ACL defi-cient patients combined with meniscus tear（ACL＋M group,n=13） and healthy controls（C group,n=13） participated in this study. In the gait analysis,three-dimensional knee kinematic and kinetic param-eters were collected synchronously and compared. Results The peak knee flexion angles were greaterin the ACL＋M group and C group compared with the ACL group（P=0.001,P=0.001）,with no signifi-cant differences between the former two groups（P=0.847）. Lower first peak vertical ground reaction force,peak posterior ground reaction force,sagittal plane knee excursions and peak knee extension mo-ment were found in ACL-injured side compared with the contralateral side（P=0.001,P〈0.001,P=0.006,P=0.001）. Greater peak knee abduction moment was found in group ACL＋M compared with both theACL and C groups（P=0.045,P=0.014）. However,no significant difference was observed between theACL group and C group in peak knee abduction moment（P=0.616）. Conclusions The altered loadingin unilateral ACL deficient patients can lead to lower ground reaction force in injured knee and great-er ground reaction force in the contralateral side,which may increase the risk of developing knee osteo-arthritis. The greater internal knee abduction moment in ACL deficient patients combined with menis-cus injury may be a risking factor for the knee osteoarthritis.
出处
《中国运动医学杂志》
CAS
CSCD
北大核心
2017年第10期858-864,共7页
Chinese Journal of Sports Medicine
基金
北京市科技新星计划交叉学科合作课题(编号:xxjc201705)
2016年度北京大学医学-信息科学联合研究种子基金项目(BMU20160590)
关键词
前交叉韧带断裂
半月板损伤
步态分析
膝骨关节炎
anterior cruciate ligament deficiency, meniscus injury, gait analysis, knee osteoarthritis
