摘要
目的探究单间室膝关节置换术(unicompartmental knee arthroplasty,UKA)与全膝关节置换术(total knee arthroplasty,TKA)对膝骨关节炎术后的临床疗效。方法随机招募TKA患者21例、UKA患者15例。分别在术前以及术后6、12个月进行生物力学测试。采用Vicon红外动作捕捉系统和Kistler三维测力台同步采集受试者楼梯行走的运动学和动力学数据。结果在上楼梯时,TKA组受试者术前膝屈曲力矩峰值显著低于UKA组,术后6个月到达膝屈曲/内收力矩峰值时间、膝屈曲力矩冲量及膝内收力矩峰值负载率显著小于UKA组。在下楼梯时,UKA组术前和术后6个月伸膝功率峰值显著较小,垂直地面反作用力峰值负载率术前显著较大,膝伸展力矩峰值术后6个月显著较大;在术后12个月,楼梯行走的生物力学特征未出现明显的差异性。结论TKA组和UKA组在手术后表现出相似的膝关节功能,但TKA组可能采取不同于UKA组的下肢生物力学模式。在楼梯行走时,UKA组术后表现出更好的股四头肌控制能力,提高了楼梯行走尤其是下楼梯的姿势控制能力,而TKA组则采取保守的楼梯步态策略以降低楼梯行走的膝关节负荷。相比于力矩峰值,到达力矩峰值的时间及力矩峰值负载率是发现膝关节负荷差异性更灵敏的指标。
Objective To explore the clinical efficacy of single unicompartmental knee arthroplasty(UKA)and total knee arthroplasty(TKA)for the treatment of knee osteoarthritis.Methods A total of 21 patients who 670 underwent TKA and 15 who underwent UKA were randomly recruited.Biomechanical tests were performed before surgery and at 6 th and 12 th month after surgery.A Vicon infrared motion capture system and Kistler threedimensional force plate were used to simultaneously acquire the kinematic and kinetic data of the patients during stair walking.Results During stair ascent,the peak knee flexion moment in the TKA group was significantly lower than that in the UKA group;the time to peak knee flexion/adduction moment,knee flexion moment impulse,and load rate of the peak knee adduction moment in the UKA group were significantly lower than those in the UKA group.During stair descent,the peak knee extension power in the UKA group was significantly lower before surgery and at 6 th month after surgery;the load rate of the peak vertical ground reaction force was significantly higher before surgery and the peak knee extension moment was significantly greater at 6 th month after surgery;at 12 th month after surgery,there was no significant difference in the biomechanical characteristics during stair ascent and descent.Conclusions The TKA and UKA groups showed similar knee joint function after surgery;however,compared with the UKA group,the TKA group may adopt a different lower extremity biomechanical pattern.The UKA group showed better quadriceps control after surgery and improved postural control during stair descent,whereas the TKA group adopted a conservative stair gait strategy to reduce the knee load.Compared with the peak moment,the time to peak moment and load rate of the peak moment were more sensitive indicators for determining the difference in the knee load.
作者
曹传宝
史东林
柴光伟
王鑫
张艳红
马刚
闫士芳
CAO Chuanbao;SHI Donglin;CHAI Guangwei;WANG Xin;ZHANG Yanhong;MA Gang;YAN Shifang(Department of Wushu,Hebei Sport University,Shijiazhuang 050041,China;Hebei Key Laboratory of Sports Technology Research and Application,Shijiazhuang 050041,China;Department of Human Science in Sports,Hebei Sport University,Shijiazhuang 050041,China;Department of Health Services,Logistics University of People’s Armed Police Force,Tianjin 300309,China)
出处
《医用生物力学》
CAS
CSCD
北大核心
2024年第4期670-676,共7页
Journal of Medical Biomechanics
基金
河北省重点研发计划项目(22375701D)。
关键词
单间室膝关节置换术
全膝关节置换术
楼梯行走
膝骨关节炎
负载率
冲量
total knee arthroplasty(TKA)
unicompartmental knee arthroplasty(UKA)
stair walking
knee osteoarthritis
load rate
impulse
