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[1]金建偉,王金杰,朱磊,等.膝關(guān)節(jié)面夾角和股脛角對膝骨關(guān)節(jié)炎患者步態(tài)的影響[J].中醫(yī)正骨,2018,30(11):17-20,27.
　JIN Jianwei,WANG Jinjie,ZHU Lei,et al.Influence of knee joint surface angle and femorotibial angle on gait of patients with knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(11):17-20,27.
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膝關(guān)節(jié)面夾角和股脛角對膝骨關(guān)節(jié)炎患者步態(tài)的影響()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年11期
頁碼:
17-20,27
欄目:
臨床研究
出版日期:
2018-11-20

文章信息/Info

Title:
Influence of knee joint surface angle and femorotibial angle on gait of patients with knee osteoarthritis
作者:
金建偉1; 王金杰2; 朱磊2; 俞倩麗2; 莊汝杰3
(1.浙江省東陽市人民醫(yī)院巍山分院,浙江 東陽 322103; 2.浙江中醫(yī)藥大學(xué),浙江 杭州 310053; 3.浙江中醫(yī)藥大學(xué)附屬第一醫(yī)院,浙江 杭州 310006)
Author(s):
JIN Jianwei1; WANG Jinjie2; ZHU Lei2; YU Qianli2; ZHUANG Rujie3
1.Weishan branch of People's Hospital of Dongyang City,Dongyang 322103,Zhejiang,China 2.Zhejiang University of Traditional Chinese Medicine,Hangzhou 310053,Zhejiang,China 3.The First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310006,Zhejiang,China
關(guān)鍵詞:
骨關(guān)節(jié)炎; 膝;  步態(tài);  膝關(guān)節(jié)面夾角;  股脛角
Keywords:
osteoarthritis; knee;  gait;  knee joint surface angle;  femorotibial angle
摘要:
目的:探討膝關(guān)節(jié)面夾角和股脛角對膝骨關(guān)節(jié)炎(knee osteoarthritis,KOA)患者步態(tài)的影響。方法:納入KOA患者72例,男34例、女38例,左側(cè)33例、右側(cè)39例,年齡(62.8±7.2)歲,病程(12.54±6.37)年。拍攝負重位膝關(guān)節(jié)X線片,測量患側(cè)膝關(guān)節(jié)面夾角和股脛角; 并進行步態(tài)分析測試,記錄步速及患側(cè)步長、步角、支撐期時間、支撐期百分數(shù)等步態(tài)參數(shù)。分別依據(jù)膝關(guān)節(jié)面夾角和股脛角測量結(jié)果將患者分組,對各組患者的步態(tài)參數(shù)進行比較。結(jié)果:72例患者,患側(cè)膝關(guān)節(jié)面夾角0.2°～7.8°,中位數(shù)3.1°(<1.0°13例,1.0°～3.5°34例,3.6°～8.0°25例); 股脛角170°～186°,中位數(shù)178°(170°～176°18例,177°～180°31例,181°～187°23例)。不同膝關(guān)節(jié)面夾角患者的步角、步速、步長比較,組間差異均有統(tǒng)計學(xué)意義[12.28°±3.43°,15.43°±3.83°,20.50°±2.72°,F=18.571,P=0.000;(70.59±9.88)cm·s-1,(62.15±11.47)cm·s-1,(41.10±7.90)cm·s-1,F=27.621,P=0.000;(55.71±4.87)cm,(51.94±4.17)cm,(36.78±7.14)cm,F=40.272,P=0.000]。膝關(guān)節(jié)面夾角<1.0°患者的步角小于膝關(guān)節(jié)面夾角1.0°～3.5°和3.6°～8.0°的患者(P=0.030,P=0.000),膝關(guān)節(jié)面夾角1.0°～3.5°患者的步角小于膝關(guān)節(jié)面夾角3.6°～8.0°的患者(P=0.001)。膝關(guān)節(jié)面夾角3.6°～8.0°患者的步速、步長均小于膝關(guān)節(jié)面夾角<1.0°和1.0°～3.5°的患者(P=0.000,P=0.000; P=0.000,P=0.000),膝關(guān)節(jié)面夾角<1.0°患者的步速、步長與膝關(guān)節(jié)面夾角1°～3.5°患者相比,差異均無統(tǒng)計學(xué)意義(P=0.053,P=0.154)。不同膝關(guān)節(jié)面夾角患者的步態(tài)支撐期時間、支撐期百分數(shù)的組間差異均無統(tǒng)計學(xué)意義[(0.79±0.06)s,(0.86±0.71)s,(0.87±0.12)s,F=0.811,P=0.453;(63.92±6.34)%,(64.74±8.37)%,(66.74±7.31)%,F=0.421,P=0.660]。不同股脛角患者的步角、步速、步長、支撐期時間、支撐期百分數(shù)比較,組間差異均無統(tǒng)計學(xué)意義[16.42°±4.88°,13.93°±3.57°,17.04°±5.43°,F=1.311,P=0.283;(56.71±15.72)cm·s-1,(66.24±11.13)cm·s-1,(55.38±17.72)cm·s-1,F=1.983,P=0.154;(48.63±9.92)cm,(53.51±3.92)cm,(44.85±11.54)cm,F=3.294,P=0.051;(0.90±0.10)s,(0.82±0.08)s,(0.90±0.15)s,F=1.838,P=0.175;(64.93±1.37)%,(64.54±0.89)%,(65.62±1.64)%,F=1.851,P=0.173]。結(jié)論:KOA患者患側(cè)膝關(guān)節(jié)面夾角越大,步角越大、步速越慢、步長越短,步態(tài)支撐期時間、支撐期百分數(shù)則無明顯變化; 而股脛角的大小對KOA患者步態(tài)無明顯影響。
Abstract:
Objective:To explore the influence of knee joint surface angle and femorotibial angle on gait of patients with knee osteoarthritis(KOA).Methods:Seventy-two patients with KOA were enrolled in the study and they consisted of 34 males and 38 females.Their ages were 62.8+/-7.2 years and disease courses were 12.54+/-6.37 years.The KOA located in left knee for 33 patients and right knee for 39 patients.The X-ray films of affected knee in weight-bearing position were taken,and the knee joint surface angle and femorotibial angle of affected knee were measured on the X-ray films.Moreover,the gait analysis was performed on all patients,and the gait parameters including gait speed,step length,step angle,support phase time and percentage of support phase were measured and recorded.The patients were divided into different groups according to knee joint surface angle and femorotibial angle respectively,and the gait parameters were compared between different groups.Results:The knee joint surface angle ranged from 0.2 to 7.8 degrees with a median of 3.1 degrees (<1.0 degree(13),1.0-3.5 degrees(34),3.6-8.0 degrees(25)),and the femorotibial angle ranged from 170 to 186 degrees with a median of 178 degrees(170-176 degrees(18),177-180 degrees(31),181-187 degrees(23)).There was statistical difference in step angle,gait speed and step length between patients with different knee joint surface angles(12.28+/-3.43,15.43+/-3.83,20.50+/-2.72 degrees,F=18.571,P=0.000; 70.59+/-9.88,62.15+/-11.47,41.10+/-7.90 cm/s,F=27.621,P=0.000; 55.71+/-4.87,51.94+/-4.17,36.78+/-7.14 cm,F=40.272,P=0.000).The step angles were smaller in patients with knee joint surface angle of<1.0 degree compared to patients with knee joint surface angles of 1.0-3.5 degrees and 3.6-8.0 degrees(P=0.030,P=0.000),and were smaller in patients with knee joint surface angle of 1.0-3.5 degrees compared to patients with knee joint surface angle of 3.6-8.0 degrees(P=0.001).The gait speed and step length were smaller in patients with knee joint surface angle of 3.6-8.0 degrees compared to patients with knee joint surface angle of<1.0 degree and 1.0-3.5 degrees(P=0.000,P=0.000; P=0.000,P=0.000),and there was no statistical difference in gait speed and step length between patients with knee joint surface angle of<1.0 degree and patients with knee joint surface angle of 1.0-3.5 degrees(P=0.053,P=0.154).There was no statistical difference in gait support phase time and percentage of support phase between patients with different knee joint surface angles(0.79+/-0.06,0.86+/-0.71,0.87+/-0.12 seconds,F=0.811,P=0.453; 63.92+/-6.34,64.74+/-8.37,66.74+/-7.31%,F=0.421,P=0.660).There was no statistical difference in step angle,gait speed,step length,support phase time and percentage of support phase between patients with different femorotibial angles(16.42+/-4.88,13.93+/-3.57,17.04+/-5.43 degrees,F=1.311,P=0.283; 56.71+/-15.72,66.24+/-11.13,55.38+/-17.72 cm/s,F=1.983,P=0.154; 48.63+/-9.92,53.51+/-3.92,44.85+/-11.54 cm,F=3.294,P=0.051; 0.90+/-0.10,0.82+/-0.08,0.90+/-0.15 seconds,F=1.838,P=0.175; 64.93+/-1.37,64.54+/-0.89,65.62+/-1.64%,F=1.851,P=0.173).Conclusion:For patients with KOA,the larger the knee joint surface angle of affected knee is,the larger the step angle is and the slower the gait speed is and the shorter the step length is,and there are no obvious change in gait support phase time and percentage of support phase; while the femorotibial angle has no obvious effect on gait of patients with KOA.

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備注/Memo

備注/Memo:
基金項目:浙江省重大科技專項計劃項目(2014C03038)
通訊作者:莊汝杰 E-mail:[email protected]
更新日期/Last Update: 2018-11-30