为研究膝骨性关节炎合并内翻畸形患者术前生物力学群体特征，用于比较患者术前术后步态延续性及进行术后康复指导，本文采集 9 例患者水平行走和坐立-起身过程的步态，并进行骨肌多体动力学分析。本文研究结果显示，水平行走时试验组下肢运动功能减弱，试验组非手术侧膝关节平均活动范围为 22.5°～71.5°，拟置换侧膝关节平均活动范围为 24.4°～57.6°，而对照组膝关节平均活动范围为 7.2°～62.4°。单侧膝内翻患者完成坐立-起身过程时的下肢地面反作用力对称度介于 0.72～0.85，非手术侧下肢起主要支撑作用。双侧膝内翻患者坐立-起身时地面反作用力之和最小。尽管单侧膝内翻患者采用非手术侧下肢过量负载的代偿方式能完成术后日常活动，但长期过量负载容易增加非手术侧下肢膝关节罹患膝骨性关节炎风险。对膝骨性关节炎合并内翻畸形患者完成日常活动的运动学和生物力学特征进行研究，有助于从生物力学角度理解内翻膝的发病机制，对患者的术前评估、预防和术后恢复具有较强的临床指导意义。
Aiming at comparing the pre-operative and post-operative gait characteristics and therefore establishing post-operative rehabilitation guidance for patients with end-stage knee osteoarthritis (KOA) merged with varus deformity, this study captured the level walking and sit-to-stand trials of 9 patients with 3-dimensional motion analysis system and after which musculoskeletal multi-body dynamic analysis was conducted. The study indicated that the average range of motion (ROM) of the proposed-surgical knee was 24.4°–57.6° and that of the non-surgical knee was 22.5°–71.5°. The knee ROM of control group during level walking was 7.2°–62.4°. When the unilateral KOA patients stood up from chair to complete the sit-to-stand movement, the ground reaction forces (GRFs) symmetry was 0.72–0.85, which means that the non-surgical limb bear the majority of body weight. The GRFs of the bilateral KOA patients were smallest during the sit-to-stand movement. The strategy that the non-surgical limb dominates in loading bearing taken by the unilateral KOA patients to cover most post-operative daily activities could increase the risk of KOA among non-surgical side joints as a result of long-term excessive loading-bearing. The study, on kinematics and biomechanical characteristics of patients with KOA merged with varus deformity, could help to understand the pathogenesis of KOA merged with varus deformity from the perspective of biomechanics and to provide strong clinic guidance for the pre-operative evaluation, prevention and post-operative recovery for patients.
引用本文： 朱正飞, 王玲, 李涤尘, 王航辉, 靳忠民, 王志远, 惠曙国, 陈塍林, 张述, 李文娇. 膝骨性关节炎合并内翻畸形患者运动特征研究. 生物医学工程学杂志, 2018, 35(1): 38-44. doi: 10.7507/1001-5515.201702049 复制