[1]李锡,张永旺,尹世林,等.膝骨关节炎患者负重位下肢力学相关参数的测量分析[J].中国中医骨伤科杂志,2024,32(10):32-39.[doi:10.20085/j.cnki.issn1005-0205.241006]
　LI Xi,ZHANG Yongwang,YIN Shilin,et al.Measurement and Analysis of Lower Limb Mechanics Related Parameters in Patients with Knee Osteoarthritis in Weight-Bearing Position[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(10):32-39.[doi:10.20085/j.cnki.issn1005-0205.241006]
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膝骨关节炎患者负重位下肢力学相关参数的测量分析()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第32卷
期数:
2024年10期
页码:
32-39
栏目:
临床研究
出版日期:
2024-10-15

文章信息/Info

Title:
Measurement and Analysis of Lower Limb Mechanics Related Parameters in Patients with Knee Osteoarthritis in Weight-Bearing Position
文章编号:
1005-0205(2024)10-0032-08
作者:
李锡1; 张永旺1; 尹世林1; 张泽坤1; 陈连伟1; 王静西2; 刘路1; 颜运涛1; 杜双庆1△
1河北中医药大学第一附属医院(石家庄,050011)
2河北省中医院
Author(s):
LI Xi1; ZHANG Yongwang1; YIN Shilin1; ZHANG Zekun1; CHEN Lianwei1; WANG Jingxi2; LIU Lu1; YAN Yuntao1; DU Shuangqing1△
1First Affiliated Hospital of Hebei University of Chinese Medicine,Shijiazhuang 050011,China; 2Hebei Provincial Hospital of Traditional Chinese Medicine,Shijiazhuang 050011,China.
关键词:
膝骨关节炎;  下肢力线;  髋膝踝角;  正骨;  手法治疗
Keywords:
knee osteoarthritis;  lower limb alignment;  hip-knee-ankle angle;  bone setting;  manual therapy
分类号:
R684.3
DOI:
10.20085/j.cnki.issn1005-0205.241006
文献标志码:
A
摘要:
目的:测量膝骨关节炎(KOA)患者下肢力学相关参数并观察其改变规律,以期为中医正骨手法的实施提供参考。方法:纳入2022年3月至2023年11月因膝骨关节炎行负重位双下肢全长X线摄片的患者333例,测量全部患者双侧下肢髋膝踝角(HKA)、股骨近端外侧角(LPFA)、机械轴股骨远端外侧角(mLDFA)、机械轴胫骨近端内侧角(mMPTA)、机械轴胫骨远端外侧角(mLDTA)、胫骨股骨关节线夹角(JLCA)、股骨解剖机械轴角(AMA)及机械轴偏移距离(MAD); 并将每位患者疼痛较重的一侧定义为患侧,疼痛较轻或无症状的一侧定义为对侧。对自身患侧、对侧进行上述相关参数的比较,并将两侧参数分别与健康人群作对比,观察其变化规律。结果:全部膝骨关节炎患者中患侧组、对侧组髋膝踝角等参数组间比较,差异均有统计学意义(P<0.05); 两组患者髋膝踝角等参数均偏离正常参考值范围(P<0.05)。亚组分析中,膝内翻组、膝外翻组、中立位组患侧、对侧组在髋膝踝角等参数组间、组内相比差异均有统计学意义(P<0.05)。膝内翻组对侧髋膝踝角等参数偏离正常参考值; 亚组分析中膝内翻组无论患侧或对侧在股骨近端外侧角、机械轴胫骨远端外侧角方面差异无统计学意义(P>0.05)。结论:膝骨关节炎患者双下肢力学参数偏离正常参考值,患侧偏离程度常大于对侧,以膝内翻和中立位为主要表现。膝内翻、膝外翻和中立位各组下肢力线解剖位置不同,分析结果提示膝骨关节炎患者常存在患肢股骨与胫骨旋转,提示手法治疗重点可侧重于下肢旋转的复位。充分了解膝骨关节炎患者下肢力学参数有助于精确、合理运用中医理筋正骨手法。
Abstract:
Objective:To measure the lower limb mechanics related parameters of patients with knee osteoarthritis(KOA)and observe its change rule,in order to provide reference for the implementation of traditional Chinese medicine(TCM)bone-setting manipulation.Methods:From March 2022 to November 2023,333 patients with KOA who underwent full-length X-ray examination of both lower limbs in weight-bearing position were enrolled.The hip-knee-ankle angle(HKA),lateral proximal femoral angle(LPFA),mechanical lateral distal femoral angle(mLDFA),mechanical medial proximal tibial angle(mMPTA),mechanical lateral distal tibial angle(mLDTA),tibial-femoral joint line convergence angle(JLCA),femoral anatomical mechanical axis angle(AMA)and mec- hanical axis deviation distance(MAD)were measured.For each patient,the side with severe pain was defined as the affected side,and the side with mild pain or no symptoms was defined as the contralateral side.The above parameters were compared between the affected side and the contralateral side,and the parameters of both sides were compared with those of the healthy people to observe their changes.Results:In all KOA patients,there were statistically significant differences in HKA between the affected and contralateral groups(P<0.05).HKA and other aspects of the two groups deviated from the normal reference range(P<0.05).In the subgroup analysis,there were significant differences in HKA between the affected side and the contralateral side in the varus group,the valgus group,and the neutral position group(P<0.05).The HKA of the contralateral knee in the varus group deviated from the normal reference value(P<0.05).Subgroup analysis showed that there was no significant difference in LPFA and mLDTA between the affected side and the contralateral side in the varus group(P>0.05).Conclusion:The mechanical parameters of lower limbs in KOA patients deviate from the normal reference value,and the deviation of the affected side is often greater than that of the contralateral side.Knee varus and neutral position are the main manifestations.The anatomy of the lower limb alignment is different in the varus,valgus,and neutral positions of the knee.The analysis results suggest that the femur and tibia rotation of the affected limb often exist in KOA patients,suggesting that the key point of manual treatment can be focused on the reduction of lower limb rotation.Fully understanding the lower limb mechanics of KOA patients is helpful for accurate and reasonable use of traditional Chinese medical tendon bone setting techniques.

参考文献/References:

[1] 王斌,邢丹,董圣杰,等.中国膝骨关节炎流行病学和疾病负担的系统评价[J].中国循证医学杂志,2018,18(2):134-142.
[2] MATSUMOTO T,NAKANO N,ISHIDA K,et al.Ground kinematically aligned total knee arthroplasty:new personalized technique which enables a stable knee with deep flexion[J].Int Orthop,2023,47(9):2215-2223.
[3] BROWN M J C,DEAKIN A H,PICARD F,et al.Lower limb alignment becomes more varus and hyperextended from supine to bipedal stance in asymptomatic,osteoarthritic and prosthetic neutral or varus knees[J].Knee Surg Sports Traumatol Arthrosc,2019,27(5):1635-1641.
[4] TARASSOLI P,WOOD J A,CHEN D B,et al.Arithmetic hip-knee-ankle angle and stressed hip-knee-ankle angle:equivalent methods for estimating constitutional lower limb alignment in kinematically aligned total knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2022,30(9):2980-2990.
[5] 高嘉翔,邢丹,林剑浩.下肢力线的测量及其在全膝关节置换术中的应用[J].中华外科杂志,2020,58(6):478-480.
[6] 孙茂淋,何锐,张颖,等.健康人群下肢力线测量在全膝关节置换术中的应用[J].中华骨与关节外科杂志,2019,12(8):584-588.
[7] 窦勇,李平,郭邵逸,等.严重膝关节类风湿关节炎患者下肢力线的测量分析[J].中华骨与关节外科杂志,2022,15(2):99-104.
[8] 中华医学会骨科学分会关节外科学组.骨关节炎诊疗指南(2018年版)[J].中华骨科杂志,2018,38(12):705-715.
[9] SCHIRALDI M,BONZANINI G,CHIRILLO D,et al.Mechanical and kinematic alignment in total knee arthroplasty[J].Ann Transl Med,2016,4(7):130.
[10] SARMAH S S,PATEL S,HOSSAIN F S,et al.The radiological assessment of total and unicompartmental knee replacements[J].J Bone Joint Surg Br,2012,94(10):1321-1329.
[11] MENG X,WANG Z,MA X,et al.Fully automated measurement on coronal alignment of lower limbs using deep convolutional neural networks on radiographic images[J].BMC Musculoskeletal Disorders,2022,23(1):1-11.
[12] LIN Y H,CHANG F S,CHEN K H,et al.Mismatch between femur and tibia coronal alignment in the knee joint:classification of five lower limb types according to femoral and tibial mechanical alignment[J].BMC Musculoskelet Disord,2018,19(1):411.
[13] BELLEMANS J,COLYN W,VANDENNEUCKER H,et al.The Chitranjan Ranawat award:is neutral mechanical alignment normal for all patients? The concept of constitutional varus[J].Clin Orthop Relat Res,2012,470(1):45-53.
[14] WANEZAKI Y,SUZUKI A,TAKAKUBO Y,et al.Lower limb alignment in healthy Japanese adults[J].J Orthop Sci,2023,28(1):200-203.
[15] RÖSSLER R,WAGNER J,KNAIER R,et al.Spatiotemporal gait characteristics across the adult lifespan:reference values from a healthy population-analysis of the complete cohort study[J].Gait Posture,2024,109:101-108.
[16] LIU S,AMIRI P,MCGREGOR A H,et al.Bilateral asymmetry in knee and hip musculoskeletal loading during stair ascending/descending in individuals with unilateral mild-to-moderate medial knee osteoarthritis[J].Ann Biomed Eng,2023,51(11):2490-2503.
[17] LUYCKX T,ZAMBIANCHI F,CATANI F,et al.Coronal alignment is a predictor of the rotational geometry of the distal femur in the osteoarthritic knee[J].Knee Surg Sports Traumatol Arthrosc,2013,21(10):2331-2337.
[18] KHALIFÉ M,VERGARI C,REBEYRAT G,et al.Femoral neck version in the spinopelvic and lower limb 3D alignment:a full-body EOS study in 400 healthy subjects[J].Eur Spine J,2024,33:1807-1815.
[19] MOON Y W,PARK J H,LEES S,et al.Distal femoral phenotypes in Asian varus osteoarthritic knees[J].Knee Surg Sports Traumatol Arthrosc,2022,30(2):456-463.
[20] THIENPONT E,SCHWAB P E,CORNU O,et al.Bone morphotypes of the varus and valgus knee[J].Arch Orthop Trauma Surg,2017,137(3):393-400.
[21] FATEMA K,RONY M A H,AZAM S,et al.Development of an automated optimal distance feature-based decision system for diagnosing knee osteoarthritis using segmented X-ray images[J].Heliyon,2023,9(11):e21703.
[22] TURKIEWICZ A,PETERSSON I F,BJÖRK J,et al.Current and future impact of osteoarthritis on health care:a population-based study with projections to year 2032[J].Osteoarthritis Cartilage,2014,22(11):1826-1832.
[23] COLYN W,VANBECELAERE L,BRUCKERS L,et al.The effect of weight-bearing positions on coronal lower limb alignment:a systematic review[J].Knee,2023,43:51-61.
[24] BARDOT L P,MICICOI G,FAVREAU H,et al.Global varus malalignment increase from double-leg to single-leg stance due to intra-articular changes[J].Knee Surg Sports Traumatol Arthrosc,2022,30(2):715-720.
[25] SALIS Z,SAINSBURY A.Association of long-term use of non-steroidal anti-inflammatory drugs with knee osteoarthritis:a prospective multi-cohort study over 4-to-5 years[J].Sci Rep,2024,14(1):6593.
[26] DAMEN J,VAN RIJN R M,EMANS P J,et al.Prevalence and development of hip and knee osteoarthritis according to american college of rheumatology criteria in the CHECK cohort[J].Arthritis Res Ther,2019,21(1):4.
[27] LEÓN-MUÑOZ V J,MANCA S,LÓPEZ-LÓPEZ M,et al.Coronal and axial alignment relationship in Caucasian patients with osteoarthritis of the knee[J].Sci Rep,2021,11(1):7836.
[28] JAMALI A A,MEEHAN J P,MOROSKI N M,et al.Do small changes in rotation affect measurements of lower extremity limb alignment?[J]. J Orthop Surg Res,2017,12(1):77.
[29] JUD L,TRACHE T,TONDELLI T,et al.Rotation or flexion alters mechanical leg axis measurements comparably in patients with different coronal alignment[J].Knee Surg Sports Traumatol Arthrosc,2020,28(10):3128-3134.
[30] PALMER J S,JONES L D,MONK A P,et al.Varus alignment of the proximal tibia is associated with structural progression in early to moderate varus osteoarthritis of the knee[J].Knee Surg Sports Traumatol Arthrosc,2020,28(10):3279-3286.
[31] LI X,GU X,JIANG Z,et al.Statistical modeling:assessing the anatomic variability of knee joint space width[J].J Biomech,2023,147:111420.
[32] MIGLIORINI F,FEIERABEND M,HOFMANN U K.Fostering excellence in knee arthroplasty:developing optimal patient care pathways and inspiring knowledge transfer of advanced surgical techniques[J].J Healthc Leadersh,2023,15:327-338.

备注/Memo

备注/Memo:
基金项目:河北省科学技术厅重点研发计划项目(22377125D)
河北省中医药管理局科研计划项目(2023319)
△通信作者 E-mail:szdushuangqing@sina.com
更新日期/Last Update: 2024-10-05