膝骨关节炎患者本体感觉、肌力及关节功能的相关性研究  

Correlations Between Joint Proprioception, Muscle Strength,and Functional Ability in Patients with Knee Osteoarthritis

作　　者：陈瑶[1,2] 俞泳[1,2] 何成奇[1,2] 

机构地区：[1]四川大学华西医院康复医学中心,成都610041 [2]康复医学四川省重点实验室,成都610041

出　　处：《四川大学学报（医学版）》2015年第6期880-884,共5页Journal of Sichuan University(Medical Sciences)

摘　　要：目的通过研究膝骨关节炎患者的膝关节本体感觉、屈伸肌群峰力矩及膝关节功能,探索三者之间的相关性。方法本研究共纳入56例膝骨关节炎患者。本体感觉评估和膝关节屈伸肌群肌力评估均采用Isomed2000等速肌力测试训练仪。个体本体感觉功能以膝关节的被动运动感知阈为评价指标,膝关节屈伸肌群肌力以膝关节屈伸肌群的峰力矩及峰力矩体质量比为评价指标。膝关节功能评估采用WOMAC问卷量表。同时对上述三者的相关性进行分析。再以膝骨关节炎患者关节功能WOMAC评分为因变量,年龄、体质量指数、VAS疼痛评分、双侧Kellgren-Lawrance分级均值、双侧股四头肌肌力均值、双侧腘绳肌肌力均值、双侧本体感觉误差均值作为自变量进行多元逐步回归分析。结果膝关节左、右侧本体感觉与股四头肌肌力及腘绳肌肌力均存在负相关(P<0.05)。膝关节左、右侧本体感觉均值与WOMAC评分中的关节疼痛、关节僵硬无明显相关性,但与关节日常生活活动存在正相关(r=0.659,P<0.05)。WOMAC评分与左、右侧股四头肌肌力均值和腘绳肌肌力均值均存在负相关(r分别为-0.511、-0.408,P<0.05)。经多元逐步回归分析,本体感觉〔标准化偏回归系数(B)=0.385,P=0.007〕、VAS疼痛评分(B=0.347,P=0.014)与WOMAC评分呈正相关。结论膝骨关节炎患者本体感觉-被动运动感知阈的低下与关节屈伸肌群肌力下降及关节功能下降有关。膝骨关节炎患者疼痛程度、本体感觉功能一定程度上参与影响膝骨关节炎患者的关节功能。Objective To establish correlations between joint proprioception,muscle flexion and extension peak torque,and functional ability in patients with knee osteoarthritis（OA）.Methods Fifty-six patients with symptomatic knee OA were recruited in this study.Both proprioceptive acuity and muscle strength were measured using the isomed-2000 isokinetic dynamometer.Proprioceptive acuity was evaluated by establishing the joint motion detection threshold（JMDT）.Muscle strength was evaluated by Max torque（Nm）and Max torque/weight（Nm/kg）.Functional ability was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index physical function（WOMAC-PF）questionnaire.Correlational analyses were performed between proprioception,muscle strength,and functional ability.A multiple stepwise regression model was established,with WOMAC-PF as dependent variable and patient age,body mass index（BMI）,visual analogue scale（VAS）-score,mean grade for Kellgren-Lawrance of both knees,mean strength for quadriceps and hamstring muscles of both knees,and mean JMDT of both knees as independent variables.Results Poor proprioception（high JMDT）was negatively correlated with muscle strength（P〈0.05）.There was no significant correlation between knee proprioception（high JMDT）and joint pain（WOMAC pain score）,and between knee proprioception（high JMDT）and joint stiffness（WOMAC stiffness score）.Poor proprioception（high JMDT）was correlated with limitation in functional ability（WOMAC physical function score r=0.659,P〈0.05）.WOMAC score was correlated with poor muscle strength（quadriceps muscle strength r=-0.511,P〈0.05,hamstring muscle strength r=-0.408,P〈0.05）.The multiple stepwise regression model showed that high JMDT 〔standard partial regression coefficient（B）=0.385,P〈0.05〕and high VAS-scale score（B=0.347,P〈0.05）were significant predictors of WOMAC-PF score.Conclusion Patients with poor proprioception is associated with poor muscle strength and limitation in func

关 键 词：膝骨关节炎 肌力 本体感觉 关节功能 

分 类 号：R684.3[医药卫生—骨科学]