膝骨性关节炎“筋骨失衡”生物力学评价的临床对照研究  

Clinical controlled study on biomechanical evaluation of ‘tendon-bone imbalance’ in knee osteoarthritis patients

作　　者：张帅攀 朱清广[2,3] 郭光昕 程艳彬[2,3] 吴志伟 汤程[2,3] 房敏 ZHANG Shuai-pan;ZHU Qing-guang;GUO Guang-xin;CHENG Yan-bin;WU Zhi-wei;TANG Cheng;FANG Min(School of Acupuncture and Tuina,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Research Institute of Tuina,Shanghai Academy of Traditional Chinese Medicine,Shanghai 200437,China;Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)

机构地区：[1]上海中医药大学针灸推拿学院,上海201203 [2]上海市中医药研究院推拿研究所,上海200437 [3]上海中医药大学附属岳阳中西医结合医院,上海200437

出　　处：《中华中医药杂志》2022年第9期5508-5511,共4页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家万人计划教学名师(No.A2-JYB21003);上海市“超级博士后”激励计划(No.2021316);上海中医药大学预算内项目(No.2021LK101)。

摘　　要：目的:基于生物力学开展膝骨性关节炎(KOA)患者下肢“筋骨”功能态的特征研究。方法:招募KOA患者30例和健康人30名开展病例对照,应用步态分析及长轴X线实现KOA患者下肢“经筋”及“骨”的力学评价。结果:步态分析:在1个步态周期内:KOA患者步长变小、步速变慢、单支撑时长变短;两组膝关节矢状面的屈曲角度、冠状面的内收与外展角度差异明显;KOA患者膝关节伸展力矩较小,内收力矩较大。长轴X线:KOA患者髋膝踝角角度更小,股胫角更大(P<0.05)。结论:KOA患者呈现下肢关节运动功能下降、膝关节肌肉力矩不协调,下肢力线偏倚的病理力学特征,可以从生物力学角度部分阐释中医“筋骨失衡”内涵。Objective: To study the characteristics of lower limb ‘muscle-bone’ functional state in patients with knee osteoarthritis(KOA) based on biomechanics. Methods: A total of 30 KOA patients and 30 healthy people were recruited to carry out a prospective case-control study, and the mechanics evaluation of the ‘meridian’ and ‘bone’ of the lower limbs of KOA patients were realized by gait analysis and long-axis X-ray. Results: Gait analysis: Within one gait cycle: KOA patients had smaller stride length, slower stride speed, and shorter single support duration;sagittal flexion angle, coronal adduction and extension angle of knee joints in both groups were significantly different;the knee joint extension torque was smaller and the adduction torque was larger in KOA patients. Long-axis X-ray: KOA patients had a smaller varus angle and a larger tibial angle(P<0.05). Conclusion: KOA patients have pathological and mechanical characteristics of decreased lower limb joint motor function, uncoordinated knee joint muscle torque, and lower limb alignment deviation, which can partially explain the connotation of ‘muscle-bone imbalance’ in TCM from the perspective of biomechanics.

关 键 词：筋骨失衡 生物力学 膝骨性关节炎 步态分析 下肢力线 

分 类 号：R684.3[医药卫生—骨科学] R318.01[医药卫生—外科学]