足前进角对不同年龄膝关节炎患者下肢动力学影响的系统综述和Meta分析  

Effect of foot progression angle on lower extremity kinetics of knee osteoarthritis patients of different ages:a systematic review and meta-analysis

作　　者：张泽毅 杨亦敏 李文彦 张美珍[1] Zhang Zeyi;Yang Yimin;Li Wenyan;Zhang Meizhen(College of Physical Education,Taiyuan University of Technology,Taiyuan 030024,Shanxi Province,China;College of Physical Education,Woosuk University,Jeonju 55338,South Korea)

机构地区：[1]太原理工大学体育学院,山西省太原市030024 [2]韩国又石大学体育学院,韩国全州市55338

出　　处：《中国组织工程研究》2024年第6期968-975,共8页Chinese Journal of Tissue Engineering Research

基　　金：首批新文科研究与改革实践项目(2021050026),项目负责人:张美珍;山西省基础研究计划自由探索类项目(202103021224109),项目负责人:张美珍;山西省回国留学人员科研资助项目(2020-032),项目负责人:张美珍;山西省研究生教育教学改革课题(2021YJJG067),项目负责人:张美珍;太原理工大学学科建设经费(2022),项目负责人:史冬博。

摘　　要：目的:膝关节内收力矩(knee adduction moment,KAM)双峰及膝关节内收角冲量(knee adduction angular impulse,KAAI)增大是膝关节骨性关节炎主要的生物力学危险因素。据调查,调整足前进角可改变膝关节骨性关节炎患者运动模式,然而足内偏、足外偏对青年、老年患者KAM和KAAI的影响未达成共识。因此文章通过Meta分析综合论述足前进角对不同人群膝关节骨性关节炎患者KAM、KAAI的影响,为治疗膝关节骨性关节炎提供借鉴。方法:截至2022年6月,以“足前进角,膝关节内收力矩,膝关节内收角冲量,步态”为中文检索词,以“foot progression angle,knee adduction moment,knee adduction angular impulse,gait”为英文检索词在Web of Science、EBSCO、PubMed和中国知网数据库进行检索。纳入分析足内偏、足外偏对KAM双峰和KAAI影响的自身对照和随机对照试验。运用Cochrane偏倚风险评估工具对纳入文献进行文献质量评价,采用Stata 15.1软件进行亚组分析确定不同足前进角对步行KAM及KAAI的影响,应用Meta回归进一步确定结局指标(KAM及KAAI)随足前进角变化的特征。结果:(1)共15项自身对照试验和2项随机对照试验(455名受试者)纳入Meta分析,所纳入文献均为中、高质量文献。(2)Meta分析结果显示,足内偏可减小青年患者KAM第一峰值(SMD=-0.380,95%CI:-0.710至-0.060,P=0.022)和KAAI(SMD=-1.470,95%CI:-2.160至-0.770,P<0.001),足外偏降低了青年患者KAM第二峰值(SMD=-0.720,95%CI:-1.010至-1.440,P<0.001)。此外,足内偏减了小老年患者KAM第一峰值(SMD=-0.550,95%CI:-0.800至-0.300,P<0.001),但有增高KAM第二峰值的作用(SMD=0.280,95%CI:-0.010-0.560,P=0.047),足外偏可降低该人群KAM第二峰值(SMD=-0.510,95%CI:-0.830至-0.190,P=0.002)。(3)Meta回归显示,老年患者的足外偏程度越大,KAM第二峰值越低。结论:(1)足内偏降低了18-34岁的青年膝关节骨性关节炎患者的KAM第一峰值、KAAI,由于KAM、KAAI与膝关节内侧OBJECTIVE:Knee adduction moment and knee adduction angular impulse enlargement is the main biomechanical risk factor of knee osteoarthritis.According to the survey,a change in the foot progression angle could effectively change the motion mode of patients with knee osteoarthritis.However,the impact of toe-in and toe-out on knee adduction moment and knee adduction angular impulse in young and elderly patients did not reach a consensus.Therefore,this study comprehensively discussed the effect of foot progression angle on knee adduction moment and knee adduction angular impulse in different populations through meta-analysis and provided a reference for the treatment of knee osteoarthritis.METHODS:By June 2022,searches were conducted on Web of Science,EBSCO,PubMed and CNKI databases using“foot progression angle,knee adduction moment,knee adduction angular impulse,gait”as Chinese and English search terms.Self-controlled randomized controlled studies analyzing the effects of toe-in and toe-out on knee adduction moment bimodality and knee adduction angular impulse were included.The cochrane bias risk assessment tool was utilized to make a quality evaluation of the literature.Stata 15.1 software was used for subgroup analysis to determine the effect of foot progression angle on knee adduction moment and knee adduction angular impulse.Meta-regression analysis was used to further determine characteristics of outcome indicators(knee adduction moment,knee adduction angular impulse)changing with foot progression angle.RESULTS:(1)A total of 15 self-control trials and 2 randomized controlled trials(455 subjects)were included in the meta-analysis.All of the included articles were of medium to high quality.(2)The meta-analysis results showed that the toe-in gait could reduce the first peak of knee adduction moment(SMD=-0.380,95%CI:-0.710 to-0.060,P=0.022)and knee adduction angular impulse(SMD=-1.470,95%CI:-2.160 to-0.770,P<0.001)in young patients.The toe-out gait reduced the second peak of knee adduction moment(SMD=-0.720,95%

关 键 词：膝关节骨性关节炎 膝关节软组织退化 青年患者 老年患者 足内偏 足外偏 膝关节内收力矩 膝关节内收角冲量 步态 META分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R604