不同年龄膝骨关节炎患者坐起生物力学特征的系统综述和Meta分析  

Biomechanics characteristics during sitting up in knee osteoarthritis patients of different ages:a systematic review and meta-analysis

作　　者：王珂 张泽毅 张力文 张美珍[1] Wang Ke;Zhang Zeyi;Zhang Liwen;Zhang Meizhen(College of Physical Education,Taiyuan University of Technology,Taiyuan 030024,Shanxi Province,China)

机构地区：[1]太原理工大学体育学院,山西省太原市030024

出　　处：《中国组织工程研究》2024年第18期2939-2946,共8页Chinese Journal of Tissue Engineering Research

基　　金：山西省基础研究计划自由探索类项目(202103021224109),负责人:张美珍;首批新文科研究与改革实践项目(2021050026),负责人:张美珍;太原理工大学学科建设经费,负责人:史冬博。

摘　　要：目的:不同年龄的膝骨关节炎患者采取何种坐起策略尚未达成共识。为此,文章通过Meta分析系统评估不同年龄的膝骨关节炎患者与健康人坐起的生物力学特征,分析不同年龄患者的坐起运动模式,为改善患者坐起功能提供参考。方法:截至2023年3月,在PubMed、Web of Science和中国知网等数据库进行文献检索,纳入膝骨关节炎患者和健康人群坐起的生物力学特征的观察性研究,要求研究对象为膝关节影像学Kellgren-Lawrence严重程度分级≥Ⅰ级的50岁以上的膝骨关节炎患者,且定期出现膝关节疼痛,并根据纳入排除标准对受试者进行年龄(50-60岁vs.60岁以上)及严重程度(轻中度患者vs.重度患者)亚组分析。运用Down and black改良量表进行文献质量评价,采用Stata 16.0软件进行亚组分析确定不同年龄与严重程度的膝骨关节炎患者坐起的生物力学特征。结果:共14项随机对照试验(824例受试者)纳入Meta分析,所有纳入文献质量平均得分为76.2分,评分范围为66.7-86.7分,均达到中、高质量,具有一定代表性。Meta分析结果发现:①相比健康人,膝骨关节炎患者坐起总时长(SMD=0.92,95%CI:0.76-1.09,P<0.001)、伸展阶段时长(SMD=0.46,95%CI:0.18-0.74,P=0.001)更久;相比膝骨关节炎轻中度患者,重度患者总时长增加更明显(P<0.001),且60岁以上患者比50-60岁患者伸展阶段时长增加更明显(P=0.001)。②相比健康人,膝骨关节炎患者坐起躯干屈曲活动度(SMD=0.64,95%CI:0.37-0.91,P<0.001)更大;膝关节屈曲活动度(SMD=-0.47,95%CI:-0.70至-0.24,P<0.001)和踝关节背屈活动度(SMD=-0.32,95%CI:-0.56至-0.08,P=0.01)更小,且60岁以上患者的膝关节屈曲活动度比50-60岁患者下降更明显(P<0.001)。③膝骨关节炎患者髋关节屈曲力矩峰值(SMD=-0.57,95%CI:-0.83至-0.31,P<0.001)、膝关节伸展力矩峰值(SMD=-0.83,95%CI:-1.08至-0.59,P<0.001)更小。结论:①60岁以上膝骨关节炎患者比50-60岁患者坐�OBJECTIVE:There is no consensus on which sit-up strategy to adopt in knee osteoarthritis patients of different ages.Therefore,this study evaluated the biomechanical characteristics of sit-ups in knee osteoarthritis patients of different ages compared with healthy individuals by meta-analysis system and analyzed the sit-up movement patterns of patients of different ages to provide a reference for improving the sit-up function of patients.METHODS:By March 2023,observational studies of biomechanical characteristics of sitting up in patients with knee osteoarthritis and healthy population were retrieved on PubMed,Web of Science and CNKI.Subjects were required to be patients over 50 years of age with knee osteoarthritis who had Kellgren-Lawrence severity grading≥I on knee imaging and who had regular knee pain.Subjects were analyzed by age(50-60 years vs.over 60 years)and severity(mild to moderate patients vs.severe patients)subgroups according to inclusion and exclusion criteria.Quality assessment was performed using the modified Down and black scale.Stata 16.0 software was used to perform subgroup analysis to determine the biomechanical characteristics of sitting up in patients with knee osteoarthritis of different ages and severities.RESULTS:A total of 14 randomized controlled trials(824 subjects)were included in the meta-analysis.The mean quality score of all included literature was 76.2,with a range of 66.7 to 86.7,all of which were of medium to high quality and representative.The included studies were of moderate to high quality and representative.Meta-analysis results found that(1)compared to healthy individuals,patients with knee osteoarthritis had longer total sitting up time(SMD=0.92,95%CI:0.76-1.09),P<0.001)and longer extension phase time(SMD=0.46,95%CI:0.18-0.74,P=0.001).Compared to mild to moderate patients,the total duration increased more significantly in severe patients(P<0.001)and the duration of the extension phase increased more significantly in patients over 60 years of age than in patients 50-60

关 键 词：膝骨关节炎 膝关节软组织退化 年龄 严重程度 坐起运动 运动学 动力学 膝关节伸展力矩峰值 膝关节内收力矩峰值 META分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R605