股骨内翻和胫骨内翻的运动学和足底压力分析  

Kinematics and Plantar Pressure Analysis of Varus Femur and Varus Tibia

作　　者：代菁 马剑雄 柏豪豪[2,3] 卢斌 吴研飞 马信龙[1,2,3] DAI Jing;MA Jianxiong;BAI Haohao;LU Bin;WU Yanfei;MA Xinlong(Clinical College of Orthopedics,Tianjin Medical University,Tianjin 300203,China;Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering,Tianjin 300050,China;Institute of Orthopedics,Tianjin Hospital,Tianjin 300050,China)

机构地区：[1]天津医科大学骨科临床学院,天津300203 [2]天津市骨科生物力学与医学工程重点实验室,天津300050 [3]天津市天津医院骨科研究所,天津300050

出　　处：《医用生物力学》2023年第3期561-567,共7页Journal of Medical Biomechanics

基　　金：国家自然科学基金项目(11772226,81871777,81572154);天津市科技计划项目(18PTLCSY00070,16ZXZNGX00130)。

摘　　要：目的探究胫骨侧和股骨侧来源的两种单侧膝骨关节炎膝内翻在步态分析中的运动学参数和足底压力差异,为不同类型膝内翻提供生物力学理论基础。方法招募26名单侧膝骨关节炎型膝内翻患者,股骨侧和胫骨侧来源各13名受试者。利用Noraxon MyoMotion三维动作捕捉系统和Footscan平板式足底压力测试系统,测量受试者在自然行走状态下的步态,采集受试者步态的时空指标、下肢各关节运动学参数、足底压力,并进行两组间对比分析。结果胫骨侧膝内翻的膝关节屈伸范围、髋关节外展峰值、髋关节内收外展活动范围、踝关节内旋峰值均大于股骨侧膝内翻,而膝关节屈曲峰值、髋关节内收峰值小于股骨侧膝内翻;与股骨侧膝内翻相比,胫骨侧膝内翻受试者第4、5跖骨足底受力时间、压力峰值都增加(P<0.05)。在第3跖骨区域中,股骨健侧肢体比胫骨畸形健侧肢体的冲量更大;而在足跟内侧区域,股骨健侧肢体的冲量更小(P<0.05)。结论两种不同类型单侧膝内翻患者在运动学参数和足底压力方面存在一定差异。研究结果有助于正确认识膝内翻引起的异常步态,为不同类型膝内翻诊治、术后康复和肢体锻炼提供可靠参考。Objective To compare the differences in kinematic parameters and plantar pressures for two types of knee varus with tibial and femoral origins in gait analysis,so as to provide biomechanical theoretical basis for different types of genu varus.Methods Twenty-six patients with unilateral knee osteoarthritis(KOA)varus genu were enrolled,with 13 from femoral and 13 from tibial sources.Using Noraxon MyoMotion three-dimensional(3D)motion capture system and Footscan plantar pressure test system,the gait of the subjects during natural walking was measured,the temporal and spatial parameters of the gait,the kinematics parameters of lower limb joints and plantar pressures were collected,to make comparative analysis between the two groups.Results The range of knee flexion and extension of tibial varus,the peak of hip abduction,the range of motion(ROM)of hip adduction and abduction and the peak of ankle pronation were larger than those of femoral lateral genu varus.The peak of knee flexion and hip adduction was smaller than that of femoral lateral genu varus.Compared with femoral varus,subjects with tibial varus had increased stress time and peak pressure on the plantar of the 4th and 5^(th)metatarsals(P<0.05).In the 3^(rd)metatarsal region,the impulse of healthy femoral limb was greater than that of healthy limb with tibial deformity.While in the medial calcaneal region,the impulse of healthy femoral limb was smaller(P<0.05).Conclusions There are some differences in kinematic parameters and plantar pressures between two different types of unilateral genu varus patients.The results of this study are helpful to understand the abnormal gait caused by genu varus,and provide reliable references for postoperative rehabilitation and limb exercise for different types of genu varus.

关 键 词：膝骨关节炎 膝内翻 运动学分析 足底压力 

分 类 号：R318.01[医药卫生—生物医学工程]