不同严重程度的双侧膝骨关节炎患者步态及足底压力分析  

Analysis of Gait and Foot Pressure in Patients with Bilateral Knee Osteoarthritis of Different Severity

作　　者：林星瑾 欧建林 谢文浩 陈卓铭[1] 欧阳辉[1] LIN Xingjin;OU Jianlin;XIE Wenhao;CHEN Zhuoming;OUYANG Hui(The First Affiliated Hospital of Jinan University,Guangzhou,Guangdong 510630,China)

机构地区：[1]暨南大学附属第一医院,广东广州510630

出　　处：《康复学报》2023年第5期436-441,448,共7页Rehabilitation Medicine

基　　金：国家重点研发计划项目(2020YFC2005700);广州市基础研究计划市校(院)联合资助项目(202201020082)。

摘　　要：目的:通过分析不同严重程度的双侧膝骨关节炎(OA)患者步态特征及足底不同分区的压力点峰值的差异,为OA的诊治及康复提供依据。方法:选取2020年8月—2021年2月暨南大学附属第一医院骨关节外科、风湿免疫科、康复医学科及脊柱创伤外科收治的双侧OA患者64例,根据影像学的K-L分级标准,将符合标准的50例分为轻度组和中重度组,其中Ⅰ、Ⅱ级患者纳入轻度组,共26例,Ⅲ、Ⅳ级患者为中重度组,共24例。使用步态与平衡功能训练评估系统及康复智能鞋分别检测出2组患者的步态分析时空参数及足底压力点峰值分区。其中步态分析时空参数包括步伐时间、步幅时间、步幅长度、单支撑相时间、双支撑相时间、站立相时间、摆动相时间、单支撑相百分比、双支撑相百分比、步速、步频、步宽和步向角;足底压力点峰值分区包括足趾区、跖骨区、中足内侧区、中足外侧区、足跟内侧区及足跟外侧区。结果:中重度组步幅长度、步速、步频、单支撑相时间、单支撑相百分比、摆动相时间均小于轻度组(P<0.05),而步幅时间、步宽、双支撑相时间、双支撑相百分比均大于轻度组(P<0.05)。在足底压力点峰值中,与轻度组比较,中重度组跖骨区2压力点峰值减小(P<0.05)。结论:不同严重程度OA患者的步态及足底压力特征具有差异,随着OA严重程度增加,患者步态呈现步行速度减慢、步幅减小、站立时间延长、单足撑地时间缩短及足压向外偏移的特点。临床上可通过评估OA患者的步态来快速判断疾病严重程度及分析患者生物力学的变化特征,为康复治疗提供理论依据。Objective:To analyze the gait characteristics of patients with bilateral knee osteoarthritis(KOA)of different severity and to investigate the differences in the peak pressure points in different subdivisions of foot to provide a basis for the clinical diagnosis,treatment and rehabilitation of KOA.Methods:A total of 64 patients with bilateral KOA admitted to the Department of Bone and Joint Surgery,Department of Rheumatology and Immunology,Department of Rehabilitation Medicine,and Department of Spine and Trauma Surgery of the First Affiliated Hospital of Jinan University from August 2020 to February 2021 were selected,based on the K-L classification criteria of imaging,and 50 cases who met the criteria were divided into mild group and moderate-severe group,of which 26 cases with gradesⅠandⅡwere enrolled in the mild group,and 24 cases with gradesⅢandⅣwere enrolled in the moderate-severe group.The gait spatiotemporal parameters and peak plantar pressure points of the two groups were detected using the gait and balance function training assessment system and intelligent rehabilitation shoes,respectively.The gait spatiotemporal parameters included stride time,stride duration,stride length,single support phase time,double support phase time,stance phase time,swing phase time,single support phase percentage,double support phase percentage,stride speed,stride frequency,stride width and stride direction angle.The peak plantar pressure points included the toe area,metatarsal area,medial area,lateral area,medial heel area and lateral heel area.Results:Among the spatiotemporal parameters of gait measured in both groups,stride length,stride speed,stride frequency,single support phase time,single support phase percentage,and swing phase time in the moderate-severe group were smaller than those in the mild group(P<0.05),while stride time,stride width,double support phase time,and double support phase percentage in the moderate-severe group were larger than those in the mild group(P<0.05).In the peak pressure points,the

关 键 词：膝骨关节炎 步态分析 足底压力 生物力学 康复评估 

分 类 号：R684.3[医药卫生—骨科学]