中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (27): 4312-4317.doi: 10.12307/2021.188

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

单侧膝骨关节炎临床分期与双足足底压力的相关性

王  欣，罗  文，黄文泽，许燕飞，艾元亮，夏煜博，周晓寒，王  涛，郭  英   

  1. 1昆明市中医医院呈贡院区，云南省昆明市   650500；2云南中医药大学，云南省昆明市   650500；3昆明市中医医院，云南省昆明市   650000
  • 收稿日期:2020-09-07 修回日期:2020-09-14 接受日期:2020-11-11 出版日期:2021-09-28 发布日期:2021-04-10
  • 通讯作者: 王涛，硕士，主治医师，昆明市中医医院呈贡院区，云南省昆明市 650500 郭英，主任医师，昆明市中医医院，云南省昆明市 650000
  • 作者简介:王欣，男，1995年生，云南省镇雄县人，汉族，2020年云南中医药大学毕业，硕士，医师，主要从事骨与关节疾病防治方面的研究。
  • 基金资助:
    昆明市科技局计划项目重点项目(2019-1-S-25318000001103)，项目负责人：王涛

Correlation between clinical stage of unilateral knee osteoarthritis and double plantar pressure

Wang Xin, Luo Wen, Huang Wenze, Xu Yanfei, Ai Yuanliang, Xia Yubo, Zhou Xiaohan, Wang Tao, Guo Ying   

  1. 1Chenggong Branch, Kunming Hospital of Traditional Chinese Medicine, Kunming 650500, Yunnan Province, China; 2Yunnan University of Chinese Medicine, Kunming 650500, Yunnan Province, China; 3Kunming Hospital of Traditional Chinese Medicine, Kunming 650000, Yunnan Province, China
  • Received:2020-09-07 Revised:2020-09-14 Accepted:2020-11-11 Online:2021-09-28 Published:2021-04-10
  • Contact: Wang Tao, Master, Attending physician, Chenggong Branch, Kunming Hospital of Traditional Chinese Medicine, Kunming 650500, Yunnan Province, China Guo Ying, Chief physician, Kunming Hospital of Traditional Chinese Medicine, Kunming 650000, Yunnan Province, China
  • About author:Wang Xin, Master, Physician, Chenggong Branch, Kunming Hospital of Traditional Chinese Medicine, Kunming 650500, Yunnan Province, China
  • Supported by:
    the key project of kunming Science and technology bureau, No. 2019-1-S-25318000001103 (to WT)

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摘要：

文题释义：
膝骨关节炎：是由关节软骨退化开始的一系列关节退行性改变所导致的关节炎症，伴随着年龄的增长发病率逐渐增加；临床常表现为疼痛、肿胀、僵硬、活动受限，日久可见关节畸形等症状。
足底压力：是人体在静止站立或者动态行走时，在自身重力的作用下，足底在垂直方向上受到的一个地面的反作用力。足底压力测定是步态分析的一个重要组成部分，是分析和衡量异常足底应力分布和步态的基础，它对运动系统病的病因分析、诊断、功能及恢复成果评定均有重要意义。

背景：足底压力是人体在静止站立或者动态行走时，在自身重力的作用下，足底在垂直方向上受到的一个地面反作用力。通过对膝骨关节炎不同分期的足底压力进行相关性分析，可以为膝骨关节炎早期干预和指导调理提供证据。
目的：观察单侧膝骨关节炎不同分期的足底压力变化，为单侧膝骨关节炎病情发生发展提供足底压力变化的相关依据。
方法：收集2018年10月至2019年12月云南中医药大学第三附属医院骨伤科收治的单侧膝骨关节炎患者，结合临床症状与放射学Kellgren-lawrence分级进行临床分期，其中早期29例，中期32例，后期27例。通过LorAn足底压力测试仪采集足底压力，其中静态压力数据包含前压力、后压力、左压力、右压力占比及骨盆旋转量；动态压力取“特征脚步”数据，包含拇趾、第2-5趾、第1-5跖骨、足中部、足跟内侧及足跟外侧压力占比；分析临床分期与足底压力的相关性。
结果与结论：①3组患者在静态压力分布中的左压力、右压力、骨盆旋转量相比差异有显著性意义(P < 0.05)；3组患者的动态“特征脚步”中患侧拇趾、第2-5趾、第2跖骨、第5跖骨、足跟外侧压力及健侧第2跖骨、第3跖骨、第4跖骨压力相比差异有显著性意义(P < 0.05)；②静态压力中左压力、右压力、骨盆旋转量及动态“特征脚步”患侧第5跖骨、足中部、足跟外侧压力、健侧第2跖骨、第3跖骨、第4跖骨压力与临床分期进展呈正相关(P < 0.05)；③静态压力中左压力、右压力及动态“特征脚步”患侧拇趾、第2-5趾压力与临床分期进展呈负相关(P < 0.05)；④有序多元Logistic回归分析显示，“特征脚步”患侧第2-5趾、第5跖骨、足跟外侧压力及健侧第3跖骨压力为膝骨关节炎临床分期的独立影响因素(β=-0.329，0.333，0.199，0.654；P < 0.05)；⑤结果表明随着膝骨关节炎分期的进展，“静态压力”分布逐渐趋向于健侧，骨盆旋转度逐渐增大，以增加足部的代偿能力；患侧“动态压力”向外分布，拇趾、第2-5趾压力占比减轻，为蹬离期提供更强的动力；健侧“动态压力”向前、向外分布，促使重心前移，减轻患侧膝关节负荷。
https://orcid.org/0000-0001-9924-8441 (王欣) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 膝关节, 骨关节炎, 疾病分期, 步态分析, 足底压力

Abstract: BACKGROUND: Plantar pressure is the reaction force exerted by the plantar region in the vertical direction under the action of gravity when the human body is standing still or walking dynamically. Correlation analysis of plantar pressure at different stages of knee osteoarthritis may provide evidence for early intervention and guidance of conditioning for knee osteoarthritis.  
OBJECTIVE: To investigate the changes of plantar pressure in different stages of unilateral knee osteoarthritis, and to provide relevant basis for the occurrence and development of unilateral knee osteoarthritis.
METHODS:  Unilateral knee osteoarthritis patients in the Department of Orthopedics and Traumatology, the Third Affiliated Hospital of Yunnan University of Chinese Medicine from October 2018 to December 2019 were collected for clinical staging according to clinical symptoms combined with radiology Kellgren-Lawrence classification, including 29 cases in the early stage, 32 cases in the middle stage and 27 cases in the later stage. LorAn plantar pressure tester was used to collect plantar pressure. Static pressure included anterior pressure, posterior pressure, left pressure, right pressure ratio and pelvic rotation. The dynamic pressure was taken as “characteristics of footsteps”, including pressure ratio in thumb, 2nd-5th toe (T2-5), 1st-5th (M1-5) metatarsal, middle foot, medial heel and lateral heel, to study the correlation between clinical staging and plantar pressure.  
RESULTS AND CONCLUSION: (1) In the static pressure distribution, there were significant differences in left pressure, right pressure and pelvic rotation among the three groups (P < 0.05). There were significant differences in T1, T2-5, M2, M5 and lateral heel on the affected side and M2, M3 and M4 on the healthy side (P < 0.05). (2) In static pressure, left pressure, right pressure, pelvic rotation and dynamic “characteristic foot” on M5, middle foot, and lateral heel of the affected side, and M2, M3, and M4 on the healthy side were positively correlated with clinical stage (P < 0.05). (3) In the static pressure, the left pressure and the right pressure, as well as the dynamic “characteristic feet” on the T1 and T2-5 of the affected side were negatively correlated with the clinical stage (P < 0.05). (4) The ordered multiple Logistic regression analysis showed that T2-5, M5, lateral heel and M3 on the affected side of characteristic feet were independent factors influencing clinical stages of knee osteoarthritis (β=-0.329, 0.333, 0.199, 0.654; P < 0.05). (5) The results showed that with the progression of knee osteoarthritis staging, the distribution of “static pressure” gradually tended to the uninjured side, and the rotation degree of the pelvis gradually increased to increase the compensatory capacity of the foot. The “dynamic pressure” on the affected side was distributed outward, and the pressure proportion of T1-5 was reduced, which provided stronger motivation for the departure stage. The “dynamic pressure” of the healthy side is distributed forward and outward to promote the center of gravity to move forward and reduce the load of the affected side knee joint.

Key words: knee, osteoarthritis, disease staging, gait analysis, plantar pressure

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