膝骨性关节炎患者登梯时下肢肌肉活动和膝关节负荷的分析

目的:分析膝骨性关节炎患者(KOA)登梯时下肢肌群肌电活动与关节角冲量与正常人的差异,为康复方案设计提供生物力学参考。方法:采用Qualisys三维运动分析系统以及Delsys无线表面肌电系统对招募10名符合纳排标准的膝骨性关节炎患者和10名正常人进行登梯活动的步态检测,采用下肢肌群均方根值、股内外侧肌协同收缩比值、股二头肌和股外侧肌共同活动比值和髋、膝关节在冠状面和矢状面上角冲量对比分析与两组登梯时下肢肌群收缩模式对关节负荷的影响。结果:与正常对照相比,上梯时膝骨性关节炎患者股直肌均方根值RMS(Root Mean Square)增大(P0.05),膝骨性关节炎患者股内外侧肌收缩均方根值比值(RMS(Vastus Medialis)VM/(Vastus Lateralis)VL)减小(P0.05),膝骨性关节炎患者腘绳肌与股外侧肌收缩比值(RMS(Biceps Femoris)BF/VL增大(P0.05)。下梯时,膝骨性关节炎患者股直肌均方根值(RMS)增大(P0.05),臀大肌均方根值(RMS)减小(P0.05),股内外侧肌收缩均方根比值(RMS VM/VL)减小(P0.05)。上梯时,膝骨性关节炎患者髋、膝关节冠状面上的关节角冲量大于正常人(P0.05),膝关节在矢状面上关节角冲量大于正常组(P0.05),下梯髋、膝关节冠状面、矢状面上的角冲量无统计学差异(P0.05)。KOA组VM/VL、BF/VL与膝关节在冠状面和矢状面上的角冲量的改变没有直接的相关性(P0.05)。结论:膝骨性关节炎患者在登梯活动时股直肌的收缩活动增加,股内外侧肌的协同收缩下降,主动肌与拮抗肌的共同收缩增加,膝骨性关节炎患者在面对登梯活动时下肢肌群选择性激活和高激活状态协调一致,促进关节稳定。虽然下肢神经肌肉的收缩模式和膝关节负荷之间没有直接的相关性,可能是对膝关节负荷产生影响的生物力学因素较多,神经肌肉的收缩模式只是部分影响因素,后续将增加其他生物力学因素进一步研究。

Analysis of Lower Limb Muscle Activity and Knee Joint Loading for Stair Climbing in Knee Osteoarthritis Patients

ABSTRACT Objective: To analyze the differences of EMG activity of lower limb muscle group and joint angle impulse in knee osteoarthritis (KOA) patients and normal people, for rehabilitation programmes designed to provide biomechanics of reference. Methods: Using the Qualisys 3D motion analysis system and the Delsys wireless surface electromyography system, gait analysis was performed on 10 KOA patients and 10 normal persons who met the inclusion and exclusion criteria, and the root mean square value (RMS) of the lower limb muscle group, the ratio of the synergistic co-activation of the medial and lateral muscles, the ratio of the common activities of the biceps femoris and the lateral femoral muscle, and the contrast of the hip and knee joints on the frontal and sagittal planes was used to compare and analyze the effect of lower limb muscle co-activation pattern on joint loading. Results: Compared to the normal control, during ascending stairs, rectus femoris RMS in KOA (P<0.05), the ratio of VM/VL RMS was decreased in KOA patients (P<0.05), the ratio of BF/VL RMS was increased in KOA patients (P<0.05). During descending stairs, rectus femoris RMS increased in KOA patients (P<0.05), gluteus maximus and the ratio of VM/VL RMS descresed (P<0.05). During ascending stairs, the angular impulse of joint on the frontal planes of hip and knee joint in KOA patients is larger than that of normal people, the angular impulse of the knee joint on the sagittal plane was greater than that of the normal group. During descending stairs, there was no statistical difference in the angular impulse on the frontal planes and sagittal planes of hip and knee (P>0.05). There was no direct correlation between VM/VL and BF/VL in KOA group and the change of angular impulse on frontal planes and sagittal planes of knee joint (P>0.05). Conclusion: In KOA patients, the co-activation activity of rectus femoris increased, while the muscle co-activation of medial and lateral femoris decreased, while the joint co-activation of agonist and antagonist muscles increased. In KOA patients, both muscle co-activation strategies modulate in unison to promote joint stability. Although there is no direct correlation between the lower limb neuromuscular co-activation mode and knee joint loading, it may be that there are many biomechanical factors influencing knee joint loading. The neuromuscular co-activation mode is only a part of the influencing factors, and other biomechanical factors will be added in the future.