目的 探究全膝关节置换术（total knee arthroplasty, TKA）对老年膝关节等速肌力曲线特征的影响。 方法 采集TKA术后一年和性别、年龄与之相匹配的健康人在180 °/s、60 °/s角速度下进行等速肌力测试和等长屈伸测试。采集屈伸肌群的峰力矩和腘绳肌/股四头肌比率(H/Q)，并采用 1°递增的平均力矩结果进行标准化(力矩/体质量)。 结果 TKA术后患者在180°/s的角速度下患侧屈膝力矩在16°至64°范围内低于健侧，在10°至83°范围内低于健康受试者同侧（P<0.05）；60°/s的角速度下患侧屈膝力矩在72°至76°范围内低于健侧，在59°至87°范围内低于健康受试者同侧（P<0.05）；患侧与健康受试者同侧等长屈膝力矩无统计学差异（P>0.05）。TKA术后患者在180°/s的角速度下患侧伸膝力矩、峰力矩、H/Q与健康受试者同侧均无统计学差异（P>0.05）；60°/s的角速度下患侧伸膝力矩在68°至85°范围内低于健侧，在18°至37°和72°至81°范围内低于健康受试者同侧，患侧H/Q高于健康受试者同侧（P<0.05），两组伸展峰力矩和等长伸膝力矩无统计学差异（P>0.05）。 结论 TKA术后高速运动及关节活动末低速运动中患侧腘绳肌肌力下降，患侧股四头肌在关节活动起始和终末范围内低速运动中肌力下降。
Abstract
Objective To explore the influence of total knee arthroplasty (TKA) on the isokinetic muscle strength curve of knee joints in the aged. Methods Patients underwent TKA one year after surgery and healthy people who matched in age and sex were selected. Isometric and isokinetic strength of knee flexion and extension at velocity of 180°/s and 60°/s was tested by isokinetic dynamometer. The peak moment and hamstring/quadriceps ratio (H/Q) of flexion and extension muscles were collected, normalized torque-angle curves (torque/body mass) were generated in steps of 1°. Results At 180°/s for patients after TKA, the flexion moment of the affected side was lower than that of the healthy side in the range of 16° to 64° and lower than that of the same side of the healthy subjects in the range of 10° to 83° (P<0.05); at 60°/s, the flexion moment of the affected side was lower than that of the healthy side in the range of 72° to 76° and lower than that of the healthy subjects in the range of 59° to 87° (P<0.05). There were also no significant differences in knee extension moment, the peak moment and H/Q between the affected side of patients and healthy subjects at 180°/s (P>0.05); at 60°/s, the knee extension moment on the affected side was lower than that on the healthy side in the range of 68° to 85°, and lower than that of the healthy subjects in the range of 18° to 37° and 72° to 81°, the H/Q on the affected side was higher than that of the healthy subjects (P<0.05). There was no significant difference in the peak moment and extension moment of isometric test between the affected side and the healthy subjects (P>0.05). Conclusions After total knee arthroplasty, the hamstring strength of the affected side decreased during high-speed and low-speed within the end range of joint movement, and the quadriceps strength of the affected side decreased during low-speed within the starting range of joint movement.
关键词
全膝关节置换术 /
等速肌力测试 /
膝关节 /
膝骨关节炎
Key words
Total knee arthroplasty /
Isokinetic muscle test /
Knee /
Knee osteoarthritis
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参考文献
[1] 王斌，邢丹，董圣杰，等. 中国膝骨关节炎流行病学和疾病负担的系统评价[J]. 中国循证医学杂志,2018,18(2):134-142. DOI: 10.7507/1672-2531.201712031.
[2] Planckaert Célia, Larose G, Ranger P, et al. Total knee arthroplasty with unexplained pain: new insights from kinematics[J]. Arch Orthop Trauma Surg,2018,138(4):553-561. DOI: 10.1007/s00402-018-2873-5.
[3] 李孝强，陈唯，李明樾，等. 全膝关节置换前股四头肌超声定量分析对置换后慢性疼痛的预测价值[J]. 中国组织工程研究,2024,28(9):1388-1393. DOI: 10.12307/2023.900.
[4] Capin JJ, Bade MJ, Jennings JM, et al. Total knee arthroplasty assessments should include strength and performance-based[J]. Phys Ther,2022,102(6):pzac033. DOI: 10.1093/ptj/pzac033.
[5] Hafer JF, Kent JA, Boyer KA. Physical activity and age-related biomechanical risk factors for knee osteoarthritis[J]. Gait Posture,2019,70:24-29. DOI:10.1016/j.gaitpost.2019.02.008.
[6] Reid KF, Price LL, Harvey WF, et al. Muscle power is an independent determinant of pain and quality of life in knee [J]. Arthritis Rheumatol,2015,67(12):73-3166. DOI:10.1002/art.39336.
[7] Schache MB, McClelland JA, Webster KE. Lower limb strength following total knee arthroplasty: a systematic review[J]. Knee, 2014,21(1):12-20. DOI: 10.1016/j.knee.2013.08.002.
[8] Urhausen AP, Berg B, Øiestad BE, et al. Measurement properties for muscle strength tests following anterior cruciate [J]. Br J Sports Med,2022,56(24):1422-1431. DOI: 10.1136/bjsports-2022-105498.
[9] 许玉林，高鹏，张智海，等.膝关节骨关节炎患者术前等速肌力测试研究[J]. 中国康复医学杂志, 2004, (3): 44-45. DOI: 10.3969/j.issn.1001-1242.2004.03.016.
[10]Czamara A, Królikowska, Aleksandra. Two-plane assessment of knee muscles isometric and isokinetic torques after anterior cruciate ligament reconstruction[J]. Med Sci Monit, 2018, 24:4882-4893. DOI: 10.12659/MSM.908411.
[11]王晓非. 全膝关节置换术对膝关节周围肌力及运动功能变化的分析研究[D]. 大连医科大学,2021.
[12] Collados-Maestre I, Lizaur-Utrilla A, Gonzalez-Navarro B, et al. Better functional outcome after single-radius TKA compared with multi-radius TKA[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(11):3508-3514. DOI:10.1007/s00167-016-4273-0.
[13] Mao H, Hu M, Yen Y, et al. Kinesio taping relieves pain and improves isokinetic not isometric muscle strength in patients with knee osteoarthritis-a systematic review and meta-analysis [J]. Int J Environ Res Public Health, 2021, 18(19):10440. DOI:10.3390/ijerph181910440.
[14] 赖辛琦. 膝关节屈伸肌力及比值对平衡能力的影响研究[D]:吉林体育学院,2023.
[15] Prieske O, Aboodarda SJ, , José A, et al. Slower but not faster unilateral fatiguing knee extensions alter contralateral limb performance without impairment of maximal torque output[J]. Eur J Appl Physiol, 2017, 117(2):323-334. DOI: 10.1007/s00421-016-3524-6.
[16] 李俊毅，陈泽华，吴祖贵，等. 超声回声强度评价膝骨关节炎患者股四头肌质量的信度[J]. 中国康复理论与实践,2023,29(6):738-744. DOI: 10.3969/j.issn.1006-9771.2023.06.017.
[17] 徐远红，王俊华，谢谨，等. 温针灸阳陵泉结合等速肌力训练对膝关节骨性关节炎疗效研究[J]. 环球中医药,2015,8(8):908-912. DOI: 10.3969/j.issn.1674-1749.2015.08.004.
[18] Iacono AD, Buksbaum C, Padulo J, et al. Isokinetic moment curve abnormalities are associated with articular knee lesions[J]. Biol Sport,2018,35(1):83-91. DOI: 10.5114/biolsport.2018.71486.
[19]Read PJ, Trama R, Racinais S, et al. Angle specific analysis of hamstrings and quadriceps isokinetic torque identify residual deficits in soccer players following ACL reconstruction: a longitudinal investigation[J]. J Sports Sci,2022,40(8):871-877. DOI: 10.1080/02640414.2021.2022275.
基金
广东省医学科学技术研究基金项目(A2022507)；广东省人民医院国家自然科学基金启动项目(82170900328/KY012021754)
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