膝骨关节炎患者膝屈伸肌群等速肌力及其与功能的相关性

摘要

目的：观察膝关节骨关节炎(KOA)患者膝屈伸肌群等速肌力变化及其与膝关节功能的关系。方法23例双侧KOA患者及14名正常人进行膝屈伸肌等速肌力检查、五次坐-起试验(FTSST)、静态平衡测试、步态分析。KOA组还完成疼痛视觉模拟评分(VAS)及WOMAC骨关节炎指数评定。结果 KOA组伸肌及屈肌峰力矩、峰力矩均值、平均功率、单次最佳做功及总功主患侧均小于对侧(P<0.05)；峰力矩屈肌/伸肌(H/Q)百分比主患侧大于对侧(P<0.05)。组间比较，伸肌所有观察指标、屈肌平均功率KOA组均小于正常对照组(P<0.05)；峰力矩H/Q百分比KOA组大于正常对照组(P<0.05)。KOA组伸肌等速肌力峰力矩与FTSST、步行速度、步行距离、跌倒指数、VAS评分、WOMAC-疼痛评分之间存在相关性(P<0.05)，屈肌等速肌力峰力矩与FTSST、步态参数、跌倒指数、VAS评分、WOMAC评分之间无明显相关性(P>0.05)。结论 KOA患者伸肌及屈肌等速肌力主患侧较对侧减弱，伸肌等速肌力较正常人减弱，膝伸屈肌肌力变化不同步。KOA患者伸肌等速肌力峰力矩与膝关节疼痛、功能之间存在相关性。%Objective To investigate the isokinetic strength of knee extensors and flexors in patients with knee osteoarthritis (KOA), and to establish the correlation between the isokinetic strength and function in patients with KOA. Methods 23 patients with bilateral KOA and 14 matched normal controls finished the isokinetic test of knee extensors and flexors, the Five Times Sit-to-Stand Test (FTSST), Gait analy-sis, and Balance test. The KOA patients were evaluated with Visual Analog Scale (VAS) for pain and Western Ontario and McMaster Univer-sity Osteoarthritis Index (WOMAC). Results It was less of the peak torque, average peak torque, average power, max rep total work, total work of knee extensors and flexors in the mainly involved limbs than the contralateral limbs (P<0.05), and more of the hamstring/quadriceps peak torque (H/Q) percentage (P<0.05) in the patients. It was less of all the observed indicators of knee extensors and average power of knee flexors in the patients than in the normal controls (P<0.05), and was more of the H/Q percentage (P<0.05). The peak torque of knee exten-sors correlated with the results of FTSST, walking speed, walking distance, falling index, VAS, and WOMAC-pain (P<0.05), but the peak torque of knee flexors did not (P>0.05). Conclusion It is weak of the isokinetic strength of knee extensors and flexors in patients with KOA in the mainly involved limb, as well as the isokinetic strength of knee extensors compared with the normal controls. The changes in the ex-tensors and flexors are not equivalent. The peak torque of knee extensors significantly correlated with the pain and functions of the knee.