内侧开放楔形胫骨高位截骨术治疗膝关节内侧单间室骨关节炎后的足底压力分析
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国家自然科学基金项目(82173627)


Plantar Pressure Analysis after Medial Opening Wedge High Tibial Osteotomy Treatment of Medial Single Compartmental Knee Osteoarthritis
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    摘要:

    目的 分析内侧单间室膝关节骨性关节炎(knee osteoarthritis,KOA)患者接受内侧开放楔形胫骨高位截骨术(medial opening wedge high tibial osteotomy,MOWHTO)治疗后的足底压力分布情况,为患者的手术治疗和康复提供生物力学参考。 方法 选取 31 例行单侧 MOWHTO 治疗后的内侧单间室 KOA 患者作为实验组,同时以 35 例同年龄健康人群作为对照组,使用 Pedomedic 40?? 足底压力测试系统进行动态足底压力的测试。 通过比较步行状态下实验组(术侧及未术侧)与对照组不同足底分区的峰值压强(pmax)、压力时间积分(force-time integral,FTI)和接触面积(contact area, CA),评估内侧单间室 KOA 患者 MOWHTO 术后的足底压力变化。 结果 与未术侧和对照组相比,术侧第 1 跖骨区(MH1)CA 和 FTI 偏高(P<0. 05),第 4 跖骨区(MH4)CA 偏小(P<0. 001),第 5 跖骨区(MH5)pmax 和 FTI 偏小(P<0. 05),中足部外侧区(MF-L)CA 偏小(P<0. 001),后足部内侧区(RF-M)CA 偏大(P<0. 05)。未术侧与对照组相比,MH1、MH2 的 pmax 偏小(P<0. 05),MH5 的 CA、FTI 偏大(P<0. 05),MF-L 的 pmax 偏大(P<0. 001),后足部外侧区(RF-L)的 FTI 偏大(P<0. 05)。 结论 内侧单间室 KOA 患者在 MOWHTO 术后和健康人相比存在足底压力残余异常。 临床中需要有针对性地强化康复治疗来恢复患者正常的足底压力分布。

    Abstract:

    Objective To analyze the plantar pressure distribution of knee osteoarthritis ( KOA) patients after medial opening wedge high tibial osteotomy ( MOWHTO), so as to provide biomechanical references for the surgical treatment and rehabilitation of patients. Methods A total of 31 patients with medial single compartmental KOA after unilateral MOWHTO treatment were selected as the experimental group, and 35 healthy subjects at same age were selected as the control group. The Pedomedic 40 ?? pressure measuring system was used to test dynamic plantar pressure. By comparing the maximum pressure ( pmax ), force-time integral ( FTI) and contact area (CA) of different plantar zones between the experimental group (operative side and unoperated side) and the control group during walking, the changes of plantar pressure in patients with medial single compartmental KOA after MOWHTO were evaluated. Results Compared with the unoperated side and the control group, the CA and FTI of the 1st metatarsal head (MH1) were higher (P<0. 05), the CA of the 4th metatarsal head (MH4)was smaller (P<0. 001), the pmax and FTI of the 5th metatarsal head (MH5) were smaller (P<0. 05), the CA of the lateral middle foot (MF-L) was smaller (P<0. 001), and the CA of the medial rear foot (RF-M) was larger (P<0. 05). Compared with the control group, the pmax of MH1 and MH2 was smaller (P<0. 05), the CA and FTI of MH5 were larger (P<0. 05), the pmax of MF-L was larger (P<0. 001), and the FTI of lateral rear foot (RF-L) was larger (P<0. 05). Conclusions Compared with healthy people, patients with medial single compartmental KOA have abnormal plantar pressure residual after MOWHTO. In clinical practice, targeted intensive rehabilitation therapy is necessary to restore the normal plantar distributions of patients.

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王朝阳,卿 忠,支力强,昝 强,单 婳,尚 磊,马建兵,徐 超.内侧开放楔形胫骨高位截骨术治疗膝关节内侧单间室骨关节炎后的足底压力分析[J].医用生物力学,2023,38(2):310-316

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  • 收稿日期:2022-06-06
  • 最后修改日期:2022-07-02
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  • 在线发布日期: 2023-04-25
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