来源：风湿病与关节炎,2022,11（4）:7-12.

膝骨关节炎患者上下梯过程中膝关节的稳定性特征分析（临床研究）

刘本科^1,2，陈　博³，熊　凤⁴，侯美金^1,2，姚如婕⁵，林紫玲^1,2，李镇辉^1,2，傅升星^1,2，杨凤娇^1,2，王芗斌^1,2

　　【摘　要】目的：通过研究膝骨关节炎患者与无膝骨关节炎症状者上下梯过程中膝关节加速度的差异，分析其与垂直地面反作用力、肌肉共激活指数之间的关系，探寻膝骨关节炎患者上下梯易跌倒的原因。方法：通过三维运动分析系统，采集与分析24例膝骨关节炎患者及16例无膝骨关节炎症状受试者在上下梯过程中支撑期膝关节矢状面线加速度峰值、垂直地面反作用力第一峰值、第二峰值；通过无线表面肌电图同步采集上下梯过程中股外侧肌/股内侧肌、股外侧肌/股二头肌、股内侧肌/腓肠肌内侧头的共激活指数。结果：上梯过程中，膝骨关节炎患者膝关节线加速度峰值、股外侧肌与股二头肌共激活指数显著增高（P < 0.01），垂直地反力第二峰值显著降低（P < 0.05）；膝骨关节炎患者膝关节线加速度峰值与垂直地反力第二峰值呈负相关（r = -0.43，P < 0.05），垂直地反力第二峰值降低是膝骨关节炎患者膝关节线加速度峰值增高的影响因素（P < 0.05）。下梯过程中，膝骨关节炎患者股外侧肌与股二头肌共激活指数显著增高（P < 0.01），垂直地反力第二峰值显著降低（P < 0.05）。结论：在上梯过程中，膝骨关节炎患者的膝关节稳定性降低，垂直地反力第二峰值降低是影响膝骨关节炎患者膝关节稳定性的危险因素。

　　【关键词】　膝骨关节炎；关节稳定性；线加速度；肌肉共激活；地面反作用力

Analysis of Stability Characteristics of Knee Joint in the Process of Ascending and Descending Stairs in Patients with Knee Osteoarthritis

LIU Ben-ke,CHEN Bo,XIONG Feng,HOU Mei-jin,YAO Ru-jie,LIN Zi-ling,LI Zhen-hui,FU Sheng-xing,YANG Feng-jiao,WANG Xiang-bin

　　【ABSTRACT】Objective:To study the difference of knee acceleration between patients with knee osteoarthritis and those without such symptom,analyze its relationship with vertical ground reaction force and muscle co-activation index,and explore the reason why patients with knee osteoarthritis are easy to fall up and down the stairs.Methods:Through the three-dimensional motion analysis system,twenty-four patients with knee osteoarthritis and 16 subjects without symptoms of knee osteoarthritis were collected,analyzing the peak value of sagittal linear acceleration of knee joint and the first,second peak values of vertical ground reaction force during support period while ascending and descending stairs.Through wireless surface electromyography,the coactivation indexes of lateral femoral muscle/medial femoral muscle,lateral femoral muscle/biceps femoris muscle and medial femoral muscle/medial head of gastrocnemius muscle were synchronously collected.Results:In the process of ascending stairs,the peak value of linear acceleration of knee joint and the co-activation index of lateral femoral muscle and biceps femoris in patients with knee osteoarthritis increased significantly（P < 0.01）,and the second peak value of vertical reaction force decreased significantly（P < 0.05）.The peak value of knee linear acceleration in patients was negatively correlated with the second peak value of vertical reaction force（r = -0.43,P < 0.05）.The decrease of the second peak value of vertical reaction force was the influencing factor of the increase of peak value of knee linear acceleration in such patients（P < 0.05）.In the process of descending stairs,the co-activation index of lateral femoral muscle and biceps femoris muscle in patients increased significantly（P < 0.01）,and the second peak of vertical reaction force decreased significantly（P < 0.05）.Conclusion:In the process of ascending stairs,the stability of the knee joint in patients with knee osteoarthritis decreases,and the decrease of the second peak of vertical ground reaction force is a risk factor affecting the stability of the knee joint.

　　【Keywords】knee osteoarthritis;joint stability;linear acceleration;muscle co-activation;ground reaction