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中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (01) : 33 -39. doi: 10.3877/cma.j.issn.1674-134X.2020.01.006

所属专题： 文献；

临床论著

全身关节过度活动患者步行时膝关节步态图特征
钟国庆1, 曾小龙2, 谢宇3, 赖俊雅3, 刘春生3, 郑泽壕3, 陈寿炫3, 黄洁3, 黄乐曦3, 徐卓成3, 吴俊翰3, 黄文汉2, 马立敏2, 王鸣2, 李丽萍3, 张余2,†()   
  1. 1. 510000　广州，广东省人民医院（广东省医学科学院）骨科中心；515041　汕头大学医学院
    2. 510000　广州，广东省人民医院（广东省医学科学院）骨科中心
    3. 515041　汕头大学医学院
  • 收稿日期:2020-02-03 出版日期:2020-02-01
  • 通信作者: 张余

Knee joint kinematic characteristics of general joint hypermobility patients during walking

Guoqing Zhong1, Xiaolong Zeng2, Yu Xie3, Junya Lai3, Chunsheng Liu3, Zehao Zheng3, Shouxuan Chen3, Jie Huang3, Lexi Huang3, Zhuocheng Xu3, Junhan Wu3, Wenhan Huang2, Limin Ma2, Ming Wang2, Liping Li3, Yu Zhang2,†()   

  1. 1. Department of Orthopedics Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510000, China; Shantou University Medical College, Shantou 515041, China
    2. Department of Orthopedics Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510000, China
    3. Shantou University Medical College, Shantou 515041, China
  • Received:2020-02-03 Published:2020-02-01
  • Corresponding author: Yu Zhang
  • About author:
    Corresponding author: Zhang Yu, Email:
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引用本文：

钟国庆, 曾小龙, 谢宇, 赖俊雅, 刘春生, 郑泽壕, 陈寿炫, 黄洁, 黄乐曦, 徐卓成, 吴俊翰, 黄文汉, 马立敏, 王鸣, 李丽萍, 张余. 全身关节过度活动患者步行时膝关节步态图特征[J]. 中华关节外科杂志(电子版), 2020, 14(01): 33-39.

Guoqing Zhong, Xiaolong Zeng, Yu Xie, Junya Lai, Chunsheng Liu, Zehao Zheng, Shouxuan Chen, Jie Huang, Lexi Huang, Zhuocheng Xu, Junhan Wu, Wenhan Huang, Limin Ma, Ming Wang, Liping Li, Yu Zhang. Knee joint kinematic characteristics of general joint hypermobility patients during walking[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(01): 33-39.

目的

研究全身关节过度活动(GJH)患者平地行走及下坡步行时膝关节步态图特征。

方法

招募18～24岁健康大学生志愿者(排除膝关节外伤史等)，分为全身关节过度活动组(GJH组，Beighton评分5分，21人)和正常组(49人)。采集性别、身高、体重等信息，使用国际膝关节评分(IKDC)2000、Lysholm评分等问卷调查膝关节功能，测量Beighton评分系统的指标。采用三维运动分析系统测量受试者平地行走和下坡步行时的膝关节运动学参数。

结果

屈伸自由度上，平地行走时GJH组和正常组无明显差异，但在下坡步行时，在摆动相GJH组较正常组表现出更大的屈曲角度，最大屈曲角度：(67.40±5.48)°vs (62.27±6.57)°(t＝－2.961，P<0.01)。与正常组相比，在内外旋和前后位移自由度上，无论是平地行走还是下坡行走，GJH组均表现出较大的外旋角度和前向位移，平地支撑相中期12%前后位移：(0.73±0.45)mm vs(0.23±0.27)mm(t ＝－4.713，P<0.001)，且在下坡行走时，外旋角度和前向位移，支撑相中期12%前后位移：(0.78±0.62)mm vs (0.20±0.36)mm(Z＝－3.873，P<0.001)，增大更明显。

结论

GJH患者在下坡步行时表现出更明显的步态参数的变化，以适应功能需求更高的下坡运动，可能是由膝关节周围肌肉来代偿的。针对步态参数的异常，可通过步态再训练及关节稳定性训练，以增强关节过度活动患者膝关节周围肌肉力量，从而增强膝关节的稳定性。

关键词: 关节不稳定性, 膝关节, 生物力学现象, 步行
Objective

To study the knee joint kinematic characteristics of general joint hypermobility (GJH) patients during level and downhill walking.

Methods

18-24-year-old healthy college volunteers were recruited(Exclude the history of knee joint injury, etc) and divided into two groups: general joint hypermobility group (GJH group)(Beighton score ≥ 5, n=21) and normal group (n=49). The demographic information and questionnaires like IKDC 2000, Lysholm score of all subjects were investigated. The Beighton scoring system were assessed by the experienced operator. The gait analysis system was used to collect the data of the knee joint kinematic parameters. Independent sample t test and chi-square test were used for statistical analysis.

Results

There was no significant difference in flexion and extension angles between the GJH group and the normal group during level walking. However, compared to the normal group the GJH group showed a greater flexion angle in the swing phase than the normal group when walking downhill (maximum flexion angle): (67.40±5.48)°vs (62.27±6.57)°(t=-2.961, P<0.01). The GJH group showed a greater external angle and anterior translation during level walking (anterior/posterior translation in the middle stance phase, 12% gait) and downhill walking: (0.73±0.45)mm vs (0.23±0.27)mm(t =-4.713, P<0.001). The greater external angle and anterior translation (anterior/posterior translation in the middle stance phase, 12% gait): (0.78±0.62)mm vs (0.20±0.36)mm(Z =-3.873, P<0.001)increased more obviously when walking downhill.

Conclusions

The GJH patients present greater changes in gait parameters when walking downhill, which may be compensated by the muscles around the knee joint. As for the abnormal gait parameters, it is possible to enhance the muscle strength around the knee joint of the GJH patients through gait retraining and joint stability training, so as to enhance the stability of the knee joint.

Key words: Joint laxity, Knee joint, Biomechanical phenomena, Walking
图1 Beighton评分系统测量方案。图A为第五掌指关节被动背屈角度测量；图B为肘关节被动过伸；图C为膝关节被动过伸角度；图D为大拇指伸直时能被动贴向前臂屈侧；图E为站立体前屈，手掌轻松地落于地面上
图2 Optimum三维运动捕捉系统
图3 下坡步行示意图
表1 受试者的一般资料
组别 例数 年龄[岁，(±s)] BMI [kg/m2, (±s)] 身高[cm，(±s)] 体重[kg，(±s)]
GJH组 21 20.2±1.6 20.9±3.0 162.8±6.2 55.3±9.9
正常组 49 20.2±1.4 20.9±2.7 169.1±8.6 60.3±8.7
统计值 － t＝－0.016 t＝0.083 t＝3.417 t＝1.991
P值 － >0.05 >0.05 <0.01 <0.05
组别 例数 性别(男/女) 运动后关节不适史[例，(是/否)] IKDC量表[分，(±s)] Lysholm评分[分，(±s)]
GJH组 21 2/19 5/16 80.0±13.0 95.0±7.1
正常组 49 38/11 9/40 77.0±12.0 95.6±6.3
统计值 － χ2＝27.778 χ2＝0.038 t＝－0.441 t＝0.288
P值 － <0.05 >0.05 >0.05 >0.05
表2 GJH组和正常组平地行走时主要参数(±s)
组别 例数 最大屈曲角度(73%) (°) 支撑相中期(31%)内外旋角度(°) 支撑相末期(50%)内收外展角度(°) 支撑相中期(12%)前后位移(mm) 摆动相早期(62%)内外侧位移(mm) 屈伸活动范围(°) 前后位移活动范围(mm)
GJH组 21 59.32±4.42 2.06±2.90 －0.70±1.16 0.73±0.45 0.49±0.25 60.41±5.33 1.66±0.68
正常组 49 56.61±5.90 －0.48±2.69 －1.33±1.24 0.23±0.27 0.20±0.28 56.84±4.95 1.33±0.38
统计值 － t＝－1.864 t＝－3.482 t＝－1.956 t＝－4.713 t＝－3.990 t＝－2.662 Z＝－1.480
P值 － >0.05 <0.05 >0.05 <0.01 <0.01 <0.05 >0.05
图4 GJH组(全身关节过度活动组)和正常组平地行走时的膝关节步态图
表3 全身关节过度活动组(GJH组)和正常组下坡行走时主要参数(±s)
组别 例数 最大屈曲角度(73%) (°) 支撑相中期(31%)内外旋角度(°) 支撑相末期(50%)内收外展角度(°) 支撑相中期(12%)前后位移(mm) 摆动相早期(62%)内外侧位移(mm) 屈伸活动范围(°) 前后位移活动范围(mm)
GJH组 21 67.40±5.48 4. 00±7.90 －2.26±2.06 0.78±0.62 0.60±0.51 0.67±0.28 1.17±0.41
正常组 49 62.27±6.57 －0.90±3.36 －2.50±2.09 0.20±0.36 0.11±0.27 0.62±0.21 1.07±0.50
统计值 － t＝－2.961 Z＝－2.868 t＝－0.414 Z＝－3.873 Z＝－4.440 Z＝－0.163 Z＝－1.381
P值 － <0.05 <0.05 >0.05 <0.01 <0.01 >0.05 >0.05
图5 GJH组(全身关节过度活动组)和正常组下坡行走时的膝关节步态图
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