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中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 19 -28. doi: 10.3877/cma.j.issn.1674-134X.2023.01.003

临床论著

全身关节过度活动青年步行时踝关节运动学特征
陈浩斌1, 曾小龙2, 谢珍艳3, 钟国庆3, 何学程4, 周欣羽5, 黄文汉3, 张余3,†()   
  1. 1. 510080　广州，南方医科大学附属广东省人民医院（广东省医学科学院）骨肿瘤科；510515　广州，南方医科大学第二临床医学院
    2. 510006　广州，华南理工大学医学院
    3. 510080　广州，南方医科大学附属广东省人民医院（广东省医学科学院）骨肿瘤科
    4. 510515　广州，南方医科大学第二临床医学院
    5. 510080　广州，广东省心血管病研究所，广东省人民医院，广东省医学科学院
  • 收稿日期:2021-05-05 出版日期:2023-02-01
  • 通信作者: 张余
  • 基金资助:
    国家自然科学基金项目(81972126)

Kinematic characteristics of ankle joint during walking in young adults with general joint hypermobility

Haobin Chen1, Xiaolong Zeng2, Zhenyan Xie3, Guoqing Zhong3, Xuecheng He4, Xinyu Zhou5, Wenhan Huang3, Yu Zhang3,†()   

  1. 1. Department of Orthopedic Oncology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
    2. School of Medicine South China University of Technology, Guangzhou 510006, China
    3. Department of Orthopedic Oncology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
    4. The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
    5. Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
  • Received:2021-05-05 Published:2023-02-01
  • Corresponding author: Yu Zhang
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引用本文：

陈浩斌, 曾小龙, 谢珍艳, 钟国庆, 何学程, 周欣羽, 黄文汉, 张余. 全身关节过度活动青年步行时踝关节运动学特征[J]. 中华关节外科杂志(电子版), 2023, 17(01): 19-28.

Haobin Chen, Xiaolong Zeng, Zhenyan Xie, Guoqing Zhong, Xuecheng He, Xinyu Zhou, Wenhan Huang, Yu Zhang. Kinematic characteristics of ankle joint during walking in young adults with general joint hypermobility[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(01): 19-28.

目的

采集全身关节过度活动(GJH)受试者与健康对照受试者的上坡和下坡步行时踝关节步态数据，分析其6个自由度运动学特征及规律。

方法

本研究招募健康大学生受试者(排除踝关节其他疾病及伴有神经精神疾病等病史)，分为对照组(Beighton评分<4分，45人)和全身关节过度活动组(GJH组，Beighton评分≥4分，33人)。采用三维运动分析系统采集受试者踝关节上坡和下坡步行时的运动学参数。对两组符合正态分布且方差齐步态分析数据进行独立样本t检验；若不满足正态分布或方差齐性检验则采用Mann-Whitney U检验。

结果

屈伸自由度上，上坡行走时GJH组和对照组差异无统计学意义(P>0.05)，但在下坡步行时，在初始着地期和摆动相末期GJH组较对照组表现出较小的跖屈角度，初始着地期2%屈伸角度：(－28.19±9.23)° vs(－32.92±9.90)°(t＝2.119，P＝0.037)。与对照组相比，在内外旋和内外位移自由度上，无论是上坡行走还是下坡行走，GJH组均表现出较大的内旋角度和外向位移，上坡承重反应期9%内外旋角度：(－2.84±6.18)°vs(－0.04±5.93)°(t＝2.028，P＝0.046)，且在下坡行走时，内旋角度和外向位移，承重反应期9%内外旋角度：(－7.7±4.8)° vs(－5.0±6.3)°(t＝2. 057，P＝0. 043)，增大更明显。

结论

相比于正常人，GJH组在下坡步行时较上坡步行时表现出更明显的运动学参数的变化，以适应功能需求更高的下坡运动，可能是腓肠肌等肌肉过度激活来维持踝关节稳定性。

关键词: 关节不稳定性, 踝关节, 步态分析
Objective

To analyse kinematic characteristics and regularity of six-degrees of freedom (6-DOF) of both healthy participates and study subjects with general joint hypermobility (GJH) by collecting ankle gait data during uphill and downhill walking.

Methods

Healthy college students, excluded from ankle history and medical history associated with neuropsychiatric diseases, were divided into control group (Beighton score<four, 45 subjects) and general joint hypermobility group (GJH group, Beighton score≥four, 33 subjects). A three-dimensional motion analysis system was employed to collect kinematic parameters of ankle joints from the healthy participates and study subjects during walking uphill and downhill. Independent sample t test was used to analyse the two groups of gait data which were in accordance with normal distribution and homogeneity of variance. If a normal distribution or variance homogeneity test was not applicable, Mann-Whitney U test was used instead.

Results

There was no significant difference in the angles of dorsal extension and plantar flexion between the two groups in uphill walking (P>0.05). While in downhill walking, GJH group showed a smaller angle of plantar flexion in the initial contact and at the end of swing phase, with flexion and extension angles at (-28.19±9.23)° vs (-32.92±9.90)° (t=2.119, P=0.037) in the initial landing state of 2% gait. In comparison with the control group, GJH group showed greater medial rotation angle and lateral translation when walking uphill and downhill, with medial and lateral rotations while in uphill walking with loading response period of 9% gait: (-2.84±6.18)° vs (-0.04±5.93)° (t=2.028, P=0.046). In downhill walking, in the GJH group, the medial rotation and lateral translation occurred with more significantly increased angles of medial and lateral rotations in loading response period of 9% gait: (-7.7±4.8)° vs (-5.0±6.3)° (t=2. 057, P=0. 043).

Conclusions

Compared with a normal young adult, the young adult with GJH showed more significant changes in kinematic parameters in downslope walking than an upslope walking. In order to adapt to higher functional requirements in downhill movement, muscles such as gastrocnemius muscle should be excessively activated to maintain an ankle stability.

Key words: Joint instability, Ankle joint, Gait analysis
图1 踝关节运动坐标系的建立注：系统在依靠骨性标记点与刚体之间的关系建立踝关节运动坐标体系，踝关节由胫骨远端和足围绕着坐标轴进行运动。Iversion/Enversion-内翻/外翻；Internal/External-内旋/外旋；Plantarflexion/Dorsiflexion-跖屈/背伸；Posterior/Anterior-前位移/后位移；Distal/Proximal-远位移/近位移；Media/Lateral-外位移/关节内位移
Figure 1 Establishment of coordinate system of ankle joint motion
表1 GJH组和对照组的一般资料
Table 1 Demographic characteristics of GJH group and control group
组别Group 例数Case number 性别Gender[男/女，例(%)][male/female，number (%)] 年龄Age[岁，(±s)] 身高Hight[cm，(±s)] 体重Weight[kg，(±s)] BMI[kg /m2, (±s)]
对照组Nonrmal group 33 25(83.3)/ 20(41.7) 20.3±1.7 167.5±7.4 59.5±10.6 21.1±2.9
GJH组GJH group 45 5(16.7)/ 28(58.3) 20.2±1.7 163.4±6.5 55.1±11.4 20.5±2.9
统计值   χ2＝13.131 t＝0.254 t＝－2.593 t＝1.755 t＝0.926
P值   <0.001 >0.05 0.011 >0.05 >0.05
图2 GJH组(全身关节过度活动组)和对照组上坡行走时的踝关节步态分析图。图A为步态周期中两组背伸/跖屈角度的比较；图B为步态周期中两组前/后位移的比较；图C为步态周期中两组内/外旋角度的比较；图D为步态周期中两组远/近位移的比较；图E为步态周期中两组内/外翻角度的比较；图F为步态周期中两组内/外位移的比较注：图C中*表示在8%~9%步态周期中两组在内/外旋自由度差异有统计学意义(步态周期9%：t＝2.028，P＝0.046)
Figure 2 Uphill walking diagrams of ankle gait analysis of GJH group (general joint hypermobility group) and control group. A is the comparison of the dorsiflexion/plantarflexion angles of the two groups in the gait cycle; B is the comparison of the anterior/posterior displacement of the two groups in the gait cycle; C is the comparison of the internal/external rotation angles of the two groups in the gait cycle; D is the comparison of the two groups of distal/proximal displacements in the gait cycle; E is the comparison of the two groups of inversion/ eversion angles in the gait cycle; F is the comparison of the two groups of medial/lateral displacements in the gait cycle
表2 GJH组和对照组上坡行走时主要参数
Table 2 Main parameters of GJH group and control group when walking uphill
组别Group 例数Case number 最大跖屈角度(68%)Maximum plantar flexion angle at 68% of the gait cycle[°，(±s)] 承重反应期(9%)内外旋角度Internal/external rotation angle at loading response period (9%)[°，(±s)] 摆动相早期(67%)内翻外翻角度Eversion/inversion angle at initial swing phase (67%)[°，(±s)] 屈伸活动范围Range of dorsiextension/plantar flexion angle [°，M(P25，P75)] 前后位移活动范围Range of anterior/posterior displacement[mm，M(P25，P75)] 远近位移活动范围Range of proximal/distal displacement [mm，M(P25，P75)] 内外位移活动范围Range of medical/lateral displacement [mm，M(P25，P75)]
GJH组GJH group 33 －33.33±11.10 －2.84±6.18 －5.59±8.40 －11.18(－14.80，－5.38) －4.26(－5.23，－3.74) 4.92(2.81，6.00) 0.93(0.52，1.30)
正常组Nonrmal group 45 －31.73±18.21 －0.04±5.93 －7.09±7.94 －9.85(－13.61，－4.03) －6.74(－8.14，－5.70) 4.47(1.93，6.11) 0.61(0.11，0.81)
统计值   t＝0.448 t＝2.028 t＝0.802 Z＝2.292 Z＝7.748 Z＝0.828 Z＝5.104
P值   >0.05 0.046 >0.05 0.022 <0.001 >0.05 <0. 001
图3 GJH组(全身关节过度活动组)和对照组下坡行走时的踝关节步态分析图。图A为步态周期中两组背伸/跖屈角度的比较；图B为步态周期中两组前/后位移的比较；图C为步态周期中两组内/外旋角度的比较；图D为步态周期中两组远/近位移的比较；图E为步态周期中两组内/外翻角度的比较；图F为步态周期中两组内/外位移的比较注：图A中*表示在0%~3%和84%~100%步态周期中两组在背伸/跖屈自由度差异有统计学意义(步态周期2%：t＝2.119，P＝0.037)；图C中*表示在9%~13%和19%~40%步态周期中两组在内/外旋自由度差异有统计学意义(步态周期9%：t＝2.057，P＝0. 043)
Figure 3 Downhill walking diagram of ankle gait analysis diagram of GJH group and control group. A is the comparison of the dorsiflexion/plantarflexion angles of the two groups in the gait cycle；B is the comparison of the anterior/posterior displacement of the two groups in the gait cycle; C is the comparison of the internal/external rotation angles of the two groups in the gait cycle; D is the comparison of the two groups of distal/proximal displacements in the gait cycle; E is the comparison of the two groups of inversion/ eversion angles in the gait cycle; F is the comparison of the two groups of medial/lateral displacements in the gait cycle
表3 GJH组和对照组下坡行走时主要参数
Table 3 Main parameters of GJH group and control group when walking downhill
组别Group 例数Case number 初始着地期(2%)的屈伸角度Dorsiflexion/plantarflexion angle at the initial contact stage (2%)[°，(±s)] 承重反应期(9%)内外旋角度Internal/external rotation angle at loading response period (9%) [°，(±s)] 摆动相早期(67%)内翻外翻角度Eversion/inversion angle at initial swing phase (67%) [°，(±s)] 屈伸活动范围Range of dorsiextension/plantarflexion angle[°，M(P25，P75)] 前后位移活动范围Range of anterior/posterior displacement[mm，M(P25，P75)] 远近位移活动范围Range of proximal/distal displacement[mm，M(P25，P75)] 内外位移活动范围Range of medial/lateral displacement[mm，M(P25，P75)]
GJH组GJH group 33 －28.19±9.23 －7.72±4.82 －6.67±9.23 －19.97(－24.98，－16.33) －7.18(－8.06, －6.32) 2.47(0.24，4.00) 2.22(1.31，2.51)
正常组Nonrmal group 45 －32.92±9.90 －5.03±6.26 －8.28±8.91 －21.68(－26.49，－16.91) －8.41(－10.01，－6.97) 2.98(0.08，4.49) 1.12(0.75，1.40)
统计值   t＝2.119 t＝2.057 t＝0.777 Z＝1.752 Z＝4.183 Z＝0.596 Z＝7.650
P值   0.037 0.043 >0.05 >0.05 <0.001 >0.05 <0.001
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