大学生运动相关下肢损伤与下坡行走的步态运动学关联

doi:10.3877/cma.j.issn.1674-134X.2025.03.004

目的

前瞻性研究下坡行走的步态相关危险因素与运动相关下肢损伤的关系。

方法

纳入标准为健康的大学生，排除标准为1年内有下肢外伤或韧带损伤、手术史、神经肌肉疾病或影响运动表现及生活质量的疾病。收集研究对象的人口统计学资料和人体测量数据，利用三维步态分析系统获得在跑步机上下坡行走时膝关节6自由度（6DOF）运动学参数。18个月后，记录下肢损伤。采用独立样本t检验和Wilcoxon Mann-Whitney检验比较各变量差异，通过二元分析识别风险因素，并将P<0.05的变量纳入多因素logistic回归分析。

结果

共招募518名受试者，其中399人最终纳入本研究；男性190人，女性209人，年龄（20.3±3.7）岁，随访率为80.7%，共36例（9.0%）损伤。多因素logistic回归分析表明，损伤的受试者在下坡行走负重反应中表现出更显著的胫骨前平移（ATT）[比值比（OR）=2.563，95%置信区间（CI）（1.439，4.565）]。未损伤的受试者在下坡行走时表现出更显著的最大膝关节屈曲角（KFA）[OR=0.969，95%CI（0.953，1.014）]。

结论

较大的ATT可能是与步态相关的下肢损伤危险因素，而较大的KFA可能是保护因素。在下坡条件下评估的其他步态相关因素，特别是肌肉质量、性别和BMI在大学生中没有显示出显著的病因相关性。

关键词: 步态, 生物力学现象, 膝关节, 腿损伤

Objective

To prospectively investigate gait-related risk factors associated with downslope walking concerning sport-related lower limb injuries.

Methods

The inclusion criteria comprised healthy college students, and the exclusion criteria were lower limb trauma or ligament injury in the last year, history of surgery, neuromuscular disorders, and conditions impairing athletic performance or quality of life. Demographics and anthropometric data of participants were collected, and a three-dimensional gait analysis system was employed to obtainsix degreeoffreedom (6 DOF) kinematic parameters of the knee during down-slope walking on a treadmill. Over 18 months, lower limb injuries were documented. Independent samples t tests and Wilcoxon Mann-Whitney tests were used to compare variable differences. Binary analysis identified risk factors, with variables showing P<0.05 included in multivariate logistic regression analysis.

Results

A total of 518 subjects were recruited, of whom 399 were ultimately included, including 190 males and 209 females, average age were (20.3±3.7) years, resulting in a follow-up rate of 80.7%. A total of 36 injuries (9.0%) were reported. Multivariate logistic regression analysis indicated that subjects who sustained injuries exhibited significantly greater anterior tibia translation (ATT) during the loading response [odds ratio (OR) =2.563, 95% confidence interval (CI) (1.439, 4.565)]while walking down-slope. The uninjured subjects exhibited a greater maximum knee flexion angle (KFA) during down-slope walking[OR=0.969, 95%CI (0.953, 1.014)].

Conclusions

Greater ATT may serve as a gait-related risk factor for lower limb injuries, whereas greater KFA may act as a protective factor. Other gait-related factors assessed under downs-lope conditions, especially muscle mass, gender, and BMI, do not demonstrate significant etiological relevance among college students.

Key words: Gait, Biomechanical phenomena, Knee joint, Leg injuries

图1 Optimum三维运动捕捉系统

Figure 1 Optimum 3D Motion Capture System

图2 下坡行走示意图

Figure 2 Downslope walking

图3 参与者的纳入和排除过程的流程图

Figure 3 Flowchart of participant recruitment and exclusion procedures

表1 人口统计学与人体测量特征

Table 1 Demographic and anthropometric characteristics

组别Groups	例数Number of cases	性别Gender[n（%）]		身高[m，（±s）]Hight	体重[kg，（±s）]Weight
组别Groups	例数Number of cases	男Male	女Female	身高[m，（±s）]Hight	体重[kg，（±s）]Weight
损伤组Injury group	36	17 (11.8)	19 (7.4)	1.66±0.11	59.17±10.83
非损伤组Control group	363	127 (88.2)	236 (92.6)	1.65±0.08	56.07±9.68
统计值Statistical values		χ²=2.126		t=0.693	t=1.817
P值		>0.05		>0.05	>0.05
组别Groups	例数Number of cases	BMI[kg/m²，M（P₂₅，P₇₅）]	运动时长[min，（±s）]Sport time	股四头肌周径[cm，（±s）]Quadriceps circumference	小腿肌肉周径/BMIM（P₂₅，P₇₅）Calf circumference/BMI
损伤组Injury group	36	20.94 (19.91，22.58)	21.39±48.34	36.55±2.62	1.72 (1.66，1.74)
非损伤组Control group	363	18.73 (20.12，21.88)	17.54±34.13	35.14±3.02	1.73 (1.66，1.79)
统计值Statistical values		Z=-2.411	t=0.012	t=1.893	Z=-8.875
P值		0.016	>0.05	>0.05	>0.05

表1 人口统计学与人体测量特征

Table 1 Demographic and anthropometric characteristics

组别Groups	例数Number of cases	性别Gender[n（%）]		身高[m，（±s）]Hight	体重[kg，（±s）]Weight
组别Groups	例数Number of cases	男Male	女Female	身高[m，（±s）]Hight	体重[kg，（±s）]Weight
损伤组Injury group	36	17 (11.8)	19 (7.4)	1.66±0.11	59.17±10.83
非损伤组Control group	363	127 (88.2)	236 (92.6)	1.65±0.08	56.07±9.68
统计值Statistical values		χ²=2.126		t=0.693	t=1.817
P值		>0.05		>0.05	>0.05
组别Groups	例数Number of cases	BMI[kg/m²，M（P₂₅，P₇₅）]	运动时长[min，（±s）]Sport time	股四头肌周径[cm，（±s）]Quadriceps circumference	小腿肌肉周径/BMIM（P₂₅，P₇₅）Calf circumference/BMI
损伤组Injury group	36	20.94 (19.91，22.58)	21.39±48.34	36.55±2.62	1.72 (1.66，1.74)
非损伤组Control group	363	18.73 (20.12，21.88)	17.54±34.13	35.14±3.02	1.73 (1.66，1.79)
统计值Statistical values		Z=-2.411	t=0.012	t=1.893	Z=-8.875
P值		0.016	>0.05	>0.05	>0.05

表2 6DOF膝关节运动学参数的平均旋转和平移ROM（

±s）

Table 2 Mean rotational and translational ROM for 6DOF knee joint kinematic parameters

组别Groups	例数Number of cases	内收-外展（°）Adduction-abduction	内翻-外翻（°）Internal-external	伸展-屈曲（°）Extension-flexion
损伤组Injury group	36	10.3±4.1	13.4±4.9	61.1±6.7
非损伤组Control group	363	9.6±3.8	13.3±4.5	62.3±6.0
t值		1.287	0.063	1.401
P值		>0.05	>0.05	>0.05
组别Groups	例数Number of cases	前倾-后倾(mm)Anterior-posterior	远端-近端(mm)Distal-proximal	内旋-外旋(mm)Medial-Lateral
损伤组Injury group	36	12.8±6.4	13.3±4.4	7.3±2.4
非损伤组Control group	363	12.5±5.3	13.6±4.7	7.0±2.7
t值		0.298	0.346	1.106
P值		>0.05	>0.05	>0.05

表2 6DOF膝关节运动学参数的平均旋转和平移ROM（

±s）

Table 2 Mean rotational and translational ROM for 6DOF knee joint kinematic parameters

组别Groups	例数Number of cases	内收-外展（°）Adduction-abduction	内翻-外翻（°）Internal-external	伸展-屈曲（°）Extension-flexion
损伤组Injury group	36	10.3±4.1	13.4±4.9	61.1±6.7
非损伤组Control group	363	9.6±3.8	13.3±4.5	62.3±6.0
t值		1.287	0.063	1.401
P值		>0.05	>0.05	>0.05
组别Groups	例数Number of cases	前倾-后倾(mm)Anterior-posterior	远端-近端(mm)Distal-proximal	内旋-外旋(mm)Medial-Lateral
损伤组Injury group	36	12.8±6.4	13.3±4.4	7.3±2.4
非损伤组Control group	363	12.5±5.3	13.6±4.7	7.0±2.7
t值		0.298	0.346	1.106
P值		>0.05	>0.05	>0.05

表3 下坡行走关键事件的步态参数比较（

±s）

Table 3 Comparison of gait parameters for key events in down-slope walking

组别Groups	例数Number of cases	50%步态周期站立相末期屈曲角度[°，（±s）]Flexion angle in terminal stance phase at 50% of gait cycle	73%步态周期最大屈曲角度[°，（±s）]Maximum flexion angle at73% of gait cycle	87%步态周期摆动相中期外角[°，（±s）]External angle in mid-swing phase at 87% of gait cycle	50%步态周期站立相末期内收角[°，（±s）]Adduction angle in terminal stance phase at 50% of gait cycle
损伤组Injury group	36	21.9±6.2	64.5±7.1	2.6±5.7	-1.8±3.5
非损伤组Control group	363	23.2±7.3	66.7±6.7	2.4±5.0	-2.1±3.2
t值		t=1.325	t=2.294	t=0.267	t=0.194
P值		>0.05	0.029	>0.05	>0.05
组别Groups	例数Number of cases	12%步态周期负重反应的前平移[mm，M（P₂₅，P₇₅）]Anterior translation in loading response at 12% of gait cycle	50%步态周期站立相末期近端平移[mm，M（P₂₅，P₇₅）]Proximal translation in terminal stance phase at 50% of gait cycle	4%步态周期负重反应的侧向平移[mm，（±s）]Lateral translation in loading response at 4% of the gait cycle	-
损伤组Injury group	36	6.7 (3.6，9.8)	1.3 (-1.7，4.3)	2.7±5.3	-
非损伤组Control group	363	5.3 (2.9，7.8)	3.0 (0.4，5.5)	2.3±3.7	-
t值		Z=-2.326	Z=-2.241	t=0.387	-
P值		0.020	0.025	>0.05	-

表3 下坡行走关键事件的步态参数比较（

±s）

Table 3 Comparison of gait parameters for key events in down-slope walking

组别Groups	例数Number of cases	50%步态周期站立相末期屈曲角度[°，（±s）]Flexion angle in terminal stance phase at 50% of gait cycle	73%步态周期最大屈曲角度[°，（±s）]Maximum flexion angle at73% of gait cycle	87%步态周期摆动相中期外角[°，（±s）]External angle in mid-swing phase at 87% of gait cycle	50%步态周期站立相末期内收角[°，（±s）]Adduction angle in terminal stance phase at 50% of gait cycle
损伤组Injury group	36	21.9±6.2	64.5±7.1	2.6±5.7	-1.8±3.5
非损伤组Control group	363	23.2±7.3	66.7±6.7	2.4±5.0	-2.1±3.2
t值		t=1.325	t=2.294	t=0.267	t=0.194
P值		>0.05	0.029	>0.05	>0.05
组别Groups	例数Number of cases	12%步态周期负重反应的前平移[mm，M（P₂₅，P₇₅）]Anterior translation in loading response at 12% of gait cycle	50%步态周期站立相末期近端平移[mm，M（P₂₅，P₇₅）]Proximal translation in terminal stance phase at 50% of gait cycle	4%步态周期负重反应的侧向平移[mm，（±s）]Lateral translation in loading response at 4% of the gait cycle	-
损伤组Injury group	36	6.7 (3.6，9.8)	1.3 (-1.7，4.3)	2.7±5.3	-
非损伤组Control group	363	5.3 (2.9，7.8)	3.0 (0.4，5.5)	2.3±3.7	-
t值		Z=-2.326	Z=-2.241	t=0.387	-
P值		0.020	0.025	>0.05	-

图4 两组患者在下坡时的膝关节6DOF（6自由度）运动学注：*-与未受伤的对照组相比，下坡行走时运动学参数差异有统计学意义（P<0.05）

Figure 4 Knee joint 6DOF（6 degree of freedom）kinematics in two groups during down-slope walkingNote: *-a statistically significant difference in kinematic parameters during down-slope walking compared to the uninjured group（P<0.05）

表4 多变量分析的参数估计

Table 4 Parameter estimates for multivariable analysis

参数	BMI（kg/m²）	最大屈曲角度（°）Maximum flexion angle	负重反应期的前平移（mm）Anterior translation in loading response	站立相末期的近端平移（mm）Proximal translation in terminal stance phase
优势比Odds Ratio	1.070	0.969	2.563	1.342
95%CI	（0.953，1.202）	（0.925，1.014）	（1.439，4.565）	（0.798，2.258）
P值	>0.05	0.003	0.001	>0.05

表4 多变量分析的参数估计

Table 4 Parameter estimates for multivariable analysis

参数	BMI（kg/m²）	最大屈曲角度（°）Maximum flexion angle	负重反应期的前平移（mm）Anterior translation in loading response	站立相末期的近端平移（mm）Proximal translation in terminal stance phase
优势比Odds Ratio	1.070	0.969	2.563	1.342
95%CI	（0.953，1.202）	（0.925，1.014）	（1.439，4.565）	（0.798，2.258）
P值	>0.05	0.003	0.001	>0.05

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Association between sports-related lower extremity injuries and gait kinematics during down-slope walking in college students

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Association between sports-related lower extremity injuries and gait kinematics during down-slope walking in college students