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全膝关节置换术对膝骨关节炎患者本体感觉的影响

Effects of Total Knee Arthroplasty on Proprioception in Patients with Knee Osteoarthritis

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目的 探究膝骨关节炎(knee osteoarthritis,KOA)患者进行全膝关节置换术前后本体感觉的变化.方法 选择34 名KOA患者作为实验组,术后根据手术方式分为后交叉韧带保留型全膝关节置换术(CR-TKA)组和后稳固型全膝关节置换术(PS-TKA)组,并对患者进行 3 个月术后随访,同时纳入 20 名健康受试者作为对照组.采用Biodex System Ⅲ多关节等速测试系统、自行设计的施力装置、无线表面肌电测试系统采集健康受试者以及患者手术前后的本体感觉(位置觉、运动觉和力觉)数据,并对数据进行处理和分析.结果 与健康受试者相比,KOA患者患侧和对侧膝关节 30°、45°和 60°位置觉、运动觉、半腱肌力觉显著变差(P<0.05);术后 3 个月,CR-TKA组患者患侧股二头肌力觉和对侧半腱肌力觉与健康受试者均存在显著差异(P<0.05);对CR-TKA组和PS-TKA组患者患侧和对侧的位置觉、运动觉、力觉术后 3 个月与术前的差值做组间比较,均无统计学差异(P>0.05).结论 KOA患者膝关节本体感觉较健康受试者明显减退.术后 3 个月,CR-TKA和PS-TKA两组患者本体感觉未见明显改善.不同手术方式对本体感觉的影响没有差异.研究结果 可以为医生的临床诊疗提供一定数据支持,以及为后续的康复方案确定一个方向.
Objective To explore proprioceptive changes in patients with knee osteoarthritis(KOA)before and after total knee arthroplasty(TKA).Methods Thirty-four KOA patients were selected as the experimental group and divided into posterior-cruciate-retaining TKA(CR-TKA)and posterior-stabilized TKA(PS-TKA)groups according to the surgical method and followed up for three months after the surgery.Twenty healthy individuals were included as the control group.The proprioception(position sense,kinesthesia,and force sense)of healthy individuals and KOA patients before and after surgery was assessed using the Biodex system III isokinetic training system,self-designed force sense test equipment,and surface electromyography test system,and the data were processed and analyzed.Results Compared with healthy individuals,KOA patients had significantly worse position sense at 30°,45°,and 60°,kinesthesia,and semitendinosus force sense in the affected and unaffected knees(P<0.05).Three months after surgery,there were significant differences in the force sense of the affected biceps femoris and contralateral semitendinosus forces in the CR-TKA group compared with healthy individuals(P<0.05).There were no statistically significant differences in deviation for preoperative and 3-month preoperative position sense,kinesthetic sense,and force sense on the affected and contralateral knee joints between the CR-TKA and PS-TKA groups(P>0.05).Conclusions Knee proprioception in KOA patients was significantly impaired compared with that in healthy individuals.No significant improvement in proprioception was found three months after TKA in the CR-TKA and PS-TKA groups.There was no difference in proprioception among the different surgical methods.The results can provide data support for clinical diagnosis and treatment,as well as determine a direction for subsequent rehabilitation programs.

knee osteoarthritis(KOA)total knee replacement(TKA)position sensekinesthesiaforce sense

张权、石静楠、张宽、张昊华、闫松华

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首都医科大学 生物医学工程学院,北京 100069

国家知识产权局专利局专利审查协作河南中心,郑州 450046

首都医科大学附属北京积水潭医院 矫形骨科,北京 100035

膝骨关节炎 全膝关节置换术 位置觉 运动觉 力觉

北京市自然科学基金

7222300

2024

医用生物力学
上海第二医科大学

医用生物力学

CSTPCD北大核心
影响因子:0.858
ISSN:1004-7220
年,卷(期):2024.39(4)