北京生物医学工程

单侧膝内翻型膝骨关节炎患者足底压力分布特征研究

Plantar pressure distribution in patients with unilateral varus knee osteoarthritis

作者：王子坚闫松华李伟刘艳成全海英曾纪洲张宽

单位：首都医科大学生物医学工程学院(北京 100069) 首都医科大学临床生物力学应用基础研究北京市重点实验室(北京 100069) 首都医科大学附属北京康复医院康复诊疗中心(北京 100144) 天津医院脊柱外科(天津 300211) 首都医科大学附属北京潞河医院骨关节外科(北京 101149)

关键词：膝骨关节炎；膝内翻；步态；足底压力分布；步态周期

分类号：R318.01

出版年·卷·期（页码）：2019·38·2（151-158）

摘要：

目的对比分析单侧膝内翻型膝骨关节炎（knee osteoarthritis, KOA）患者和健康人在步态周期中的足底压力分布特征的差异，为KOA患者的康复治疗评估提供量化参考。方法利用Footscan足底压力测试系统对40名单侧膝内翻型KOA患者（Kellgren-Lawrence评分符合Ⅰ~Ⅲ级KOA，左右膝各20人）及20名健康人自然行走时的步态进行测试，采集受试者足底各区域的压力峰值、受力时间百分比、冲量，及单足支撑期参数和足轴角等参数，并进行对比分析。结果对于足中部区域所受冲量，左KOA患者(左足98.57 N·s±38.58 N·s)和右KOA患者(右足65.11 N·s±32.52 N·s)均比健康人(左足45.53 N·s±12.69 N·s，右足39.58 N·s±15.74 N·s)大60%以上(P＜0.05）；患者第1趾区域压力峰值比健康人减小40%以上(P＜0.001）；患者足跟内外侧压力峰值比健康人减小27%以上(P＜0.001)。与健康人相比，患者足轴角、足底各区域受力时间百分比、整足支撑阶段时间百分比均增大(P＜0.05)，足跟着地阶段时间百分比和前足离地阶段时间百分比减小(P＜0.05)。结论单侧膝内翻型膝骨关节炎患者与健康人相比足底压力分布特征有显著差异，足轴角明显增大，整足支撑期阶段时间延长，第1趾和足跟内外侧压力峰值及足中部所受冲量差异尤为显著，这些指标可为KOA患者的康复疗效评估提供量化参考。

Objective To compare and analyze the distribution of plantar pressure in patients with unilateral varus knee osteoarthritis (UVKOA) and healthy people, and to provide quantitative reference for rehabilitation assessment of knee osteoarthritis patients. Methods Contact time percentage, peak pressure and contact time-pressure integral of each area, single foot support phase parameters and foot axis angle from 40 patients with UVKOA patients（Kellgren-Lawrence scores in accordance with grade I-III knee osteoarthritis, 20 left knees and 20 right knees）and 20 healthy people were measured by Footscan plantar pressure measurment system. Results The contact time-pressure integral in mid foot area of left UVKOA patients（left foot 98.57 N·s±38.58 N·s）and right UVKOA patients（right foot 65.11 N·s±32.52 N·s）increased than healthy people（left foot 45.53 N·s±12.69 N·s, right foot 39.58 N·s±15.74 N·s）by 60% (P＜0.05). Compared with healthy people, the peak pressure of UVKOA patients decreased in toe 1st area by 40% (P＜0.001) and heel（lateral and medial）area by 27% (P＜0.001). Compared with healthy people, foot axis angle, contact time percentage of each area and foot flat phase percentage of UVKOA patients increased (P＜0.05), while initial contact phase and forefoot push off phase percentage decreased (P＜0.05). Conclusions Compared with healthy people, the UVKOA patients showed significant differences in the plantar pressure distribution, the foot axis angle significantly increased and foot flat phase was significantly prolonged. Peak pressures in toe 1st area, heel lateral area and heel medial area reduced, while contact time-pressure integral in mid foot area significantly increased. These indicators provide a quantitative reference for the assessment of the efficacy of knee osteoarthritis rehabilitation.

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