基于三维步态分析及动态有限元模型探讨电针改善膝内侧间室骨性关节炎患者登梯负重功能的生物力学机制

Stair climbing is one of the major daily dysfuctions in patients with medial compartment knee osteoarthritis due to the several times greater loading on knee joints compared with level walking. The changes of biomechanical characteristics in lower limbs remain even when the pain disappears. Acupuncture's effect on the improvement of motor function has been confirmed, we hypothesed that its mechanism is not only on pain relief, but also on the improvement of biomechanical environment of knee joints, such as muscle coordination and . In this study, we plan to use three-dimensional motion analysis system with synchorized surface EMG and dynamic finite element model to objectively evaluate the effects of acupuncture on patients's motion during climbing, also to analyse the possible biomechanical factors that may influence on weight-bearing, such as muscle coordination, limb alignment,stress-strain changes of cartilage and ligaments, alteration of contact points on joints surface. By integrating static and dynamic biomechanical methods, the mechanism of acupuncture effect on motion in medial compartment KOA patients during climbing will be investigated. The results may provide biomechanical evidence for enhancing the effect of acupuncture when serving as a rehabilitation therapy in medial compartment KOA patients.

登梯运动是膝内侧间室骨性关节炎患者日常生活的主要功能障碍，关节内负重较平地行走增加数倍，引发下肢特征性的生物力学变化，且这些变化在疼痛消失后仍然存在。针灸对运动功能的改善效应已得到证实，我们认为其作用机制不仅在于止痛，也通过改善膝关节的生物力学环境而起作用。本研究采用三维运动分析系统、同步表面肌电图配合动态有限元模型，客观反映针灸后KOA患者登梯活动中关节负重情况、肌群协调性、下肢力线、关节内软骨与韧带的应力应变情况及关节面接触点变化，并分析针灸对运动功能的改善可能与哪些生物力学的因素相关，综合动静态的生物力学方法探讨针灸对KOA患者登梯运动康复疗效的机制，为提高针灸对膝内侧骨性关节炎患者的康复疗效提供生物力学依据。

登梯运动是膝内侧间室骨性关节炎患者日常生活的主要功能障碍，关节内负重较平地行走增加数倍，引发下肢特征性的生物力学变化，且这些变化在疼痛消失后仍然存在。针灸对运动功能的改善效应已得到证实，我们认为其作用机制不仅在于止痛，也通过改善膝关节的生物力学环境而起作用。本研究采用三维运动分析系统、同步表面肌电图配合动态有限元模型，客观反映针灸后KOA 患者登梯活动中关节负重情况、肌群协调性、下肢力线、关节内软骨的应力的变化。目前已分析的结果包括：KOA患者平地行走的生物力学参数与正常人有差异。坐-站活动中膝屈伸肌群共同激活增加，协调性改变。通过有限元模型测量发现膝关节内外侧间隙不同，但体积接近。平地行走时内侧半月板的应力较外侧大，且女性半月板应力分布较男性更不对称。已分析的10例患者经过3周电针治疗后，WOMAC疼痛、躯体功能及总分均优于治疗前，但关节僵硬评分治疗前后无差异，10例非经非穴浅刺对照组治疗前后均无显著差异。登梯活动的运动分析数据尚未全部完成，有限元数据及肌肉力的数据也将在1一个月后完成。届时将分析针灸对运动功能的改善是否与肌肉协调性及关节负荷的改变等生物力学因素有关，综合动静态的生物力学方法探讨针灸对KOA 患者登梯运动康复疗效的机制，为提高针灸对膝内侧骨性关节炎患者的康复疗效提供生物力学依据。