不同海拔世居藏族膝骨关节炎患者足底压力特征研究

娄本敬; 次旺; 强巴旦增; 严华韬; 尊珠; 谢露; 边巴

doi:10.16766/j.cnki.issn.1674-4152.003537

不同海拔世居藏族膝骨关节炎患者足底压力特征研究

doi: 10.16766/j.cnki.issn.1674-4152.003537

娄本敬¹,
次旺²,
强巴旦增²,
严华韬²,
尊珠²,
谢露¹,
边巴^{1, 3, ,}

1.
西藏大学医学院，西藏拉萨 850000
2.
西藏自治区第二人民医院骨科，西藏拉萨 850030
3.
西藏大学高原健康科学研究中心

基金项目:

国家自然科学基金联合基金重点项目 U21A20385

西藏大学研究生高水平人才培养计划 2021-GSP-S057

详细信息

通讯作者:
边巴，E-mail: 1744613356@qq.com

中图分类号: R684.3 R681.8
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- 被引次数: 0
出版历程
- 收稿日期: 2023-12-11
- 网络出版日期: 2024-07-22

Study on plantar pressure characteristics of Tibetan knee osteoarthritis patients living at different altitudes

1.
College of Medicine, Tibet University, Lhasa, Tibet 850000, China

摘要

摘要: 目的分析不同海拔患者足底压力变化，为高原世居藏族膝骨关节炎患者提供足底压力变化的量化依据。方法选取2023年3—8月西藏自治区第二人民医院进行全膝关节置换的膝骨关节炎患者94例，依据患者长期居住地进行海拔分类，海拔3 000~3 700 m为29例，3 701~4 500 m为38例，4 501~5 500 m为27例。使用LorAn足底压力测试系统进行静态站立和动态行走分析，运用Spearman分析方法分析不同海拔梯度与足底压力之间的相关性。结果患者置换侧与未置换侧拇趾(T1)、足内侧(MH)、足外侧(LH)区域差异有统计学意义(P＜0.05)；患者静态指标、置换侧与未置换侧足轴角、骨盆旋转度、步行速度及患者关节评分在不同海拔间差异有统计学意义(P＜0.05)；患者静态站立与动态行走指标与海拔高度呈负相关关系(P＜0.05)；患者关节评分与海拔高度呈正相关(P＜0.05)；患者足底T1和第4跖骨(M4)区域足底压强峰值以及第5跖骨(M5)区域受力时间比与海拔高度呈负相关关系(r=-0.287、-0.282、-0.252，P＜0.05)；患者BMI与足中部和后足部压强峰值呈正相关(r=0.330、0.238、0.226，P＜0.05)。结论足底压强峰值的变化可作为监测不同海拔世居藏族膝骨关节发生指标；高海拔地区世居藏族膝骨关节炎患者平衡能力较特高海拔患者差。
- 世居藏族 /
- 膝骨关节炎 /
- 海拔梯度 /
- 足底压力 /
- 步态分析
Abstract: Objective To analyze the changes of plantar pressure in patients with different altitudes, and to provide a quantitative basis for the changes of plantar pressure in patients with Tibetan knee osteoarthritis (KOA) living in the plateau. Methods Patients with knee osteoarthritis who underwent total knee arthroplasty in the Second People' s Hospital of Tibet Autonomous Region from March to August 2023, were selected according to their long-term residence, and 29 cases were classified according to their long-term residence, 29 cases were 3 000-3 700 m, 38 cases were 3 701-4 500 m, and 27 cases were 4 501-5 500 m. Static standing and dynamic walking analysis was performed using the LorAn plantar pressure test system, and the correlation between different elevation gradients and plantar pressure were analyzed by Spearman method. Results There were significant differences in T1, MH and LH between the replaced and non-replaced sides (P < 0.05). Differences in patient static indices, foot-axis angle between replacement and non-replacement sides, pelvic rotation, walking speed, and patient joint scores were statistically significant between elevations (P < 0.05). The static standing and dynamic walking indexes were negatively correlated with altitude (P < 0.05), joint scores were positively correlated with altitude (P < 0.05), plantar pressure peaks in T1 and M4 regions and stress time ratios in M5 region were negatively correlated with altitude (r=-0.287, -0.282, -0.252, P < 0.05), and BMI were positively correlated with mid-foot and post-foot pressure peaks (r=0.330, 0.238, 0.226, P < 0.05). Conclusion The change of the peak plantar pressure can be used as an indicator to monitor the occurrence of knee joints in Tibetan people living at different altitudes. Tibetan patients with osteoarthritis of the knee who live at high altitudes have poor balance compared with patients at very high altitudes.
- Tibetan ethnic group /
- Knee osteoarthritis /
- Altitude gradient /
- Plantar pressure /
- Gait analysis

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表 1 不同性别世居藏族KOA患者基本情况比较(x±s)

Table 1. Comparison of basic information of KOA patients from Tibetan ethnic groups of different genders(x±s)

性别	例数	年龄(岁)	身高(cm)	体重(kg)	BMI	鞋码(EU)
男性	37	60.76±8.10	157.09±10.12	67.72±15.21	25.99±4.80	37.88±2.13
女性	57	61.88±7.45	156.07±8.92	68.15±12.70	29.09±4.99	34.59±1.72
t值		0.689	0.516	0.147	3.005	6.380
P值		0.439	0.607	0.883	0.004	＜0.001

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表 2 不同海拔梯度KOA患者基线资料比较

Table 2. Comparison of baseline data of KOA patients with different altitude gradients

海拔梯度(m)	例数	性别(例)		置换侧(例)		年龄(x±s，岁)	BMI (x±s)
海拔梯度(m)	例数	男性	女性	左	右	年龄(x±s，岁)	BMI (x±s)
3 000~3 700	29	11	18	14	15	61.34±8.26	27.36±5.04
3 701~4 500	38	16	22	17	21	62.55±6.27	27.92±5.33
4 501~5 500	27	10	17	10	17	59.96±8.82	28.36±5.05
统计量		0.206^a		0.751^a		0.897^b	0.265^b
P值		0.902		0.687		0.411	0.767
注：^a为χ²值，^b为F值。

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表 3 KOA患者置换侧与未置换侧静态和动态指标分析(x±s)

Table 3. Analysis of static and dynamic indicators on the replacement and non replacement sides of KOA patients(x±s)

测试指标	例数	压力占比(%)	压强峰值(kPa)	平均压强(kPa)	表面积(cm²)	T1区域压强峰值(kPa)	MH区域压强峰值(kPa)	LH区域压强峰值(kPa)
置换侧	94	42.44±14.69	133.66±53.54	42.42±14.92	61.36±19.16	78.02±66.33	163.46±60.34	161.96±58.02
未置换侧	94	57.56±14.69	146.12±36.47	51.55±15.37	68.80±16.22	97.62±88.61	187.41±55.81	187.04±50.39
t值		4.993	2.151	4.811	3.639	2.803	2.151	3.261
P值		＜0.001	0.034	＜0.001	＜0.001	0.005	0.033	0.001

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表 4 不同海拔KOA患者静态指标比较

Table 4. Comparison of static indicators of KOA patients at different altitudes

海拔梯度(m)	例数	前压(x±s，%)	后压(x±s，%)	椭圆面积[M(P₂₅, P₇₅)，mm²]	骨盆旋转度[M(P₂₅, P₇₅)，°]
3 000~3 700	29	49.50±15.05	50.50±15.05	73.55(51.98，147.90)	7.5(2.25, 9.60)
3 701~4 500	38	59.33±17.29	40.67±17.30	113.76(36.48，232.00)	2.5(1.48, 6.35)
4 501~5 500	27	53.83±15.31	46.17±15.31	34.03(22.76，76.81)	2.4(1.10, 5.50)
统计量		3.134^a	3.135^a	16.530^b	6.637^b
P值		0.048	0.048	0.001	0.036
注：^a为F值，^b为H值。

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表 5 不同海拔KOA患者动态指标比较(x±s)

Table 5. Comparison of dynamic indicators of KOA patients at different altitudes(x±s)

海拔梯度(m)	例数	置换侧足轴角(°)	未置换侧足轴角(°)	步行速度(km/h)
3 000~3 700	29	11.23±9.93	10.50±6.61	1.81±0.44
3 701~4 500	38	16.29±9.10	14.44±9.19	1.58±0.52
4 501~5 500	27	11.67±8.36	9.42±9.00	1.32±0.39
F值		3.176	3.252	8.088
P值		0.046	0.043	0.001

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表 6 不同海拔KOA患者关节评分比较(x±s，分)

Table 6. Comparison of joint scores among KOA patients at different altitudes(x±s, points)

海拔梯度(m)	例数	VAS评分	WOMAC总分	疼痛评分	身体功能评分
3 000~3 700	29	6.11±1.82	16.59±10.37	6.28±2.45	9.24±3.88
3 701~4 500	38	7.19±1.58	21.65±12.88	8.32±3.50	12.08±9.39
4 501~5 500	27	6.72±1.71	26.63±17.23	8.78±3.77	16.7±14.05
F值		3.369	3.806	4.752	3.478
P值		0.039	0.026	0.011	0.035

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表 7 不同海拔KOA患者置换侧动态“特征脚步”足底压强峰值比较(kPa)

Table 7. Comparison of dynamic "characteristic footsteps" plantar pressure peaks on the displacement side of KOA patients at different altitudes(kPa)

海拔梯度(m)	例数	T1[M(P₂₅, P₇₅)]	T2~T5[M(P₂₅, P₇₅)]	M1[M(P₂₅, P₇₅)]	M2(x±s)	M3(x±s)
3 000~3 700	29	66.00(20.50, 150.50)^a	55.00(10.00, 110.50)^a	186.00(143.00, 214.50)	210.21±60.18	217.21±54.03
3 701~4 500	38	58.50(0.00, 114.25)	49.50(0.00, 83.25)	175.00(146.00, 210.00)	202.66±73.81	199.95±64.05
4 501~5 500	27	0.00(0.00, 68.00)	25.00(0.00, 74.00)	170.00(115.00, 249.00)	190.15±58.26	193.19±55.75
统计量		7.995^b	2.506^b	0.221^b	0.666^c	1.273^c
P值		0.018	0.286	0.896	0.516	0.285

海拔梯度(m)	例数	M4(x±s)	M5(x±s)	MF[M(P₂₅, P₇₅)]	MH(x±s)	LH(x±s)
3 000~3 700	29	207.24±46.38^a	183.93±59.22	147.00(115.50, 199.50)	158.28±57.62	158.07±54.55
3 701~4 500	38	186.66±62.00	170.21±73.32	128.00(104.00, 168.50)	156.50±65.79	155.66±63.21
4 501~5 500	27	171.44±42.67	153.48±45.92	132.00(86.00, 162.00)	178.81±54.25	175.00±53.83
统计量		3.309^c	1.679^c	3.397^b	1.240^c	0.971^c
P值		0.041	0.192	0.183	0.294	0.383
注：与4 501~5 500 m组比较，^aP＜0.05。^b为H值，^c为F值。

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表 8 不同海拔KOA患者未置换侧动态“特征脚步”足底压强峰值比较(kPa)

Table 8. Comparison of peak plantar pressure of non displaced side dynamic "characteristic footsteps" in KOA patients at different altitudes(kPa)

海拔梯度(m)	例数	T1[M(P₂₅, P₇₅)]	T2~T5[M(P₂₅, P₇₅)]	M1(x±s)	M2[M(P₂₅, P₇₅)]	M3(x±s)
3 000~3 700	29	117.00(38.00, 197.00)^ab	83.00(34.50, 135.50)^ab	195.14±73.31	218.00(166.50, 269.50)	221.79±66.79
3 701~4 500	38	84.50(21.75, 146.50)	61.50(18.25, 90.00)	180.50±53.60	210.50(184.75, 233.25)	213.32±52.63
4 501~5 500	27	49.00(0.00, 131.00)	35.00(0.00, 78.00)	188.33±62.69	225.00(173.00, 253.00)	211.11±67.88
统计量		5.902^c	7.448^c	0.452^d	0.543^c	0.242^d
P值		0.042	0.024	0.638	0.762	0.786

海拔梯度(m)	例数	M4(x±s)	M5[M(P₂₅, P₇₅)]	MF[M(P₂₅, P₇₅)]	MH(x±s)	LH[M(P₂₅, P₇₅)]
3 000~3 700	29	202.41±57.33	185.00(140.50, 214.500)	153.00(121.00, 188.50)	208.28±50.46^a	190.00(165.50, 235.50)^a
3 701~4 500	38	194.18±53.32	149.50(130.00, 201.25)	124.50(98.50, 171.00)	172.11±64.28	186.50(127.25, 215.50)
4 501~5 500	27	200.30±59.57	166.00(122.00, 264.00)	145.00(122.00, 264.00)	186.56±41.14	189.00(160.00, 213.00)
统计量		0.195^d	1.636^c	3.161^c	3.656^d	1.399^c
P值		0.823	0.441	0.206	0.03	0.497
注：与3 701~4 500 m组比较，^aP＜0.05；与4 501~5 500 m组比较，^bP＜0.05。^c为H值，^d为F值。

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表 9 海拔高度与患者静态和动态指标的相关性

Table 9. Correlation between altitude and static and dynamic indicators of patients

指标	r_s	P值
骨盆旋转度	-0.246	0.017
步行速度	-0.382	0.001
椭圆面积	-0.349	0.001

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表 10 海拔高度与KOA患者评分的相关性

Table 10. Correlation between altitude and KOA patient scores

评分项目	r_s	P值
WOMAC评分	0.257	0.013
身体功能评分	0.227	0.028
疼痛评分	0.267	0.009

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表 11 海拔高度与患者置换侧“特征脚步”足底各区域指标的相关性

Table 11. Correlation between altitude and various indicators of the patient' s "characteristic foot" plantar area on the replacement side

指标	r_s	P值
T1压强峰值	-0.287	0.005
M4压强峰值	-0.282	0.006
M5受力时间比	-0.252	0.014
MH受力时间比	0.233	0.024

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表 12 BMI与置换侧足底压强峰值的相关性

Table 12. Correlation between BMI and peak plantar pressure on the replacement side

指标	r_s	P值
MF	0.330	0.001
MH	0.238	0.021
LH	0.226	0.028

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