Study on plantar pressure characteristics of Tibetan knee osteoarthritis patients living at different altitudes
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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。 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. -
Key words:
- 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 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) 男性 女性 左 右 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 0.206a 0.751a 0.897b 0.265b P值 0.902 0.687 0.411 0.767 注:a为χ2值,b为F值。 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 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 3.134a 3.135a 16.530b 6.637b P值 0.048 0.048 0.001 0.036 注:a为F值,b为H值。 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 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 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 7.995b 2.506b 0.221b 0.666c 1.273c 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±46.38a 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 3.309c 1.679c 3.397b 1.240c 0.971c 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。 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 5.902c 7.448c 0.452d 0.543c 0.242d 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±50.46a 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 0.195d 1.636c 3.161c 3.656d 1.399c 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。 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 rs 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 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 rs 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 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 rs 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 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 rs P值 MF 0.330 0.001 MH 0.238 0.021 LH 0.226 0.028 -
[1] GIORGINO R, ALBANO D, FUSCO S, et al. Knee osteoarthritis: epidemiology, pathogenesis, and mesenchymal stem cells: what else is new? An update[J]. Int J Mol Sci, 2023, 24(7): 6405. DOI: 10.3390/ijms24076405. [2] 苏鸿年, 司马靓杰, 杨木强, 等. 富血小板血浆联合透明质酸钠治疗膝骨关节炎的效果观察[J]. 中华全科医学, 2022, 20(9): 1509-1512. 10.16766/j.cnki.issn.1674-4152.002636SU H N, SIMA L J, YANG M Q, et al. Effect of platelet-rich plasma combined with sodium hyaluronate in the treatment of knee osteoarthritis[J]. Chinese Journal of General Practice, 2022, 20(9): 1509-1512. 10.16766/j.cnki.issn.1674-4152.002636 [3] LI D, LI S, CHEN Q, et al. The prevalence of symptomatic knee osteoarthritis in relation to age, sex, area, region, and body mass index in China: a systematic review and meta-analysis[J]. Front Med (Lausanne), 2020, 7: 304. DOI: 10.3389/fmed.2020.00304. [4] 周伟, 向阳, 丁增尼玛, 等. 416例藏族人群慢性膝关节疾病的发病特点[J]. 西藏医药, 2021, 42(3): 41-42. https://www.cnki.com.cn/Article/CJFDTOTAL-XZYY202103017.htmZHOU W, XIANG Y, DING Z N M, et al. Incidence characteristics of chronic knee joint disease in 416 Tibetan people[J]. Tibetan Medicine, 2021, 42(3): 41-42. https://www.cnki.com.cn/Article/CJFDTOTAL-XZYY202103017.htm [5] 廖秋菊, 温卫友, 李瑞, 等. 陇上高原地区膝骨性关节炎《国际功能、残疾和健康分类康复组合》应用的初步研究[J]. 中国康复医学杂志, 2021, 36(3): 337-340. doi: 10.3969/j.issn.1001-1242.2021.03.016LIAO Q J, WEN W Y, LI R, et al. Preliminary study on the application of the International Classification of Functioning, Disability, and Health Rehabilitation Combination for knee osteoarthritis in high-altitude areas of Gansu Province[J]. Chinese Journal of Rehabilitation Medicine, 2021, 36(3): 337-340. doi: 10.3969/j.issn.1001-1242.2021.03.016 [6] HE Y J, ZHENG X L, WANG D F, et al. Static and dynamic plantar pressure distribution in 94 patients with different stages of unilateral knee osteoarthritis using the Footscan® Platform System: an observational study[J]. Med Sci Monit, 2023, 29: e938485. DOI: 10.12659/MSM.938485. [7] 王欣, 罗文, 黄文泽, 等. 单侧膝骨关节炎临床分期与双足足底压力的相关性[J]. 中国组织工程研究, 2021, 25(27): 4312-4317. doi: 10.12307/2021.188WANG X, LUO W, HUANG W Z, et al. Correlation between clinical stage of unilateral knee osteoarthritis and double plantar pressure[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(27): 4312-4317. doi: 10.12307/2021.188 [8] PANYARACHUN P, ANGTHONG C, JINDASAKCHAI P, et al. Abnormal foot pressure in older adults with knee osteoarthritis: a systematic review[J]. Eur Rev Med Pharmacol Sci, 2022, 26(17): 6236-6241. [9] 中华医学会骨科学分会关节外科学组. 骨关节炎诊治指南(2018版)[J]. 中华骨科杂志, 2018, 38(12): 705-715.Joint Surgery Group, Branch of Orthopedics, Chinese Medical Association. Guidelines for the Diagnosis and Treatment of Osteoarthritis (2018 Edition)[J]. Chinese Journal of Orthopedics, 2018, 38(12): 705-715. [10] ALMEHEYAWI R N, BRICCA A, RISKOWSKI J L, et al. Foot characteristics and mechanics in individuals with knee osteoarthritis: systematic review and meta-analysis[J]. J Foot Ankle Res, 2021, 14(1): 24. DOI: 10.1186/s13047-021-00462-y. [11] 黄萍, 钱念东, 齐进, 等. 膝骨关节炎患者膝关节置换术后足底压力研究[J]. 中国运动医学杂志, 2018, 37(3): 197-201. https://www.cnki.com.cn/Article/CJFDTOTAL-YDYX201803003.htmHUANG P, QIAN N D, QI J, et al. Plantar Pressure in Patients with Knee Osteoarthritis after Knee Joint Replacement Surgery[J]. Chinese Journal of Sports Medicine, 2018, 37(3): 197-201. https://www.cnki.com.cn/Article/CJFDTOTAL-YDYX201803003.htm [12] ZHANG Z, WANG L, HU K, et al. Characteristics of plantar loads during walking in patients with knee osteoarthritis[J]. Med Sci Monit, 2017, 23: 5714-5719. doi: 10.12659/MSM.905136 [13] 王欣. "足膝同治"法治疗单侧早中期KOA的临床疗效观察[D]. 昆明: 云南中医药大学, 2021.WANG X. Clinical efficacy observation of the "foot knee joint treatment" method in the treatment of unilateral early to mid stage KOA[D]. Kunming: Yunnan University of Traditional Chinese Medicine, 2021. [14] 于经伦, 闫红光. 足底压力分析在运动生物力学研究中的应用与进展[C]//第二十届全国运动生物力学学术交流大会论文摘要汇编. 兰州, 2018: 353-355.YU J L, YAN H G. Application and Progress of Foot Pressure Analysis in Sports Biomechanics Research[C]//Compilation of Abstracts from the 20th National Sports Biomechanics Academic Exchange Conference. Lanzhou, 2018: 353-355. [15] ZHANG Z, DAI Y, XU Z, et al. Insole systems for disease diagnosis and rehabilitation: a review[J]. Biosensors (Basel), 2023, 13(8): 833. DOI: 10.3390/bios13080833. [16] CHAHARMAHALI L, GANDOMI F, YALFANI A, et al. The effect of self-reported knee instability on plantar pressure and postural sways in women with knee osteoarthritis[J]. J Orthop Surg Res, 2021, 16(1): 677. DOI: 10.1186/s13018-021-02823-6. [17] YAN Y, OU J, SHI H, et al. Plantar pressure and falling risk in older individuals: a cross-sectional study[J]. J Foot Ankle Res, 2023, 16(1): 14. DOI: 10.1186/s13047-023-00612-4. [18] 颜雯婷, 杨倩倩, 任凤, 等. 双侧膝骨关节炎患者足底压力分布及平衡特征研究[J]. 中国康复医学杂志, 2023, 38(5): 696-699. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGKF202305008.htmYAN W T, YANG Q Q, REN F, et al. Study on plantar pressure distribution and balance characteristics in patients with bilateral knee osteoarthritis[J]. Chinese Journal of Rehabilitation Medicine, 2023, 38(5): 696-699. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGKF202305008.htm [19] 孙鑫, 娄本敬, 谢露, 等. 高海拔地区人群膝关节骨关节炎危险因素的研究进展[J]. 中国骨与关节杂志, 2023, 12(2): 156-160. https://www.cnki.com.cn/Article/CJFDTOTAL-GZGL202302013.htmSUN X, LOU B J, XIE L, et al. Research progress on risk factors of knee osteoarthritis in people at high altitude[J]. Chinese Journal of Bone and Joint, 2023, 12(2): 156-160. https://www.cnki.com.cn/Article/CJFDTOTAL-GZGL202302013.htm [20] 都晨雅, 赵晓光. 体重增加对足底压力分布的量效反应研究[C]//中国体育科学学会运动生物力学分会. 第二十一届全国运动生物力学学术交流大会论文摘要汇编. 宁波: 宁波大学体育学院, 2021: 2.DU C Y, ZHAO X G. Dose response study of weight gain on plantar pressure distribution[C]//Sports Biomechanics Branch of the Chinese Society of Sports Sciences. Compilation of abstracts from the 21st National Sports Biomechanics Academic Exchange Conference. School of Physical Education, Ningbo University; Ningbo University Institute of Health, 2021: 2. [21] 格日力. 高原医学[M]. 2版. 北京: 北京大学医学出版社, 2020: 1-2.GE R L, Editor in Chief. High Altitude Medicine[M]. 2nd Edition. Beijing: Peking University Medical Press, 2020: 1-2. [22] 王子坚, 闫松华, 李伟, 等. 单侧膝内翻型膝骨关节炎患者足底压力分布特征研究[J]. 北京生物医学工程, 2019, 38(2): 151-158. https://www.cnki.com.cn/Article/CJFDTOTAL-BJSC201902006.htmWANG Z J, YAN S H, LI W, et al. Plantar pressure distribution in patients with unilateral varus knee osteoarthritis[J]. Beijing Biomedical Engineering, 2019, 38(2): 151-158. https://www.cnki.com.cn/Article/CJFDTOTAL-BJSC201902006.htm -
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