Exploring the effectiveness of seated knee adjustment method for treating knee osteoarthritis based on anybody simulation technology
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摘要:
目的 探讨坐位调膝法对单侧膝骨性关节炎(KOA)患者下肢关节力和肌肉力的影响，并通过计算机仿真评估其生物力学特性。 方法 选取2023年8月—2024年3月在上海中医药大学附属岳阳中西医结合医院门诊就诊的20例符合单侧膝骨关节炎诊断标准的患者。干预方案为坐位调膝法，每周2次，疗程为5周。通过Vicon Nexus系统采集步态数据，使用AnyBody软件对下肢关节力和肌肉力进行仿真分析。 结果 临床疗效显示干预后总有效20例(100%)。患者干预后VAS疼痛评分[3.00(2.00, 3.00)分]和骨关节炎指数评分[(34.10±14.14)分]均低于干预前[5.00(3.00, 6.25)分、(42.80±17.49)分]，差异均有统计学意义(P < 0.05)。患者干预后相对关节力峰值在患膝垂直轴、额状轴、与健膝垂直轴较干预前差异均有统计学意义(P < 0.05)。患者干预后相对肌肉力峰值在患膝股外侧肌上缘、股直肌、胫前肌、半腱肌、阔筋膜张肌与健膝股外侧肌上缘、股直肌较干预前差异均有统计学意义(P < 0.05)。 结论 坐位调膝法能够减轻KOA患者膝关节疼痛，提高日常活动功能，并有效改善了KOA患者的关节力平衡，协调下肢肌肉发力。 Abstract:Objective To explore the effects of the seated knee adjustment method on lower limb joint forces and muscle forces in patients with unilateral knee osteoarthritis (KOA) and to evaluate its biomechanical characteristics using computer simulation. Methods A total of 20 patients diagnosed with unilateral KOA who visited the outpatient clinic of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, from August 2023 to March 2024, were included. The intervention involved the seated knee adjustment method, administered twice weekly for 5 weeks. Gait data were collected using the Vicon Nexus system, and the AnyBody software was used for biomechanical simulation to analyze lower limb joint forces and muscle forces. Results The clinical outcomes indicated a total efficacy rate of 100% (20/20 cases) after intervention. Post-intervention VAS pain scores [3.00 (2.00, 3.00)] and Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores (34.10±14.14) were significantly lower than pre-intervention VAS scores [5.00 (3.00, 6.25)] and WOMAC scores (42.80±17.49, P < 0.05). Significant differences were observed in the peak relative joint forces on the vertical axis and frontal axis of the affected knee and the vertical axis of the unaffected knee before and after the intervention (P < 0.05). Additionally, the peak relative muscle forces of the vastus lateralis superior, rectus femoris, tibialis anterior, semitendinosus, and tensor fasciae latae of the affected knee, as well as the vastus lateralis superior and rectus femoris of the unaffected knee, showed significant differences before and after the intervention (P < 0.05). Conclusion The seated knee adjustment method effectively alleviates knee pain, improves daily functional activities, and optimizes joint force balance while enhancing muscle coordination in patients with KOA. -
Key words:
- Knee osteoarthritis /
- Biomechanics /
- Computer simulation /
- Seated knee adjustment method
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表 1 早中期单膝KOA患者干预前后VAS及WOMAC评分比较
Table 1. Comparison of VAS and WOMAC scores before and after intervention in patients with early and mid-stage single-knee KOA
时间 VAS评分[M(P25, P75), 分] WOMAC疼痛(x ± s, 分) WOMAC僵硬[M(P25, P75), 分] WOMAC日常活动(x ± s, 分) WOMAC总分(x ± s, 分) 干预前 5.00(3.00, 6.25) 12.84±3.99 5.50(3.00, 9.25) 25.45±12.68 42.80±17.49 干预后 3.00(2.00, 3.00) 8.85±4.18 5.00(3.75, 6.50) 21.10±10.92 34.10±14.14 统计量 150.540a 6.136b 94.500a 5.009b 6.111b P值 < 0.001 < 0.001 0.710 < 0.001 < 0.001 注：a为W值，b为t值。 
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表 2 早中期单膝KOA患者双膝相对关节力干预前后峰值比较(x ± s，N/kg)
Table 2. Comparison of the peak values of relative joint force of both knees before and after intervention in patients with early and mid-stage single-knee KOA(x ± s, N/kg)
时间 侧别 例数 额状轴 垂直轴 矢状轴 干预前 患膝 20 5.08±1.22 41.79±7.24 9.91±4.05 健膝 20 3.81±0.73 44.78±6.29 11.05±3.41 干预后 患膝 20 4.18±0.83 45.41±7.22 10.66±4.75 健膝 20 4.04±0.64 52.16±9.72 11.24±3.74 t值 患膝 4.277 3.598 0.873 健膝 1.477 4.765 0.233 P值 患膝 < 0.001 < 0.001 0.393 健膝 0.156 < 0.001 0.818 注：定义关节力额状轴上左膝左侧为-，右侧为+；右膝右侧为-，左侧为+；垂直轴上向上为+，向下为－；矢状轴上向前为+，向后为-。均为同侧干预前后比较。
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表 3 早中期单膝KOA患者双膝前侧肌群相对肌肉力干预前后峰值比较(x ± s，N/kg)
Table 3. Comparison of the peak relative muscle strength of the anterior muscle groups of both knees before and after intervention in patients with early and mid-stage single-knee KOA(x ± s, N/kg)
时间 侧别 例数 股外侧肌上缘 股内侧肌中部 股内侧肌上缘 股中间肌 股直肌 胫前肌 干预前 患膝 20 4.87±1.94 1.15±0.29 1.21±0.45 1.63±0.59 2.52±1.27 4.57±2.03 健膝 20 5.36±1.52 1.22±0.43 1.12±0.42 1.50±0.55 3.14±1.43 5.01±1.90 干预后 患膝 20 6.01±1.72 1.54±0.53 1.34±0.50 1.80±0.67 3.63±1.28 5.83±1.62 健膝 20 7.31±2.16 1.56±0.49 1.45±0.48 1.94±0.64 3.92±1.67 5.83±2.27 t值 患膝 3.309 3.234 0.978 0.978 5.340 5.380 健膝 5.949 2.872 2.782 2.795 3.108 1.641 P值 患膝 0.004 0.004 0.340 0.341 < 0.001 < 0.001 健膝 < 0.001 0.010 0.012 0.012 0.006 0.117 注：均为同侧干预前后比较。
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表 4 早中期单膝KOA患者双膝后侧肌群相对肌肉力干预前后峰值比较(x ± s，N/kg)
Table 4. Comparison of the peak relative muscle strength of the posterior muscle groups of both knees before and after intervention in patients with early and mid-stage single-knee KOA (x ± s, N/kg)
时间 侧别 例数 股二头长肌 股二头短肌 比目鱼肌内侧 比目鱼肌外侧 腓肠肌内侧 腓肠肌外侧 干预前 患膝 20 9.67±2.42 2.70±0.92 3.33±2.71 11.87±4.10 9.48±2.26 14.52±4.65 健膝 20 10.17±2.67 2.94±1.69 4.37±2.76 12.38±3.60 10.91±4.38 17.49±4.26 干预后 患膝 20 9.66±2.92 2.87±1.79 3.85±3.16 12.99±4.94 9.29±2.57 16.07±4.75 健膝 20 10.31±2.23 3.78±2.85 4.27±3.02 12.74±3.33 12.04±5.48 17.97±5.74 t值 患膝 0.043 0.469 0.444 1.252 0.354 1.292 健膝 0.309 2.401 0.181 0.399 1.775 0.469 P值 患膝 0.966 0.645 0.551 0.226 0.727 0.212 健膝 0.763 0.027 0.859 0.695 0.092 0.644 注：均为同侧干预前后比较。
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表 5 早中期单膝KOA患者双膝内侧肌群相对肌肉力干预前后峰值比较(x ± s，N/kg)
Table 5. Comparison of the peak relative muscle strength of the medial muscle groups of both knees before and after intervention in patients with early and mid-stage single-knee KOA (x ± s, N/kg)
时间 侧别 例数 大收肌远端 缝匠肌 半腱肌 干预前 患膝 20 3.33±1.05 1.83±1.07 6.26±1.91 健膝 20 3.04±1.13 1.56±0.94 5.58±1.73 干预后 患膝 20 3.05±0.95 1.52±0.82 5.24±1.66 健膝 20 3.45±0.91 1.40±0.72 5.87±1.69 t值 患膝 1.002 1.260 1.963 健膝 1.574 0.910 1.105 P值 患膝 0.329 0.226 0.006 健膝 0.132 0.374 0.394 注：均为同侧干预前后比较。
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表 6 早中期单膝KOA患者双膝外侧肌群相对肌肉力干预前后峰值比较(x ± s，N/kg)
Table 6. Comparison of the peak relative muscle strength of the lateral muscle groups of both knees before and after intervention in patients with early and mid-stage single-knee KOA (x ± s, N/kg)
时间 侧别 例数 阔筋膜张肌 腓骨长肌 腓骨短肌 干预前 患膝 20 1.67±0.60 8.97±4.78 5.84±2.29 健膝 20 2.33±0.79 8.12±4.26 6.16±3.29 干预后 患膝 20 2.23±0.15 9.50±5.86 6.63±4.62 健膝 20 2.93±1.12 8.61±4.19 5.74±2.95 t值 患膝 4.445 0.437 0.872 健膝 3.463 0.631 0.886 P值 患膝 < 0.001 0.667 0.394 健膝 0.003 0.535 0.387 注：均为同侧干预前后比较。
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