CAJ | 학술논문

目的：通过比较早期内侧间室膝骨性关节炎患者在佩戴传统与新型外侧楔形角矫形鞋垫（L W ）后步行过程中所产生的下肢生物力学变化及差异，探讨新型设计的LW在早期内侧间室骨关节炎康复治疗中的应用价值。方法：采用英国Vicon三维步态分析系统配合Kislter测力台分别测评30例早期内侧间室型膝骨性关节炎患者在佩戴传统LW （楔形角5°）、新型带足弓支撑的LW （楔形角5°）及无佩戴任何矫形器（测试过程中均穿标准鞋）3种不同条件下的下肢关节运动学、动力学及时间空间参数变化。结果：相较于未佩戴任何矫形鞋垫情况，佩戴2种LW后膝关节载荷（膝关节内翻力矩，膝关节内翻角冲量）均显著降低（P＜0．05）。此外，佩戴传统的LW后患者步行过程中踝关节外翻角度、外翻力矩及地面反作用力内侧方向较其他2种方式明显增加（P＜0．05），而佩戴新型LW后下肢前进角度较其他2种方式显著增加（P＜0．05）。结论：两种不同设计的LW均有助于缓解早期内侧间室型膝骨性关节炎患者运动过程中的膝关节载荷，且未见明显差异。但相较于传统外侧楔形矫形鞋垫，带有足弓支撑设计的矫形鞋垫佩戴后更为舒适，且不会引起踝关节内侧应力的增加。
목적：통과비교조기내측간실슬골성관절염환자재패대전통여신형외측설형각교형혜점（L W ）후보행과정중소산생적하지생물역학변화급차이，탐토신형설계적LW재조기내측간실골관절염강복치료중적응용개치。방법：채용영국Vicon삼유보태분석계통배합Kislter측력태분별측평30례조기내측간실형슬골성관절염환자재패대전통LW （설형각5°）、신형대족궁지탱적LW （설형각5°）급무패대임하교형기（측시과정중균천표준혜）3충불동조건하적하지관절운동학、동역학급시간공간삼수변화。결과：상교우미패대임하교형혜점정황，패대2충LW후슬관절재하（슬관절내번력구，슬관절내번각충량）균현저강저（P＜0．05）。차외，패대전통적LW후환자보행과정중과관절외번각도、외번력구급지면반작용력내측방향교기타2충방식명현증가（P＜0．05），이패대신형LW후하지전진각도교기타2충방식현저증가（P＜0．05）。결론：량충불동설계적LW균유조우완해조기내측간실형슬골성관절염환자운동과정중적슬관절재하，차미견명현차이。단상교우전통외측설형교형혜점，대유족궁지탱설계적교형혜점패대후경위서괄，차불회인기과관절내측응력적증가。
Objective:To investigate the biomechanics changes at lower limb joints of patients with early stage me‐dial compartment knee osteoarthritis (OA) wearing different types of lateral wedges during walking ,and to define which type of lateral wedge is potentially more suitable in the treatment of the medial compartment knee OA .Meth‐od:Thirty patients with early stage medial compartment knee OA were enrolled .Both kinematics and temporal pa‐rameters were examined by Vicon 612 3‐Dimensional gait analysis system and the kinetics changes were tested by two Kislter force platforms at the same time under three conditions :a custom‐made traditional lateral wedge of 5° (with standard shoes) ,a custom‐made arch supported lateral wedges of 5° (with standard shoes) ,control condition (standard shoes only ) .Results:Both two types of lateral wedges showed significantly decreased knee joints loading (knee adduction moment and knee adduction angular impulse) (P<0 .05) .The decreased loading on OA knees in traditional wedges condition was associated with an increased ankle valgus degrees ,moment and medial group reac‐tion force when compared to the control and arch supported conditions (P<0 .05) ,and the arch supported lateral wedges showed an increased foot progression angles (P<0 .05) .Conclusion:The results showed that under dynam‐ic condition ,both two wedges showed decreased loading in the medial compartment at knees ,and the arch supported wedges were found to be more comfortable and did not cause high loading in the ankle .