中老年女性早期膝骨关节炎的肌肉结构参数特征分析

doi:10.3969/j.issn.1006-9771.2023.03.016

摘要/Abstract

摘要：

目的通过肌骨超声评估中老年女性早期膝骨关节炎(KOA)膝周肌肉的结构参数变化，明确影响早期KOA的肌肉指标。

方法 2022年1月至8月，于北京博爱医院分别招募20例健康中老年女性(对照组)和20例单侧早期KOA中老年女性(KOA组)，采用肌骨超声测量腘肌厚度、股四头肌厚度和羽状角；其中，股四头肌分别测量股直肌、股中间肌、股外侧肌、股内长肌和股内斜肌。

结果与KOA组健侧及对照组优势侧相比，KOA组患侧股内长肌、股内斜肌和腘肌厚度变薄(t > 2.133, P < 0.05)，股内斜肌与股外侧肌比值变小(t > 3.660, P < 0.01)。与对照组匹配优势侧相比，KOA组患侧股内长肌羽状角变小(t = 3.101, P < 0.05)。Logistic回归分析表明，股内斜肌厚度(OR = 0.235, 95% CI 0.068~0.805, P = 0.021)和腘肌厚度(OR = 0.387, 95% CI 0.152~0.980, P = 0.045)与早期KOA发病有关。

结论中老年女性早期KOA患侧表现出股内长肌、股内斜肌、腘肌厚度变薄，股内斜肌和股外侧肌力量失衡。股内斜肌和腘肌厚度是KOA发病的保护因素。

关键词: 早期膝骨关节炎, 股内斜肌, 腘肌, 肌骨超声, 肌肉结构参数

Abstract:

Objective To observe the architectural parameter changes of the muscles around the knee in middle-aged and elderly women with early knee osteoarthritis (KOA) by musculoskeletal ultrasound, and to clarify the indicators of muscles that affect early KOA.

Methods From January to August, 2022, 20 healthy middle-aged and elderly healthy women (controls) and 20 middle-aged and elderly women with unilateral early KOA (KOA group) were recruited through Beijing Bo'ai Hospital, to measure muscle thickness of the popliteus muscle, the muscle thickness and the pennation angle of the quadriceps, as rectus femoris, vastus intermedius, vastus lateralis, vastus medialis longus and vastus medialis oblique.

Results Compared with the healthy limb of KOA group, and the controls, the muscle thickness of vastus medialis longus, vastus medialis oblique and popliteus muscle of the affected limb of KOA group became thinner (t > 2.133, P< 0.05); the proportion of thickness of vastus medialis oblique to thickness of vastus lateralis became smaller (t > 3.660, P< 0.05). The pennation angle was smaller in the affected limb of KOA group than in the matched dominant side of the controls (t= 3.101, P < 0.05). Logistic regression analysis showed that the muscle thickness of vastus medialis oblique (OR = 0.235, 95%CI 0.068 to 0.805, P = 0.021) and popliteus muscle (OR = 0.387, 95%CI 0.152 to 0.980, P = 0.045) were related to the onset of early KOA.

Conclusion The thickness of vastus medialis longus, vastus medialis oblique and popliteus muscle decrease, and the balance of the strength of vastus medialis oblique and vastus lateralis weakens in the affected limbs of the middle-aged and elderly women with early KOA. The thickness of vastus medialis oblique and popliteus muscle are protective factors for onset of KOA.

Key words: early knee osteoarthritis, vastus medialis oblique, popliteus muscle, musculoskeletal ultrasound, muscle architectural parameter

中图分类号:

R684.3

于丽丽, 黄秋晨, 崔志刚, 李德盛, 胡春英, 叶淼, 刘克敏. 中老年女性早期膝骨关节炎的肌肉结构参数特征分析[J]. 《中国康复理论与实践》, 2023, 29(3): 356-363.

YU Lili, HUANG Qiuchen, CUI Zhigang, LI Desheng, HU Chunying, YE Miao, LIU Kemin. Characterastics of muscle architectural parameters for early knee osteoarthritis in middle-aged and elderly women[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(3): 356-363.

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参考文献 44

[1]	DASTE C, KIRREN Q, AKOUM J, et al. Physical activity for osteoarthritis: efficiency and review of recommandations[J]. Joint Bone Spine, 2021, 88(6): 105207. doi: 10.1016/j.jbspin.2021.105207
[2]	CHOPP-HURLEY J N, WIEBENGA E G, BULBROOK B D, et al. Evaluating the relationship between quadriceps muscle quality captured using ultrasound with clinical severity in women with knee osteoarthritis[J]. Clin Biomech, 2020, 80: 105165. doi: 10.1016/j.clinbiomech.2020.105165
[3]	DE BRITO FONTANA H, HERZOG W. The role of muscles in knee joint osteoarthritis[J]. Sports Orthop Traumatol, 2021, 37: 85-100. doi: 10.1016/j.orthtr.2021.02.005
[4]	HUNTER D J, BIERMA-ZEINSTRA S. Osteoarthritis[J]. Lancet, 2019, 393(10182): 1745-1759. doi: S0140-6736(19)30417-9 pmid: 31034380
[5]	中华医学会骨科学分会关节外科学组, 中国医师协会骨科医师分会骨关节炎学组, 国家老年疾病临床医学研究中心湘雅医院, 等. 中国骨关节炎诊疗指南(2021年版)[J]. 中华骨科杂志, 2021, 41(18): 1291-1314.
	The Joint Surgery Branch of the Chinese Orthopaedic Association, The Subspecialty Group of Osteoarthritis-Chinese Association of Orthopaedic Surgeons, The National Clinical Research Center for Geriatric Disorders Xiangya Hospital, et al. Chinese Guideline for Diagnosis and Treatment of Osteoarthritis (2021 edition)[J]. Chin J Orthop, 2021, 41(18): 1291-1314.
[6]	王波, 余楠生. 膝骨关节炎阶梯治疗专家共识(2018年版)[J]. 中华关节外科杂志(电子版), 2019, 13(1): 124-130.
	WANG B, YU N S. Expert Consensus on Stepped-care of Knee Osteoarthritis (2018 edition)[J]. Chin J Joint Surg (Electr Ed), 2019, 13(1): 124-130.
[7]	BANNURU R R, OSANI M C, VAYSBROT E E, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis[J]. Osteoarthritis Cartilage, 2019, 27(11): 1578-1589. doi: 10.1016/j.joca.2019.06.011
[8]	HUNTER D J, SCHOFIELD D, CALLANDER E. The individual and socioeconomic impact of osteoarthritis[J]. Nat Rev Rheumatol, 2014, 10: 437-441. doi: 10.1038/nrrheum.2014.44 pmid: 24662640
[9]	PRIMORAC D, MOLNAR V, ROD E, et al. Knee osteoarthritis: a review of pathogenesis and state-of-the-art non-operative therapeutic considerations[J]. Genes (Basel), 2020, 11(8): 854. doi: 10.3390/genes11080854
[10]	SUZUKI Y, IIJIMA H, NAKAMURA M, et al. Rate of force development in the quadriceps of individuals with severe knee osteoarthritis: a preliminary cross-sectional study[J]. PLoS One, 2022, 17(1): e0262508. doi: 10.1371/journal.pone.0262508
[11]	TAYFUR B, CHARUPHONGSA C, MORRISSEY D, et al. Neuromuscular joint function in knee osteoarthritis: a systematic review and meta-analysis[J]. Ann Phys Rehabil Med. 2022, 66(2): 101662. doi: 10.1016/j.rehab.2022.101662
[12]	陈国茜, 陈泽华, 叶翔凌, 等. 基于肌肉功能和质量探讨肌肉与膝骨关节炎关系的研究进展[J]. 中华物理医学与康复杂志, 2022, 44(5): 471-475.
	CHEN G Q, CHEN Z H, YE X L, et al. Research progress in exploring the relationship between muscle and knee osteoarthritis based on muscle function and quality[J]. Chin J Phys Med Rehabil, 2022, 44(5): 471-475.
[13]	HATFIELD G L, COSTELLO K E, ASTEPHEN WILSON J L, et al. Association between knee joint muscle activation and knee joint moment patterns during walking in moderate medial compartment knee osteoarthritis: implications for secondary prevention[J]. Arch Phys Med Rehabil, 2021, 102(10): 1910-1917. doi: 10.1016/j.apmr.2021.03.038
[14]	朱映红, 曹晓清, 蒋双兰, 等. 超声检查在早期膝骨性关节炎的诊断价值探讨[J]. 实用医院临床杂志, 2019, 16(6): 99-101.
	ZHU Y H, CAO X Q, JIANG S L, et al. The diagnostic value of ultrasound in patients with knee osteoarthritis[J]. Pract J Clin Med, 2019, 16(6): 99-101.
[15]	BENSALMA F, HAGEMEISTER N, CAGNIN A, et al. Musculoskeletal and biomechanical characteristics are better associated with knee clinical than radiographic severity in osteoarthritis patients[J]. Osteoarthritis Cartilage, 2021, 29: S265-S267. doi: 10.1016/j.joca.2021.02.349
[16]	HANSELL L, NTOUMENOPOULOS G. Clinimetrics: quadriceps muscle ultrasound[J]. J Physiother, 2021, 67(4): 313. doi: 10.1016/j.jphys.2021.05.001
[17]	CASTANOV V, HASSAN S A, SHAKERI S, et al. Muscle architecture of vastus medialis obliquus and longus and its functional implications: a three-dimensional investigation[J]. Clin Anat, 2019, 32(4): 515-523. doi: 10.1002/ca.23344 pmid: 30701597
[18]	ALONSO-FERNANDEZ D, FERNANDEZ-RODRIGUEZ R, ABALO-NÚÑEZ R. Changes in rectus femoris architecture induced by the reverse nordic hamstring exercises[J]. Sports Med Phys Fitness, 2019, 59(4): 640-647.
[19]	CORATELLA G, LONGO S, BORRELLI M, et al. Vastus intermedius muscle architecture predicts the late phase of the knee extension rate of force development in recreationally resistance-trained men[J]. J Sci Med Sport, 2020, 23(11): 1100-1104. doi: 10.1016/j.jsams.2020.04.006 pmid: 32416973
[20]	中华医学会骨科学分会关节外科学组. 骨关节炎诊疗指南(2018年版)[J]. 中华骨科杂志, 2018, 38(12): 705-715.
	The Joint Surgery Branch of the Chinese Orthopaedic Association. Guideline for Diagnosis and Treatment of Osteoarthritis (2018 edition)[J]. Chin J Orthop, 2018, 38(12): 705-715.
[21]	GILES L S, WEBSTER K E, MCCLELLAND J A, et al. Atrophy of the quadriceps is not isolated to the vastus medialis oblique in individuals with patellofemoral pain[J]. J Orthop Sports Phys Ther, 2015, 45(8): 613-619. doi: 10.2519/jospt.2015.5852 pmid: 26110547
[22]	GILES L S, WEBSTER K E, MCCLELLAND J A, et al. Can ultrasound measurements of muscle thickness be used to measure the size of individual quadriceps muscles in people with patellofemoral pain?[J]. Phys Ther Sport, 2015, 16(1): 45-52. doi: 10.1016/j.ptsp.2014.04.002 pmid: 24894764
[23]	SODA N, FUJIHASHI Y, AOKI T. In vivo ultrasound imaging of the popliteus muscle: investigation of functional characteristics[J]. J Phys Ther Sci, 2016, 28(3): 979-982. doi: 10.1589/jpts.28.979 pmid: 27134397
[24]	YAGI M, TATEUCHI H, KURIU M, et al. The function of the popliteus muscle: an in vivo ultrasound shear wave elastography study[J]. Hum Mov Sci, 2021, 76: 102751. doi: 10.1016/j.humov.2020.102751
[25]	CHEON S, LEE J H, JUN H P, et al. Acute effects of open kinetic chain exercise versus those of closed kinetic chain exercise on quadriceps muscle thickness in healthy adults[J]. Int J Environ Res Public Health, 2020, 17(13): 4669. doi: 10.3390/ijerph17134669
[26]	ORANCHUK D J, HOPKINS W G, NELSON A R, et al. The effect of regional quadriceps anatomical parameters on angle-specific isometric torque expression[J]. Appl Physiol Nutr Metab, 2021, 46(4): 368-378. doi: 10.1139/apnm-2020-0565
[27]	CULVENOR A G, RUHDORFER A, JUHL C, et al. Knee extensor strength and risk of structural, symptomatic, and functional decline in knee osteoarthritis: a systematic review and meta-analysis[J]. Arthritis Care Res, 2017, 69: 649-658. doi: 10.1002/acr.23005
[28]	冯慧, 潘化平. 膝骨关节炎的运动治疗现状与进展[J]. 中华物理医学与康复杂志, 2016, 38(4): 313-316.
	FENG H, PAN H P. Current status and progress of exercise therapy for knee osteoarthritis[J]. Chin J Phys Med Rehabil, 2016, 38(4): 313-316.
[29]	CHANG T T, ZHU Y C, LI Z, et al. Modulation in the stiffness of specific muscles of the quadriceps in patients with knee osteoarthritis and their relationship with functional ability[J]. Front Bioeng Biotechnol, 2022, 9: 781672. doi: 10.3389/fbioe.2021.781672
[30]	ØIESTAD B E, JUHL C B, CULVENOR A G, et al. Knee extensor muscle weakness is a risk factor for the development of knee osteoarthritis: an updated systematic review and meta-analysis including 46819 men and women[J]. Br J Sports Med, 2022, 56(6): 349-355. doi: 10.1136/bjsports-2021-104861
[31]	RAJPUT H B, RAJANI S J, VANIYA V H. Variation in morphometry of vastus medialis muscle[J]. J Clin Diagn Res, 2017, 11(9): AC01-AC04.
[32]	CHIU L Z F, DAEHLIN T E. Three-dimensional modelling of human quadriceps femoris forces[J]. J Biomech, 2021, 120: 110347. doi: 10.1016/j.jbiomech.2021.110347
[33]	ABDELRAOUF O R, ABDEL-AZIEM A A, AHMED A A, et al. Backward walking alters vastus medialis oblique/vastus lateralis muscle activity ratio in females with patellofemoral pain syndrome[J]. Turk J Phys Med Rehabil, 2019, 65(2): 169-176.
[34]	PAN J, STEHLING C, MULLER-HOCKER C, et al. Vastus lateralis/vastus medialis cross-sectional area ratio impacts presence and degree of knee joint abnormalities and cartilage T2 determined with 3T MRI: an analysis from the incidence cohort of the osteoarthritis initiative[J]. Osteoarthritis Cartilage, 2011, 19(1): 65-73. doi: 10.1016/j.joca.2010.10.023
[35]	乐意, 金荣疆, 阳杨, 等. 从下肢生物力学来解析膝骨关节炎[J]. 中国康复理论与实践, 2013, 19(6): 505-509.
	LE Y, JIN R J, YANG Y, et al. Relationship between knee osteoarthritis and lower limb biomechanics (review)[J]. Chin J Rehabil Theory Pract, 2013, 19(6): 505-509.
[36]	JADHAV S P, MORE S R, RIASCOS R F, et al. Comprehensive review of the anatomy, function, and imaging of the popliteus and associated pathologic conditions[J]. Radiographics, 2014, 34(2): 496-513. doi: 10.1148/rg.342125082 pmid: 24617694
[37]	HYLAND S, VARACALLO M. Anatomy, bony pelvis and lower limb, popliteus muscle[EB/OL]. (2022-06-06) [2023-01-13]. http://www.ncbi.nlm.nih.bbb.hknsspj.cn/books/NBK526084/.
[38]	HWANG K, LEE K M, HAN S H, et al. Shape and innervation of popliteus muscle[J]. Anat Cell Biol, 2010, 43(2): 165-168. doi: 10.5115/acb.2010.43.2.165 pmid: 21189998
[39]	WOOD A, BOREN M, DODGEN T, et al. Muscular architecture of the popliteus muscle and the basic science implications[J]. Knee, 2020, 27(2): 308-314. doi: S0968-0160(19)30311-4 pmid: 31954610
[40]	OLEWNIK Ł, LAPRADE R F, PAULSEN F, et al. A proposal for a new morphological classification of the popliteus muscle tendon with potential clinical and biomechanical significance[J]. Sci Rep, 2021, 11(1): 14434. doi: 10.1038/s41598-021-93778-5 pmid: 34262097
[41]	PETRELLA M, SELISTRE L F A, SERRÃO P R M S, et al. Kinetics, kinematics, and knee muscle activation during sit to stand transition in unilateral and bilateral knee osteoarthritis[J]. Gait Posture, 2021, 86: 38-44. doi: 10.1016/j.gaitpost.2021.02.023 pmid: 33677177
[42]	SCHRIJVERS J C, RUTHERFORD D, RICHARDS R, et al. Inter-laboratory comparison of knee biomechanics and muscle activation patterns during gait in patients with knee osteoarthritis[J]. Knee, 2021, 29: 500-509. doi: 10.1016/j.knee.2021.03.001 pmid: 33756260
[43]	NÚÑEZ M, NUÑEZ E, MORENO J M, et al. Quadriceps muscle characteristics and subcutaneous fat assessed by ultrasound and relationship with function in patients with knee osteoarthritis awaiting knee arthroplasty[J]. J Clin Orthop Trauma, 2019, 10(1): 102-106. doi: 10.1016/j.jcot.2017.11.014
[44]	DANTAS G, SACCO I C N, DOS SANTOS A F, et al. Effects of a foot-ankle strengthening programme on clinical aspects and gait biomechanics in people with knee osteoarthritis: protocol for a randomised controlled trial[J]. BMJ Open, 2020, 10(9): e039279. doi: 10.1136/bmjopen-2020-039279

项目	对照组 (n = 20)	KOA组(n = 20)	t值	P值
年龄/岁	52.70±5.67	54.10±6.16	-0.748	0.459
身高/m	1.58±0.04	1.59±0.05	-1.021	0.314
体质量/kg	57.95±6.73	61.45±6.73	-1.644	0.108
体质量指数/(kg·m^-2)	23.18±1.87	24.16±2.21	-1.516	0.138

项目	对照组优势侧 (n = 20)	KOA组(n = 20)		t值^a	P值^a	t值^b	P值^b
项目	对照组优势侧 (n = 20)	健侧	患侧	t值^a	P值^a	t值^b	P值^b
股直肌厚度/mm	13.41±2.70	13.94±2.10	13.35±2.58	2.018	0.060	0.076	0.940
股中间肌厚度/mm	14.69±2.47	14.83±2.82	14.34±3.27	1.718	0.103	0.380	0.706
股外侧肌厚度/mm	17.66±2.65	17.84±3.20	17.30±3.27	1.093	0.269	0.380	0.706
股内长肌厚度/mm	24.04±2.00	23.06±3.04	21.58±2.64	3.051	0.007	3.320	0.002
股内斜肌厚度/mm	14.46±2.92	13.52±3.32	10.49±1.71	5.436	< 0.001	5.251	< 0.001
腘肌厚度/mm	10.89±1.18	10.47±1.51	9.74±2.10	2.751	0.014	2.133	0.039
股内长肌/股外侧肌	1.38±0.18	1.31±0.17	1.27±0.20	0.837	0.376	1.795	0.081
股内斜肌/股外侧肌	0.83±0.17	0.76±0.16	0.62±0.12	3.660	0.002	4.539	< 0.001

肌肉	对照组优势侧 (n = 20)	KOA组(n = 20)		t值^a	P值^a	t值^b	P值^b
肌肉	对照组优势侧 (n = 20)	健侧	患侧	t值^a	P值^a	t值^b	P值^b
股直肌	14.48±1.27	13.97±1.47	13.79±1.58	0.705	0.488	1.538	0.132
股中间肌	10.80±0.74	10.47±1.53	10.04±1.61	1.662	0.112	1.919	0.066
股外侧肌	16.51±2.70	15.25±1.70	15.41±1.63	-0.417	0.680	1.564	0.126
股内长肌	19.97±2.00	18.99±3.30	17.97±2.07	1.155	0.262	3.101	0.004
股内斜肌	26.51±3.26	25.26±2.59	25.18±2.49	0.160	0.877	1.452	0.155

项目	回归系数	标准误	Wald值	P值	OR值	95%CI
股内斜肌厚度	-1.450	0.629	5.317	0.021	0.235	0.068~0.805
腘肌厚度	-0.951	0.475	4.007	0.045	0.387	0.152~0.980
常数	27.243	11.698	5.423	0.020	6.781×10¹¹

实测是否患KOA	预测是否患有KOA
实测是否患KOA	是	否
是	17	3
否	3	17