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首页> 外文学位 >Developpement d'une approche d'evaluation clinique de la cinematique tridimensionnelle du genou durant la marche pour des patients gonarthrosiques.
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Developpement d'une approche d'evaluation clinique de la cinematique tridimensionnelle du genou durant la marche pour des patients gonarthrosiques.

机译：膝骨关节炎患者行走过程中膝部三维运动学临床评估方法的开发。

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摘要

The general purpose of this study was to propose a biomechanical approach, applicable in a clinical context, for evaluating three-dimensional (3D) angular kinematic parameters at the pathological knee level of osteoarthritis (OA) patients during gait. Specific objectives were to determine the feasibility of the measurement method here proposed (study 1) and to evaluate psychometric properties like construct validity (in study 2 and a section of supplementary analyses) and reliability (in study 3) of the knee angular kinematic parameters.;The second study (on construct validity) aimed at finding 3D knee angular kinematic parameters apt to discriminate OA patients from the AS participants or to find parameters that were sensitive to the evolution of the structural deterioration of the knee joint (with regard to the radiographic severity). OA patients were subdivided in four subgroups (OAKL1, OAKL2 , OAKL3 and OAKL4) for analysis purposes. In order to determine significantly discriminating parameters, analyses of variance using contrast AS vs. OAKL1,2,3,4 (regrouping the four OA patients' subgroups) were performed on the 22 knee angular kinematic parameters. To identify from these parameters those that covaried significantly with the deterioration of knee joint, analyses of isotonous variation (E 2) were realised. Nine parameters resulting of the analysis of the three plans of joint motion (flexion/extension, adduction/abduction and internal/external tibiae rotations) were significantly sensitive to the progressive deterioration levels of the knee. Four parameters, all resulting from the analysis of the frontal plane of joint motion (adduction/abduction), were significantly discriminating. Furthermore, additional analyses (correlation coefficients and Dunnett's t-tests) showed that three parameters (amplitude of motion in the frontal plane as well as varus bending, both occurring during the loading phase of gait, and frontal knee misalignment during the phase of single support of gait) are knee angular kinematic measurements having a better discriminating capacity than other biomechanical measures that have been recognised as development and progressive factors of knee OA (static knee misalignment in varus/valgus and external knee adduction moment parameters). Comparisons between the clinical measurements (from the battery of clinical tests) with the biomechanical measurements have shown that the parameter measuring varus bending around the knee during gait was significantly associated to knee pain and to the physical function of knee OA patients.;The last study was conducted to determine the test-retest reliability (measurement property related to inter-session stability) of the 3D knee angular kinematics parameters that have been shown to be discriminating or sensitive to the deterioration levels of knee joint at the second study. The intra class coefficients of correlation (ICC) obtained all reached over 0.75 and the associated standard errors of measurement (SE) were lower than 3.0°. These results show that the biomechanical method of measurement proposed in this research allows the evaluation of reliable 3D angular kinematic parameters at the pathological knee level of OA patients. (Abstract shortened by UMI.);The first study (on the feasibility of the measurement method) was focused on the determination of the effects of wearing the exoskeleton on pain in the pathological knee (results of VAS) and on gait patterns of the OA patients (assessed by the spatiotemporal as well as by the force and time-force parameters). These effects were evaluated across the biomechanical follow-up in order to estimate their inter-sessions stability. Analyses of variance were realised to determine statistical significant changes. Wearing the exoskeleton induced a small increase of knee pain (10 mm on average) which was statistically significant and, from a practical point of view, on the border of clinical significance. Wearing the exoskeleton altered significantly one of the 13 spatiotemporal parameters analysed and 14 of the 42 force and time-force parameters. Over all, observed effect sizes were less than 7%. The results obtained on gait parameters demonstrated that patients preserved gait symmetry for the two lower limbs, but they adopted a more cautious gait strategy when walking with the exoskeleton. Moreover, all effects observed in this study were stable across the three sessions of gait analysis.
机译：这项研究的总体目的是提出一种生物力学方法，适用于临床情况，用于评估步态中骨关节炎（OA）患者的病理膝关节水平的三维（3D）角运动学参数。具体目标是确定此处提出的测量方法的可行性（研究1），并评估心理测量学特性，例如构造角的有效性（在研究2和补充分析的一部分中）和膝关节角运动学参数的可靠性（在研究3中）。 ；第二项研究（关于构造效度）旨在寻找易于区分OA患者与AS参与者的3D膝关节角度运动学参数，或寻找对膝关节结构恶化的演变敏感的参数（关于X射线照相）严重程度）。为了分析目的，将OA患者分为四个亚组（OAKL1，OAKL2，OAKL3和OAKL4）。为了确定明显可区分的参数，对22个膝关节运动学参数进行了对比AS与OAKL1,2,3,4（重新分组四个OA患者的亚组）的方差分析。为了从这些参数中识别出那些与膝关节退化显着相关的变量，实现了等渗变化（E 2）的分析。对三个关节运动计划（屈曲/伸展，内收/外展和内/外胫骨旋转）进行分析后得出的九个参数对膝盖的渐进恶化程度非常敏感。四个参数都是通过对关节运动的前平面（内收/外展）进行分析得出的，可以明显地区分。此外，其他分析（相关系数和Dunnett的t检验）表明，三个参数（在步态加载阶段发生的额骨平面运动幅度和内翻弯曲，以及在单次支撑阶段的额骨膝盖未对准）与其他生物力学测量方法相比，膝关节角度运动学测量方法具有更好的识别能力，而其他生物力学测量方法已经被认为是膝OA的发展和进展因素（内翻/外翻中的静态膝盖未对准以及外部膝盖内收力矩参数）。临床测量结果（来自一系列临床测试）与生物力学测量结果之间的比较表明，步态期间测量膝盖内翻的参数与膝关节疼痛和膝OA患者的身体功能显着相关。进行此操作以确定3D膝关节角度运动学参数的重测可靠性（与会话间稳定性相关的测量属性），该参数在第二项研究中已显示出对膝关节的恶化水平有区别或敏感。所获得的类内相关系数（ICC）均超过0.75，并且相关的标准测量误差（SE）低于3.0°。这些结果表明，本研究提出的生物力学测量方法可以评估OA患者病理膝关节水平的可靠3D角运动学参数。 （由UMI缩短。）；第一个研究（关于测量方法的可行性）的重点是确定佩戴外骨骼对病理性膝关节疼痛（VAS的结果）和OA步态的影响患者（通过时空以及力和时间力参数进行评估）。在整个生物力学随访过程中评估了这些影响，以评估其休会期间的稳定性。实现方差分析以确定统计学上的显着变化。佩戴外骨骼会导致膝关节疼痛的轻微增加（平均10毫米），这在统计学上是显着的，并且从实际的角度来看，在临床上具有重要意义。佩戴外骨骼会显着改变所分析的13个时空参数之一和42个力和时间力参数中的14个。总体而言，观察到的效应大小小于7％。根据步态参数获得的结果表明，患者保留了两个下肢的步态对称性，但是在与外骨骼一起行走时，他们采取了更为谨慎的步态策略。而且，在该研究中观察到的所有影响在步态分析的三个阶段中都是稳定的。

著录项

  • 作者

    Boivin, Karine.;

  • 作者单位

    Ecole Polytechnique, Montreal (Canada).;

  • 授予单位 Ecole Polytechnique, Montreal (Canada).;
  • 学科 Health Sciences Rehabilitation and Therapy.;Biophysics Biomechanics.;Engineering Biomedical.
  • 学位 Ph.D.
  • 年度 2010
  • 页码 298 p.
  • 总页数 298
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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