- 學位論文
使用光學式足底壓力機對內側膝退化性關節炎病患的評估
Evaluation of Patients Bearing Medial Knee Joint Osteoarthritis by Using Optical Foot Pressure Measuring System
摘要
本研究的目的是以足底動靜態參數的量測來預測膝退化性關節炎，並討論以足部各項參數的變化是否與退化性關節炎相關。共有30位退化性關節炎的病患與35位無膝關節症狀的健康對照組病患參與本研究。採用光學式足壓量測系統收集足底壓力中心行進線路徑，足底壓力中心路徑移動時間與偏移角度，行進間足底壓力變化情形，靜態足底六區壓力的量測，及量測與參考病患其它各項臨床參數等資料。結果顯示退化性關節炎組的左側步行中期耗時0.20秒明顯大於對照組0.12秒（p<0.05），右側步行中期耗時0.19秒也明顯大於對照組0.15秒（p<0.05）。健康者在步行週期末期偏向早期離地，腳趾較少施力輔助完成步態週期，而退化性關節炎組腳指頭在步態週期末期有施力的比例較高。如腳指頭有施力，正常組足底壓力中心行進線路徑曲線末期較偏向大拇指，而退化性關節炎組較偏向至第一與第二趾之間。退化性關節炎組受試者的步態週期末期，其蹠骨頭應力分布較偏拇指側，正常組則相對較偏向第五趾側。足底壓力六區分區以獨立樣本t檢定比較退化性關節炎組得到左足內側縱弓區，外側足跟區與內側足跟區與對照組皆達顯著差異（p<0.05），自訂參數平衡線亦顯示左側亦有統計上明顯的不同（p<0.05），但右側卻未達統計明顯差異，可能與疼痛代償影響站姿有關。將六區足壓利用SPSS使用主成分分析法縮減為三個變數，再加入步行中期耗時、身體質量指數BMI及足底壓力中心飄移指標CPEI變數做邏輯迴歸分析，回歸式陽性預測率為90%，陰性預測率為88.6%。結果顯示退化性關節炎患者足底壓力的動靜態變化與健康者確有不同，光學式足底壓力機檢查配合身高體重的測量可以對於退化性關節炎發生與否有不錯的檢測效果。
並列摘要
The purpose of this study is to measure plantar dynamic and static parameters, to build a model to predict knee osteoarthritis, and to discuss changes of foot pressure parameters associated with degenerative arthritis. 30 patients with medial knee osteoarthritis were enrolled to the experiment group while 35 non-symptomatic healthy individuals were enrolled to the control group. The present study used the optical foot pressure measurement system to collect the path of the center of foot pressure in the gait cycle, to measure the travel time and offset angle of plantar pressure changes between gait cycle, and to estimate the static pressure of the plantar six districts along with the measurement of other clinical parameters and information. The results show that the mid-stance phase time of the left foot of osteoarthritis patients (0.20 seconds) is significantly longer than that of the control group (0.12 seconds) (p<0.05), and yet the mid-stance phase time of the right foot of osteoarthritis patients (0.19 seconds) is also significantly longer than that of the control group (0.15 seconds) (p<0.05). The individuals in the control (healthy group) prefer early toe-off in terminal stage of gait cycle and the toes used less force to finish the gait cycle. The center of pressure progression of the individuals in the control group is biased toward the big toe, while that of the osteoarthritis group tends to be biased toward the second toe. At the terminal stage of gait cycle, the metatarsal head stress distribution of osteoarthritis group tends to move to big toe, and the individuals in the control group tend to move to fifth toe. The independent-samples t-test compared the means of pressure of six districts regions of plantar area between two groups. It was found that the left foot medial longitudinal arch area, the lateral heel region and the inner heel region of the control group are significant different. The statistics of the modified balance line also showed obvious differences in the left side of the foot, but the right side of the foot was not statistically significant. This finding may be related to pain compensation of standing posture. SPSS was used to reduce three variables of the foot pressure in the six districts regions using the principal component analysis, and then mid-stance phase period, body mass index and center of pressure excursion index variables were included for logistic regression model. The analysis resulted in 90% of the positive predictive logistic regression and a negative predictive value of 88.6% indicating that the static and dynamic plantar pressure variables are statistically different between two groups. Therefore, it is concluded that the optic foot pressure measuring system combined with physical measurements of body height and weight measurements can predict whether the individual is bearing medial knee osteoarthritis or not.