目的 探究慢性踝关节不稳(chronic ankle instability, CAI)患者踝关节肌力缺失对患侧和健侧膝关节肌群的影响。 方法 建立健康受试者和 CAI 患者逆向动力学模型,通过改变肌肉最大等长收缩力模拟不同程度踝关节肌力缺失,分析步态周期中膝关节峰值肌力和累积肌力的改变规律。 结果 CAI 患者跖屈肌肌力缺失会同时影响患侧和健侧的股四头肌与腘绳肌,背屈肌肌力缺失主要影响患者患侧和健侧的腘绳肌。 CAI 患者患侧和健侧膝关节肌群肌肉累积负荷增大,不同踝关节肌力缺失模型都呈现出患侧股四头肌累积负荷大于健侧,健侧腘绳肌累积负荷大于患侧的规律。 结论 CAI 不仅会影响患者患侧膝关节肌群的肌力,也会影响患者健侧膝关节肌群的肌力。增强踝关节的肌肉力量和保护双侧膝关节肌肉可能对 CAI 康复具有积极的作用。

Objective To study the effect of strength loss in ankle muscles on injured and healthy side of knee joint muscles in patients with chronic ankle instability (CAI). Methods The inverse dynamic models of CAI patients and healthy subjects were established. The strength loss of ankle muscles at different degrees was simulated by changing the maximum isometric contraction force of muscles, and the change patterns for peak muscle strength and cumulative muscle strength of knee joints during a gait cycle were analyzed. Results The strength loss of plantar flexor muscle in CAI patients would affect both the quadriceps and hamstring muscles of the injured side and the healthy side. The strength loss of dorsal flexor muscle mainly affected the hamstring muscles of the injured side and the healthy side in CAI patients. The cumulative load on the affected side and the healthy side of knee joint muscles increased, and models with different strength loss of ankle muscles showed that the cumulative load of quadriceps femoris on the affected side was greater than that on the healthy side. The cumulative load on hamstring muscle of the healthy side was greater than that of the affected side. Conclusions CAI will not only affect the patients’ injured side of knee joint muscle strength, but also affect their healthy side. Strengthening the ankle muscles and protecting the bilateral knee muscles may have a positive effect on the rehabilitation of CAI.

北京市科技计划项目(Z211100004121005),载人航天工程航天医学实验领域资助项目(HYZHXM01003),中央高校基本科研业务费专项资金 (YWF-21-BJ-J-802) ,中国科协青年人才托举工程 (YESS 2015QNRC001)