踝关节重建手术前后的步态分析  

Gait analysis associated with ankle ligament reconstruction

作　　者：崔大平[1] 赵德伟[1] 孙强[1] 于小光[1] 

机构地区：[1]大连大学附属中山医院骨科,大连116001

出　　处：《中国矫形外科杂志》2013年第4期373-377,共5页Orthopedic Journal of China

摘　　要：[目的]通过三维运动捕捉步态分析的生物力学方法研究踝关节韧带损伤及重建手术后步态运动学的特点及变化规律。[方法]应用三维运动捕捉步态分析系统(东方新锐DVMC-8801三维运动分析系统),对单侧外踝韧带损伤应用腓骨短肌腱进行重建的39例患者进行步态分析,外踝韧带损伤患者自受伤到接受手术的平均时间为2.6个月(2周～16个月),分别于术前,术后6、12、18、24个月采集步态数据,同期采集58名健康人的步态数据并与之比较。受试对象按恒定速度(1.9 km/h)在运动平板上行走120 s,测量0°和15°时的步态数据,测量时空参数包括:步长、步宽;运动学数据包括:踝关节运动角度、踝关节角加速度。[结果]本组39例外踝韧带损伤患者术前及术后6个月均出现恐惧步态,术后6个月0°运动平板的时空参数与正常比较无显著性差别,术后12个月15°倾斜运动平板的时空参数与正常比较无显著性差别,术后18个月15°倾斜运动平板的运动学指标与正常比较无显著性差别。[结论]应用腓骨短肌腱进行外踝韧带重建能够恢复踝关节正常的步态模式并表现出一种时间相关趋势。运用步态分析的运动学数据对踝关节损伤进行功能量化评价,可以更为准确的了解踝关节外踝韧带损伤及重建术后的生物力学变化,为评定术后疗效、制定康复治疗方案及评定康复疗效提供客观的依据。[ Objective] The aim of this study is to determine how selected gait parameters, measured by three-dimensional motion capture system, may change as a result of ankle ligament deficiency and following ankle ligament reconstruction. [ Meth- od] The study was performed on 39 ankle ligament-deficient subjects prior to and 6 months, 12 months, 18months and 24 for months after ankle ligament reconstructive surgery by the four stranded hamstring tendon technique. The group was examined an average of 2.6 months after injury （ ranging from 2 weeks to 16 months）, but before surgery. Gait analysis was performed using the DorealSoft DVMC-8801 three-dimensional motion capture system （Doreal Software Co. , Ltd. , China）. Kinematic data were recorded for the lower limb. The results obtained from the injured subjects were compared with those of 58 individuals without ankle ligament damage. Each subject was asked to walk on a motorized treadmill （ECON USA） with different slope and per- form-after six minutes of familiarization time-at least 2 minutes of walking at a constant speed of 1.9 km/h. [ Result] The ankle ligament-deficient patients exhibited a quadriceps avoidance pattern prior to and 6 months after surgery. In the individuals oper- ated on, the spatial-temporal parameters and the ankle angle had already regained a normal pattern for the ankle ligament-defi- cient limb during gait 12 months after surgery. However, the relative ankle ligament movement parameter-which describes the tibial translation into the direction of ankle ligament-and the angular acceleration showed no significant statistical difference com- pared with the values of healthy control group just 18 months after surgery. [ Conclusion] The data from this study suggest that ANKLE LIGAMENT surgical repair significantly alters lower-extremity gait patterns, and that the establishment of pre-injury gait patterns takes at least 18 months to occur. 3D gait analysis for assessment of patients undergoing anterior cruciate ligament reconstruction surge

关 键 词：步态分析 外踝韧带重建 三维运动学 腓骨短肌腱移植 

分 类 号：R687.4[医药卫生—骨科学]