膝关节置换后患者的三维步态特征  

Three-dimensional gait characteristics of patients after knee arthroplasty

作　　者：黄萍[1] 陈博[1] 刘志宏[1] 许萍 Huang Ping;Chen Bo;Liu Zhihong;Xu Ping(Shanghai Institute of Traumatology and Orthopedics,Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine,Ruijin Hospital of Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Shanghai University of Medicine&Health Sciences,Shanghai 201318,China)

机构地区：[1]上海市伤骨科研究所,上海市中西医结合防治骨与关节病损重点实验室,上海交通大学医学院附属瑞金医院,上海市200025 [2]上海健康医学院,上海市201318

出　　处：《中国组织工程研究》2018年第35期5596-5601,共6页Chinese Journal of Tissue Engineering Research

基　　金：上海市卫生和计划生育委员会面上项目(201640190);上海市卫生和计划生育委员会面上项目(201740165)。

摘　　要：背景:膝关节置换后患者的步态越来越受到临床医生和研究者关注。目的:定量评价膝关节置换后患者的步行功能和膝关节生物力学变化,评定手术疗效,探索最佳的治疗策略和置换后康复方案。方法:采用英国Vicon三维运动捕捉系统对膝关节炎双膝关节置换后患者12例(试验组)和12例相匹配的健康志愿者(对照组)进行步态测试,以Polygon软件分析受试者步行能力和膝关节三维运动学及动力学特征。结果与结论:(1)时空参数(步频、双足支撑期、对侧足跟着地比、对侧足尖离地比、单足支撑期、步长、一步时间、步宽、步幅、步行周期、步速):2组相比差异均无显著性意义(P> 0.05);(2)角度:试验组膝关节屈曲角度峰值、内翻角度峰值、冠状面上最大活动范围均减小,与对照组相比差异有显著性意义(P <0.05);(3)角速度和角加速度:试验组膝关节角速度峰值、角速度平均值、角加速度峰值、角加速度平均值均减小,与对照组相比差异有显著性意义(P <0.05);(4)力矩:试验组膝关节伸展力矩峰值减小,与对照组相比差异有显著性意义(P <0.05)。(5)地面反力:试验组Y轴和Z轴方向地面反作用力峰值减小,与对照组相比差异有显著性意义(P <0.05);(6)结果表明,试验组患者和正常人在平地步行中时空参数没有明显差别,提示人工膝关节置换是改善下肢步行功能极为重要的治疗方法。但是结果也显示置换后患者假体关节存在一些运动和运动力学的异常,膝关节的生物力学没有完全达到正常水平,这些变化是人工膝关节置换后的运动生物力学特征,可能是影响患者长期疗效的重要因素。BACKGROUND:Gait of patients after knee arthroplasty has arisen much attention from physicians and researchers.OBJECTIVE:To quantitatively assess the function and the biomechanical changes of knee joints after knee arthroplasty,and to evaluate the curative effect,so as to select the best treatment strategy and postoperative rehabilitation program.METHODS:Twelve patients with knee arthritis undergoing bilateral knee arthroplasties(trial group)and 12 healthy individuals(control group)were enrolled,and the gait test was performed using the British Vicon three-dimensional motion capture system.The walking ability and three-dimensional kinematic and dynamic characteristics of the knee joint were analyzed with Polygon software.RESULTS AND CONCLUSION:(1)Time-space parameters(step frequency,bipedal support period,ratio of opposite heel to landing,ratio of toes to off-site of the opposite side,single-foot support period,step length,step time,step width,stride,walking cycle,pace)showed no significant differences between groups(P>0.05).(2)The peak knee flexion angle,peak knee varus angle,and maximum motion range on the coronal plane were significantly decreased in the trial group,compared with the control group(P<0.05).(3)The peak value of angular velocity,average angular velocity,peak angular acceleration,and average angular acceleration of the knee joint in the trial group were significantly decreased compared with the control group(P<0.05).(4)The peak value of the extension torque of the knee joint in the trial group was significantly decreased compared with the control group(P<0.05).(5)The peak ground reaction force in the Y-axis and Z-axis directions in the trial group was significantly decreased compared with the control group(P<0.05).(6)These results suggest that there is no significant difference in time-space parameters between trial and control groups during ground walking,indicating that knee arthroplasty is an important treatment for the improvement of lower limb walking function.However,the results of this study

关 键 词：膝关节 关节置换术 三维 运动 生物力学 步态分析 关节成形术 置换 膝 生物力学 组织工程 

分 类 号：R496[医药卫生—康复医学]