肿瘤膝关节置换术后患者下楼时的生物力学特征及临床意义  

Biomechanical characteristics and the clinical significance during stair descent after tumor-type knee arthroplasty

作　　者：王航辉 宋依芯 张敏利[1] 任玉炳 刘西纺[2] 朱正飞 朱文侠[6] 韩为华[2] Wang Hanghui;Song Yixin;Zhang Minli;Ren Yubing;Liu Xifang;Zhu Zhengfei;Zhu Wenxia;Han Weihua(Xi'an International University,Shaanxi Xi'an 710077,China;Honghui Hospital Affiliated to Medical College of Xi'an Jiaotong University,Shaanxi Xi'an 710054,China;Affiliated Hospital of Shaanxi University of Chinese Medicine,Shaanxi Xianyang 712046,China;Hanyin County Traditional Chinese Medicine Hospital,Shaanxi Ankang 725100,China;State Key Laboratory for Manufacturing System Engineering,School of Mechanical Engineering,Xi'an Jiaotong University,Shaanxi Xi'an 710054,China;Medical College of Yan'an University,Shaanxi Yan'an 716000,China)

机构地区：[1]西安外事学院,陕西西安710077 [2]西安交通大学医学院附属红会医院,陕西西安710054 [3]陕西中医药大学附属医院,陕西咸阳712046 [4]汉阴县中医医院,陕西安康725100 [5]西安交通大学机械工程学院机械制造系统国家重点实验室,陕西西安710054 [6]延安大学医学院,陕西延安716000

出　　处：《现代肿瘤医学》2019年第3期472-476,共5页Journal of Modern Oncology

基　　金：中国博士后项目(编号:2016M600804);陕西省科技厅项目(编号:2018SF-171;2018SF-194);陕西省博士后项目(编号:2016BSHEDZZ92);西安市卫计委项目(编号:J201602023);西安市科技局项目[编号:2017115SF/YX009(16)]

摘　　要：目的:旨在通过研究肿瘤膝关节置换术后患者下楼时的生物力学特征,为患者提供下楼时安全、有效的靶向康复指导。方法:采集研究对象下楼时的三维步态数据。通过下肢运动学与动力学功能参数来综合评估其下楼梯时双下肢的生物力学特征。结果:肿瘤膝关节置换术后(实验组)下楼时健侧髋与膝关节屈伸角度峰值均大于患侧,实验组健侧、患侧下肢髋关节内收外展角度活动范围分别为-12°～7°、-5°～17°;膝骨性关节炎(knee osteoarthritis,KOA)组健侧、患侧髋关节屈伸角度范围分别为14°～30°、17°～82°; KOA组健侧、患侧膝关节屈伸角度范围分别为4°～59°、3°～102°,KOA患者健侧、患侧髋关节内收外展角度范围分别为-2°～27°、-9°～38°。对照组关节力曲线出现两个波峰。实验组患者健侧关节力波峰出现在60%步态周期时刻,患侧关节力有两个波峰; KOA组患者健侧下肢关节力较小,患侧下肢关节力个体差异较大。结论:实验组术后下楼梯时以健侧补偿为主,术后良好的镇痛与超早期肌肉力量训练、神经肌肉适应性训练、户外运动、辅助个性化矫形器和手扶栏杆、改变步态等方式能提高下楼时的安全性,提升靶向康复质量。Objective:In order to investigate biomechanics and clinical significance after tumor-type knee arthroplasty during stair descent,and to explore the safety and effective rehabilitation strategies.Methods:The three-dimensional gaits were collected during stair descent.The biomechanical characteristics of the lower extremities during stair descent were comprehensively evaluated by the kinematic and dynamic parameters of the lower limbs.Results:The flexion-extension of the hip and knee joints of the healthy lower limb was higher in the experimental group during stair descent than that of the affected side.The range of adduction and outreach of hip joints in the healthy and affected side of the experimental group was-12°~7°,-5°~17°,respectively.The flexion-extension of the hip joints in the healthy and affected side of the knee osteoarthritis(KOA)group was 14°~30°,17°~82°,respectively.The flexion-extension of the knee joints in the healthy and affected side of the KOA group was 4°~59°,3°~102°,respectively.The range of adduction and outreach of hip joints in the healthy and affected side of the KOA group was-2°~27°,-9°~38°,respectively.Two peaks appeared in the control group force curve.In the experimental group,the peak of the joint force of the healthy side appeared at the moment of the 60%gait cycle.Two peaks appeared in the affected side of the experimental group.In the KOA group,the joint force of the healthy lower limb was smaller,and the joint forces of the affected lower limb have greater individual differences.Conclusion:The healthy side still was the mainstay during stair descent after tumor-type knee arthroplasty.Good analgesia,ultra-early muscle strength training,supporting with personalized orthotics and handrails,and changing gait in the postoperative period may increase the safety of downstairs and improve the quality of targeted rehabilitation.

关 键 词：肿瘤膝关节置换术 下楼 生物力学 运动 靶向康复 

分 类 号：R738.1[医药卫生—肿瘤]