前交叉韧带重建后步长增加对膝关节运动学和动力学不对称性步态的影响  

Effect of increased stride length on knee kinematics and dynamics of asymmetric gait after anterior cruciate ligament reconstruction

作　　者：刘梦玲 李永杰 刘洪举 Liu Mengling;Li Yongjie;Liu Hongju(College of Physical Education and Health,East China Jiaotong University,Nanchang 330013,Jiangxi Province,China;Department of Rehabilitation Medicine,Guizhou Hospital,Beijing Jishuitan Hospital,Guiyang 550014,Guizhou Province,China)

机构地区：[1]华东交通大学体育与健康学院,江西省南昌市330013 [2]北京积水潭医院贵州医院康复医学科,贵州省贵阳市550014

出　　处：《中国组织工程研究》2025年第33期7109-7115,共7页Chinese Journal of Tissue Engineering Research

基　　金：2023年度贵州省科技支撑计划(黔科合支撑[2023]一般179),项目负责人:刘洪举。

摘　　要：背景:前交叉韧带重建后的主要目标之一是恢复正常步态模式。但迄今为止,对前交叉韧带重建后步态不对称性变化的研究数量有限。目的:探索不同步长条件下膝关节运动学和动力学的不对称性变化。方法:纳入30例单侧膝关节前交叉韧带重建术后3个月受试者(男15例,女15例),每个受试者分别进行了3种不同步长的行走测试,分别是正常步长和正常步长的基础上增加30%及50%的步长。通过意大利BTS红外运动捕捉系统和测力台采集膝关节运动学和动力学指标,其中运动学指标包括膝关节屈曲角度、膝关节伸展角度和膝关节内收角度,动力学指标包括地面反作用力、膝关节屈曲力矩、膝关节伸展力矩和膝关节内收力矩。计算运动学和动力学指标的不对称性指数值,使用单因素方差分析比较不同步长条件下各参数的不对称性差异。结果与结论:①与正常步长相比,步长增加30%时膝关节屈曲角度、膝关节屈曲力矩、膝关节内收力矩、膝关节伸展力矩、地面反作用力不对称指数显著降低(P<0.05),步长增加50%时膝关节内收角度、膝关节屈曲角度、膝关节伸展角度、膝关节内收力矩、膝关节伸展力矩、膝关节屈曲力矩、地面反作用力不对称指数显著降低(P<0.05);②当步长增加50%时,膝关节内收角度、膝关节伸展力矩和地面反作用力不对称指数显著低于步长增加30%(P<0.05);③结果表明,增加步长可以改善前交叉韧带重建后的步态不对称性,但增加50%更优,进而缓解在步行中前交叉韧带所承受的负荷;同时在以后的临床工作中可以将步长作为步态中一个可调节变量,来预防和缓解前交叉韧带重建后损伤患者疼痛的症状、改善膝关节功能,提高生活质量。BACKGROUND:One of the main goals after anterior cruciate ligament reconstruction is to restore normal gait patterns.However,to date,a limited number of studies have examined changes in gait asymmetry after anterior cruciate ligament reconstruction.OBJECTIVE:To explore asymmetric changes in knee kinematics and dynamics under different stride length conditions.METHODS:Thirty subjects(15 males and 15 females)3 months after anterior cruciate ligament reconstruction of the single knee were included in this study.Among them,each subject received the walking test with three different stride lengths,a normal stride length and a 30%as well as a 50%increase in the normal stride length.Knee kinematic and kinetic indices were collected by means of an Italian BTS infrared motion capture system and a dynamometer table,where kinematic indices included knee flexion,extension,and adduction angles,and kinetic indices included ground reaction forces,knee flexion moments,knee extension moments,and knee adduction moments.The asymmetry index values of the kinematic and kinetic indices were calculated.A one-way analysis of variance was used to compare the differences in asymmetry of each parameter under different stride length conditions.RESULTS AND CONCLUSION:(1)Compared with the asymmetry indices of normal step length,the indices of knee flexion angle,knee flexion moments,knee adduction moments,knee extension moments,and ground reaction forces were significantly lower when the step length was increased by 30%(P<0.05);the indices of knee adduction angle,knee flexion angle,knee extension angle,knee adduction moments,knee extension moments,knee flexion moments,and ground reaction forces were significantly lower when the step length was increased by 50%(P<0.05).(2)When the step length was increased by 50%,the indexes of knee adduction angle,knee extension moments,and ground reaction forces were significantly lower than when the step length was increased by 30%(P<0.05).(3)These findings suggest that increasing stride length improves gait

关 键 词：前交叉韧带重建 步长 运动学 动力学 不对称性 行走测试 单因素方差分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R873