前交叉韧带重建手术前后的步态分析

Gait analysis associated with anterior cruciate ligament reconstruction

目的研究膝关节前交叉韧带（ACL）损伤及重建手术后步态特点及变化。方法应用三维运动捕捉步态分析系统，对单侧前交叉韧带损伤应用四股胭绳肌腱进行重建的29例患者进行步态分析，前交叉韧带损伤患者自受伤到手术的平均时间为2．6个月（2周～16个月），分别于术前、术后3、6、9、12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（1．9km／h）在运动平板上行走120s，测量0°和15°时的步态数据，时空参数包括：步长、步宽；运动学数据包括：膝关节运动角度、膝关节角加速度、前交叉韧带移动数据（以胫骨沿前交叉韧带方向的位移表示）。结果本组29例前交叉韧带损伤患者术前及术后3个月均出现股四头肌逃避步态，术后3个月0°运动平板的时空参数与正常比较无明显差别，术后6个月15°倾斜运动平板的时空参数与正常比较无明显差别，术后9个月15°倾斜运动平板的运动学指标与正常比较差异无统计学意义。结论应用四股胭绳肌腱进行前交叉韧带重建能够恢复膝关节正常的步态模式并表现出与时间相关趋势。运用步态分析的运动学数据对膝关节ACL损伤进行功能量化评价，可以更为准确的了解膝关节前交叉韧带损伤及重建术后的生物力学变化，为评定术后疗效、制定康复方案及评定疗效提供客观依据。

Objective To determine how selected gait parameters, measured by three-dimensional motion capture system, may change as a result of anterior cruciate ligament （ACL） deficiency and following ACL reconstruction. Methods The study was performed on 29 ACL-deficient subjects prior to and at 3, 6, 9 and 12 months after ACL reconstructive surgery by the four stranded hamstring tendon technique. The group was examined at an average of 2. 6 months after injury （ range ： 2 weeks-16 months）. But at pre- surgery, gait analysis was performed using the DorealSoft DVMC-8801 three-dimensional motion capture system. Kinematic data were recorded for the lower extremities. The results obtained from the injured subjects were compared with those of 58 individuals without ACL damage. Each subject was asked to walk on a motorized treadmill （ECON USA） with different slopes and perform-after a 6 minute familiarization time-at least 2 minutes of walking at a constant speed of 1.9 km/h. Results The ACL-deficient patients exhibited a quadriceps avoidance pattern prior to and at 3 months post-surgery. In the operated individuals, the spatial-temporal parameters and the knee angle had already regained a normal pattern for the ACL-deficient extremity during gait at 6 months post-surgery. However, the relative ACL movement parameter-which describes the tibial translation into the direction of ACL-and the angular acceleration showed no significant statistical difference as compared with the values of healthy control group at just 9 months post-surgery. Conclusion The ACL surgical repair significantly alters lower-extremity gait patterns, and that the establishment of pre-injury gait patterns takes at least 9 months to occur. 3D gait analysis for assessment of patients undergoing anterior cruciate ligament reconstruction surgery can precisely reflect knee biomechanical changes, and assist to explore optimal treatment approach and postoperative rehabilitation methods.