膝关节后交叉韧带合并后外复合体损伤重建术后步态分析

Gait Analysis after Posterior Cruciate Ligament and Posterolateral Corner Reconstruction

目的:通过对后交叉韧带(posteriorcruciateligament,PCL)和后外复合体损伤(posterolateralcorner,PLC)重建术后患者进行步态分析,动态评估重建术后的时间-距离指标、运动学指标和动力学指标。方法:2007年3月至2008年4月,收住后交叉韧带合并后外复合体损伤患者16例(实验组)并进行异体跟腱重建后交叉韧带以及异体胫前肌重建腘腓韧带手术,术前行外旋拨号测试、术后1年行步态分析测试和外旋拨号测试。并与对照组(16例健康志愿者)的步态分析结果进行比较。结果:实验组时间-距离指标和运动学指标与对照组均无显著性差异(P>0.05),而运动力学指标中患侧膝关节伸膝力矩占主导地位,与对照组有明显差异(P<0.01)。16例患者术前患侧外旋角度较对侧平均增大16.5±6.2度,重建术后1年,外旋拨号试验患侧较对侧外旋角度平均增大-4.4±7.8度,术前术后比较有显著性差异(P<0.01)。重建术后1年,实验组步态分析中膝关节最大外旋角度绝对值为14.1±15.7度,外旋拨号试验最大外旋角度绝对值为29.7±15.2度,二者之间存在直线相关关系(r=0.9671,P<0.05)。结论:后交叉韧带以及后外复合体重建术后1年,除屈膝力矩明显小于对照组外,患者步态基本达到正常。

Purpose To analyze the gait of patients following reconstruction of posterior cruciate ligament（PCL）and posterolateral corner（PLC）. Methods Between March 2007 and April 2008, 16 patients with combined PCL and PLC injuries-deficient knee underwent the reconstruction with allograft. Dial test were performed before surgery, andgait analysis and dial test were assessed 1 year after reconstruction. Sixteen healthy volunteers were used as controls.Results There are no differences in the time-distance factors and kinematics between patients and controls （P〉 0.05）.The torque of knee extension revealed significant difference between patients and controls （P 〈0.01）. Mean abtorsionangle of the patients increased 16.5 °±6.2° before surgery; whereas the angle increased -4.4 °±7.8 ° 1 year aftersurgery（P〈 0.01）. The maximal mean abtorsion angulation from gait analysis was 14.1°±15.7°and from dial test was29.7°±15.2°, respectively. There was a strong linear correlation （r =0.9671,P 〈0.05）between the outcomes from dialtest and gait analysis. Conclusion After reconstruction of the PCL and PLC, the gait of patients became almost normal 1 year after operation, except the torque of knee extension.