单侧全膝置换前后女性患者步态特征分析

Gait Characteristics of Female Patients before and after Unilateral Total Knee Arthroplasty

目的研究单侧全膝置换(total knee arthroplasty,TKA)手术前后女性患者双侧下肢步态特征。方法基于三维步态采集和独立样本t检验,对比10例女性患者单侧TKA手术前后双侧下肢的步态参数,并分别与对照组10例健康志愿者比较,分析女性患者双侧步态差异及分别与正常步态的差异。结果术前患者非手术侧支撑期、膝关节内收角度峰值、冠状面活动度和屈曲力矩峰值显著大于手术侧(P<0.05),术后无统计学差异;与对照组比较,术前患者步速、步长较小,双支撑期较长,手术侧膝关节伸展和内收角度峰值、冠状面活动度、屈曲和外展力矩峰值较小,内收力矩峰值较大,非手术侧膝关节伸展角度峰值较小,屈曲和内收力矩峰值较大,均存在统计学差异(P<0.05),术后双侧膝关节伸展角度和内收力矩峰值与对照组的显著差异持续存在(P<0.05)。结论单侧TKA能减轻患者疼痛,改善双侧下肢步态偏差,但与对照步态仍存在差异。患者肌力及本体感受等关节功能尚未恢复,病理步态与不良体态仍然存在,应加强患侧肌力锻炼及步态矫正训练。女性患者术后同时应注意步速控制,以防膝关节受力增加。

Objective To investigate gait characteristics of both lower limbs in female patients before and after unilateral total knee arthroplasty (TKA). Methods Based on three-dimensional (3D) motion capture system and independent-sample t test,gait parameters of 10 female patients were compared in both lower limbs and compared with those of 10 healthy subjects before and after TKA. Results The preoperative stance phase,peak adduction angle,adduction-abduction range of motion (ROM) and peak flexion moment of the unoperated knee were significantly higher than those of the operated knee (P < 0. 05),while postoperative gait parameters were similar in both sides. Compared with the control group,the patients had significantly lower speed and stride length,longer double support time before TKA (P<0. 05). Moreover, the operated knee demonstrated significantly lower peak extension and adduction angles,adduction-abduction ROM,peak flexion and abduction moments,higher peak adduction moment,and the unoperated knee revealed significantly lower peak extension angle,higher peak flexion and adduction moments than the control group before TKA (P < 0. 05). The greater differences of peak knee extension angles and adduction moments of both sides still existed in the two groups after TKA (P<0. 05). Conclusions Unilateral TKA could ease pain and reduce gait deviations in both lower limbs of patients. However,there were still gait differences compared with the control group. Patients still suffered deficits in joint function,such as muscle strength and proprioception,and revealed pathological gait and posture.It’s advised that patients should enhance muscle strength of the operated limb,and take gait correction exercises. Female patients should also control walking speed to avoid increasing pressure on the knee after TKA.