胫骨近端截骨Ilizarov技术治疗膝骨性关节炎的步态分析

Gait analysis on proximal tibial osteotomy combined with Ilizarov external fixation technique for medial knee osteoarthritis

[目的]利用三维步态分析探讨胫骨近端截骨Ilizarov外固定技术治疗内侧间室膝骨关节炎患者手术前后时空、运动学及动力学变化。[方法]对2016年9月~2018年12月本科采用胫骨近端低位微创截骨Ilizarov外固定技术治疗的11例内侧间室膝骨关节炎患者(21膝)进行步态分析研究,记录比较术前、术后拆除外固定架时及术后6个月3个时间点步态周期时空参数、运动学及运动力学参数。[结果]11例患者步幅和步速在术前、拆除外固定器时及术后6个月比较差异无统计学意义(P>0.05)。步态运动学检测方面,随时间推移,21膝的屈膝角度、伸膝角度均显著增加(P<0.05);内翻角度、外翻角度均显著减少(P<0.05)。踝关节活动范围显著增加(P<0.05),踝关节外翻角度显著增加(P<0.05)。运动力学测试方面,随时间推移,膝关节内收力矩、内收角冲量均显著减少(P<0.05);拆除外固定器时踝关节外翻力矩较术前增加(P<0.05),术后6个月随访时与拆除外固定器时踝关节外翻力矩比较差异无统计学意义(P>0.05);拆除外固定器时足底中心压力轨迹较术前明显向外侧偏移(P<0.05),术后6个月时与拆除外固定器时比较差异无统计学意义(P<0.05)。[结论]胫骨近端微创截骨Ilizarov外固定技术治疗内侧间室膝骨关节炎符合生物力学要求,步态分析测试可对该技术的临床疗效进行准确评估。

[Objective]To explore changes of time and space,as well as kinematics and dynamics using three-dimensional gait analysis in proximal tibial osteotomy combined with Ilizarove external fixation technique for medial knee osteoarthritis(MKOA).[Methods]A gait analysis study was conducted on 11 patients(21 knees)who underwent proximal tibial osteotomy combined with Ilizarov external fixation technique for MKOA in our department between September 2016 and December 2018.The parameters regarding to time and space variations,kinematics and dynamics of gait were measured and compared before operation,at the external frame removed and 6 months postoperatively.[Results]There were no significant changes in stride length and step speed among time points before operation,at the external frame removed and 6 months postoperatively in the 11 patients(P>0.05).In term of gait kinematics,the angle of knee flexion,angle of knee extension significantly increased(P<0.05),whereas the angle of knee varus and angle of knee valgus significantly decreased over time(P<0.05).On the other hand,the ankle range of motion and the angle of ankle valgus significantly increased as time went(P<0.05).With regard to the gait dynamics,knee adduction moments and knee adduction impact significantly decreased over time(P<0.05).Otherwise,the ankle valgus moments increased,while the trajectory of plantar pressure center shifted laterally,which proved statistically significant between time points before operation and at the external frame removed(P<0.05),whereas were not statistically significant between those at the external frame removed and 6 months postoperatively(P>0.05).[Conclusion]This proximal tibial osteotomy combined with Ilizarov external fixation technique does meet the biomechanical demand of treatment of medial knee osteoarthritis,while gait analysis is useful tool to evaluate the aforesaid surgical techniques.