膝关节单髁置换后早期步态的稳定性

Stability of early gait after unicompartmental knee arthroplasty

背景:对于行膝关节单髁置换的患者,虽然手术效果明确,但仍缺乏有效的定量评估工具,需进一步探索术后早期步态及稳定性变化。目的:探讨膝关节单髁置换前与置换后早期的步态及稳定性变化。方法:选择2021年5月至2022年5月计划在徐州医科大学附属医院关节外科行单侧单髁置换的患者30例为单髁置换组,年龄(63.80±9.31)岁;另招募15例无髋膝关节疼痛及髋膝关节活动功能障碍病史的健康老年人为对照组,年龄(61.28±8.60)岁。记录比较对照组及单髁置换组患者置换前、置换后1,3个月的美国特种外科医院评分、稳定性参数(足底压力中心路径长度、95%置信椭圆面积)及步态参数(步速、跨步步幅、步频、步态周期、单支撑期比例)。结果与结论:①单髁置换组患者置换后1个月步频与置换前比较,差异无显著性意义(P>0.05);置换后1个月稳定性参数较置换前差,其他参数均优于置换前,差异有显著性意义(P<0.05);②单髁置换组患者置换后3个月美国特种外科医院评分、步态及稳定性参数均优于置换前(P<0.05);③单髁置换组置换前、置换后3个月步速、跨步步幅、步频、单支撑期比例均小于对照组,足底压力中心路径长度、95%置信椭圆面积、步态周期均大于对照组,差异有显著性意义(P<0.05);④提示步态分析是定量评估单髁置换后康复状况的有效手段,单髁置换后早期步态恢复较好,但置换后1个月仍存在步频改善不明显、稳定性较差的情况。

BACKGROUND:For the patients who have undergone unicompartmental knee arthroplasty,although the surgical effect is clear,there is still a lack of effective quantitative evaluation tools,and it is necessary to further explore the early postoperative gait and stability changes.OBJECTIVE:To investigate the changes in gait and stability before and after unicompartmental knee arthroplasty.METHODS:From May 2021 to May 2022,30 patients aged(63.80±9.31)years who planned to perform unilateral unicompartmental knee arthroplasty in the Department of Joint Surgery,Affiliated Hospital of Xuzhou Medical University were selected as the unicompartmental knee arthroplasty group.15 healthy elderly patients aged(61.28±8.60)years without a history of hip and knee pain and hip and knee joint dysfunction were recruited as the control group.Hospital for special surgery scores,stability parameters(center of pressure path length,95%confidence ellipse area)and gait parameters(pace,stride length,stride frequency,gait cycle,and the proportion of single support period)were recorded and compared in the control group and unicompartmental knee arthroplasty group before operation,1 and 3 months after operation.RESULTS AND CONCLUSION:(1)There was no significant difference in the step frequency between the patients 1 month after operation and those before operation in the unicompartmental knee arthroplasty group(P>0.05).The stability of 1 month after operation was worse than that before operation,and other parameters of 1 month after operation were better than those before operation,and the difference was statistically significant(P<0.05).(2)Hospital for special surgery score,gait and stability parameters at 3 months after operation were better than those before operation(P<0.05).(3)Compared with the control group,the pace,stride length,stride frequency,and the proportion of single support period of the unicompartmental knee arthroplasty group were significantly lower before and 3 months after operation.Center of pressure path length,95%confidence ellipse area and gait cycle were greater in the unicompartmental knee arthroplasty group than those in the control group,with statistically significant differences(P<0.05).(4)It is indicated that gait analysis is an effective means to quantitatively evaluate the rehabilitation status after unicompartmental knee arthroplasty.The early gait recovery after unicompartmental knee arthroplasty is good,but the gait frequency improvement is not obvious and the stability is poor 1 month after the operation.