前交叉韧带重建术后患者不同速度行走时步态运动学特征及其变异性研究

The kinematic characteristics and their variabilities of patients walking at different speeds after anterior cruciate ligament reconstruction

目的分析前交叉韧带重建术(anterior cruciate ligament reconstruction,ACLR)术后6个月患者在舒适速度行走和最快速度行走时的步态运动学特征及其变异性。方法招募21例ACLR术后6个月受试者以及21名健康受试者,使用三维动作捕捉系统采集受试者在舒适速度行走和最快速度行走时的步态数据,计算步态时空参数和髋膝踝关节的运动学参数,并计算各参数跨步间变异系数以反映步态变异性,比较两种速度下ACLR受试者和健康受试者各参数间的差异。结果舒适速度行走时,与健康受试者相比,ACLR受试者的手术侧步频[(106.03±11.27)steps/min vs.(112.25±5.80)steps/min]、步速[(1.13±0.24)m/s vs.(1.26±0.12)m/s]、步长[(0.63±0.08)m vs.(0.67±0.04)m]偏小,跨步时间延长[(1.15±0.13)m vs.(1.07±0.05)m],膝关节活动范围[(53.77±11.09)°vs.(61.27±5.67)°]、踝关节活动范围[(29.00±4.92)°vs.(32.62±5.13)°]、站立后期跖屈幅度[(28.99±4.92)°vs.(32.59±5.17)°]偏小;变异性参数中仅伸髋幅度变异性[(3.00±1.98)%vs.(4.58±1.92)%]偏小。最快速度行走时,手术侧膝关节活动范围[(53.93±11.58)°vs.(59.53±6.44)°]仍然偏小,站立前期跖屈幅度[(6.38±2.48)°vs.(4.83±1.97)°]增加;变异性参数中步频[(3.20±1.31)%vs.(5.75±4.25)%]、步速[(4.77±2.88)%vs.(8.73±7.89)%]、步长[(3.94±1.72)%vs.(5.72±3.21)%]、跨步时间[(3.19±1.29)%vs.(5.88±4.50)%]、伸髋幅度[(4.06±1.92)%vs.(6.49±3.27)%]、踝关节活动范围[(5.84±3.15)%vs.(13.12±7.50)%]、站立后期跖屈幅度[(6.05±3.43)%vs.(14.54±11.00)%]的变异性偏小。结论舒适速度行走时,ACLR受试者形成较为稳定的步态模式,但该模式相比于健康受试者更为保守;最快速度行走时,ACLR受试者步态模式更为接近健康受试者,但相对比较僵化,灵活性降低。这可能与ACLR术后6个月患者本体感觉和神经肌肉功能并未完全恢复有关,患者应采取更加积极的康复策略,注重本体感觉与神经肌肉控制训练,改善步态模式,提升步态控制能力。

Objective To analyze the gait kinematics characteristics and their variabilities of patients walking at comfortable speed and maximum speed 6 months after anterior cruciate ligament reconstruction(ACLR)surgery.Methods A total of 21 subjects 6 months after ACLR surgery and 21 healthy subjects were recruited.A threedimensional motion capture system was used to collect the gait data of the subjects walking at a comfortable speed and maximum speed.We calculated the gait spatiotemporal parameters and the kinematic parameters of hip,knee and ankle joints,and the stride-to-stride variation coefficient of each parameter that can reflect the gait variability.The differences in parameters between ACLR subjects and healthy subjects were compared at the two gait speeds.Results When walking at a comfortable speed,the gait speed[ACLR vs.health(1.13±0.24)m/s vs.(1.26±0.12)m/s],cadence[(106.03±11.27)steps/min vs.(112.25±5.80)steps/min]and step length[(0.63±0.08)m vs.(0.67±0.04)m]of the operated side were smaller,and the step time[(1.15±0.13)m vs.(1.07±0.05)m]was extended.The knee joint range of motion(ROM)[(53.77±11.09)°vs.(61.27±5.67)°],ankle joint ROM[(29.00±4.92)°vs.(32.62±5.13)°],and the plantarflexion excursion during the late stance phase[(28.99±4.92)°vs.(32.59±5.17)°]were smaller.Among the variability parameters,only the hip extension excursion[(3.00±1.98)%vs.(4.58±1.92)%]was small.When walking at a maximum speed,the knee joint ROM[(53.93±11.58)°vs.(59.53±6.44)°]of the operated side was still smaller,and the plantarflexion excursion during early stance phase[(6.38±2.48)°vs.(4.83±1.97)°]was increased.Among the variability parameters,the gait speed[(4.77±2.88)%vs.(8.73±7.89)%],cadence[(3.20±1.31)%vs.(5.75±4.25)%],step length[(3.94±1.72)%vs.(5.72±3.21)%],step time[(3.19±1.29)%vs.(5.88±4.50)%],hip extension excursion,[(4.06±1.92)%vs.(6.49±3.27)%],ankle ROM[(5.84±3.15)%vs.(13.12±7.50)%],and the plantarflexion excursion during the late stance phase[(6.05±3.43)%vs.(14.54±11.00)%]were smaller.Conclusions ACLR subjects develop a more stable gait pattern when walking at a comfortable speed,but this pattern is more conservative than that of healthy subjects.When walking at maximum speed,the gait patterns of ACLR subjects are closer to those of healthy subjects,but they are more rigid and less flexible.This may be related to the incomplete recovery of proprioceptive and neuromuscular function 6 months after ACLR.Therefore,patients should adopt more active rehabilitation strategies focusing on proprioceptive and neuromuscular control training to improve the gait pattern and gait control ability.