髋-膝关节空间位置组合综合模式下踝关节背屈锻炼对脑出血偏瘫患者下肢功能及步行能力的影响

目的探讨髋-膝关节空间位置组合综合模式下踝关节背屈锻炼对脑出血偏瘫患者下肢功能及步行能力的影响。方法选择脑出血后偏瘫且步行功能受限患者124例,根据随机数字表法分为对照组和观察组各62例,对照组给予常规康复治疗,观察组在常规康复的基础上给予髋-膝关节空间位置组合综合模式下踝关节背屈锻炼。比较两组患者治疗前后的下肢运动功能、平衡能力、步行能力、日常生活活动能力及下肢痉挛评分。结果治疗后两组患者的下肢运动功能评分、平衡能力评分、日常生活活动能力评分较治疗前均有改善(P<0.05),但步行能力及下肢痉挛评分较前下降(P<0.05);治疗后观察组患者的各项评分均优于对照组(P<0.05)。结论采用髋-膝关节空间位置组合综合模式下踝关节背屈锻炼方式对脑出血偏瘫患者进行训练,可以有效改善患者下肢运动功能及平衡能力,增强患者日常生活活动能力及步行能力,并能减轻下肢痉挛。

儿童行走过程中下肢关节三维运动特征分析

对3-6岁健康儿童在短步态条件下的髋、膝关节三维运动特征进行分析。通过CodaMotion进行数据采集，并计算时一空参数及欧拉角度和角速度。结果表明：长步长行走（FW）与短步长行走（SW）的时一空参数有显著差异，从3岁开始与成人FW步态相似，而SW则要达到5岁；在欧拉角度和角速度方面，膝-髋关节在SW下显著低于FW，且在FW下，膝一髋关节没有表现出随年龄变化趋势，但在SW下，膝关节在5岁时与成人无显著差异，髋关节则推迟到6岁。因此可以认为，控制SW步态的运动能力将在5岁时基本发育成熟。

The use of the greater trochanter marker in the thigh segment model:Implications for hip and knee frontal and transverse plane motion

Background:The greater trochanter marker is commonly used in 3-dimensional(3D) models;however,its influence on hip and knee kinematics during gait is unclear.Understanding the influence of the greater trochanter marker is important when quantifying frontal and transverse plane hip and knee kinematics,parameters which are particularly relevant to investigate in individuals with conditions such as patellofemoral pain,knee osteoarthritis,anterior cruciate ligament(ACL) injury,and hip pain.The aim of this study was to evaluate the effect of including the greater trochanter in the construction of the thigh segment on hip and knee kinematics during gait.Methods:3D kinematics were collected in 19 healthy subjects during walking using a surface marker system.Hip and knee angles were compared across two thigh segment definitions(with and without greater trochanter) at two time points during stance:peak knee flexion(PKF) and minimum knee flexion(Min KF).Results:Hip and knee angles differed in magnitude and direction in the transverse plane at both time points.In the thigh model with the greater trochanter the hip was more externally rotated than in the thigh model without the greater trochanter(PKF:-9.34°± 5.21° vs.1.40°± 5.22°,Min KF:-5.68°± 4.24° vs.5.01°± 4.86°;p < 0.001).In the thigh model with the greater trochanter,the knee angle was more internally rotated compared to the knee angle calculated using the thigh definition without the greater trochanter(PKF:14.67°± 6.78° vs.4.33°± 4.18°,Min KF:10.54°± 6.71° vs.-0.01°± 2.69°;p < 0.001).Small but significant differences were detected in the sagittal and frontal plane angles at both time points(p < 0.001).Conclusion:Hip and knee kinematics differed across different segment definitions including or excluding the greater trochanter marker,especially in the transverse plane.Therefore when considering whether to include the greater trochanter in the thigh segment model when using a surface markers to calculate 3D kinematics for movement assessment,it is important to have a clear understanding of the effect of different marker sets and segment models in use.

An improvement to the reciprocating gait orthosis for aiding paraplegic patients in walking

As the conventional reciprocating gait orthosis(RGO)has been deemed incapable of facilitating the patients’passive movement with significant gait discrepancies and distortion,in addition to characteristics such as poor stability,and negligible knee joint rehabilitation,a power assisted reciprocating gait orthosis(PARGO)was designed.Drive devices were added to the hip and knee joints of the RGO.Through efficient implementation of structural components,the number of the required motors was reduced,therefore decreasing the weight of the orthosis.The PARGO knee joint’s structural principle was analyzed to characterize the effect of the PARGO’s single-axis knee joint design on wear comfort,thereby providing a basis for the wear of the PARGO.By analyzing the sagittal movement patterns of the hip and knee joints during normal human gait,kinematic analysis was carried out to obtain the input patterns of the PARGO hip and knee joint drive motors,enabling the patients to more accurately reproduce the normal gaits of hip and knee joints during the rehabilitation training with the aid of the PARGO,and the control process of the PARGO was studied.Finally,a prototype of the PARGO was developed,and experimentation was carried out to demonstrate the feasibility of the improved orthosis.

Ipsilateral fracture dislocations of the hip and knee joints with contralateral open fracture of the leg： a rare case and its management principles

This paper discussed the injury mechanism and management of a patient who had concomitant ipsilateral hip and knee dislocations and contralateral open leg fracture. A 32-year-old man presented with ipsilateral fracturedislocations of the left hip （Pipkin＇s type IV） and knee （Moore II）joints and contralateral open fracture of the leg bones after a car accident. After emergency resuscitative measures, the hip joint was reduced and Pipkin＇s fracture was fixed using Ganz approach with lag screws; knee joint was reduced closely and tibial plateau fracture was stabilized with lateral buttress plate and a transarticular spanning fixator. The open fracture on the other leg was debrided and fixed with an external fixator. There was no insta-bility in both joints after fixation when he was examined under anesthesia. The fractures united after 3 months and the patient had no residual instability of hip and knee. There was no clinical or radiological evidence of osteonecrosis in the hip joint after 6 months. At one-year follow-up, he had satisfactory functional outcome with almost normal range of motion at both joints. Ipsilateral hip and knee dislocations are rare injuries and more caution is needed for early diagnosis. A timely appropriate intervention can provide good functional outcome to the patient in this situation.