Duffy C M, Graham H K, Cosgrove A P
Gait Analysis Laboratory, Musgrave Park Hospital, Belfast, Northern Ireland.
J Pediatr Orthop. 2000 May-Jun;20(3):356-61.
We examined the effect of ankle-foot orthoses (AFOs) on gait and energy expenditure in children with spina bifida. Nine boys and three girls, 6 to 16 years of age, took part in the study. There were four children each with L4, L5, and sacral level lesions. Each child underwent gait analysis and energy consumption studies with and without AFOs. Walking speed was faster with AFOs (mean, 58 m/min) than without (mean, 50 m/min, p < 0.01). Stride length improved significantly (p < 0.001) from 0.89 m barefoot to 1.08 m with AFOs. Double support time was decreased from 0.32 seconds barefoot to 0.28 seconds with AFOs (p < 0.05). The oxygen cost of walking was significantly better with (0.33 mL/kg/m) than without AFOs (0.41 mL/kg/m, p < 0.001). Hip flexion at initial contact was increased. Ankle kinematics were unchanged, but ankle power generation showed a significant improvement; from 0.5 W/kg barefoot to 1.3 W/kg with AFOs. Increased ankle power generation results in improved hip flexion and stride length, which contributes to increased walking speed and reduced oxygen cost. The stability conferred by the AFOs is reflected in the reduced time spent in double support.
我们研究了踝足矫形器（AFO）对脊柱裂患儿步态和能量消耗的影响。9名男孩和3名女孩，年龄在6至16岁之间，参与了这项研究。其中，L4、L5和骶骨水平损伤的患儿各有4名。每个孩子都进行了佩戴和不佩戴AFO时的步态分析和能量消耗研究。佩戴AFO时的步行速度（平均58米/分钟）比不佩戴时（平均50米/分钟，p<0.01）更快。步幅从赤脚时的0.89米显著提高到佩戴AFO时的1.08米（p<0.001）。双支撑时间从赤脚时的0.32秒减少到佩戴AFO时的0.28秒（p<0.05）。佩戴AFO时的步行耗氧量（0.33毫升/千克/米）明显优于不佩戴时（0.41毫升/千克/米，p<0.001）。初始接触时的髋关节屈曲增加。踝关节运动学未发生变化，但踝关节产生的功率有显著改善；从赤脚时的0.5瓦/千克增加到佩戴AFO时的1.3瓦/千克。踝关节产生的功率增加导致髋关节屈曲和步幅改善，这有助于提高步行速度和降低耗氧量。AFO提供的稳定性体现在双支撑时间的减少上。
